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Antepartum Haemorrhage

Antepartum Haemorrhage. Definition :- bleeding from the genital tract after 24 th week of preg .and before birth of the child. classification. 1) pp 2) abruptio p 3) vasa p 4)show 5) rupture uterus 6) cervical polyp. Placenta praevia.

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Antepartum Haemorrhage

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  1. AntepartumHaemorrhage Definition :- bleeding from the genital tract after 24th week of preg .and before birth of the child

  2. classification • 1) pp • 2)abruptio p • 3)vasa p • 4)show • 5) rupture uterus • 6) cervical polyp

  3. Placenta praevia • Def :- placenta partialy or totally attached to the lower uterine segment . • CAUSES :- • Multiparous – previous c\s & D C - ^ Age • TYPES :- • 1)first degree (Low- lying placenta) lateralis • 2)2nd degree :- marginalis • 3)3rd degree :- incomplete centralis • 4)4th degree :- complete centralis

  4. Symptoms : - • Causless , painless, recurrent bleeding • Signs :- shock in acute severe blood loss • Uterus not tender • Malpresentations • FHS detected • Speculum EX(local lesions) • PV : -should not be done excep certain conditions (what are?) • Investigations :- U/S

  5. D/D (WHAT) • Treatment :- • 1)resuscitation • 2)If not in labour • a/bleeding is severe immediate c/s • b/ bleeding is slight :-1/ if complete 37 wks termination by c/s 2/ less than 37 wks conservative treatment (hospitalization – anaemia – anti –D If needed )

  6. 3) if in labour :- bleeding c/s Complications :-( matrenal & fetal)

  7. Abruptio placenta • Definition:- premature separation of normally situated placenta after 24 wks and before delivery. • Aetiology:- 1) hypertensive disorders • 2) trauma. • 3)folate deficiency • 4) smoking Pathology:-

  8. 1) concealed • 2) revealed • 3) mixed • 4)couvelaires uterus • 5) DIC. • 6)acute renal failure • SYMPTOMS :- severe abdominal pain – vaginal bleeding – fetal distress or death • SIGNS ;- shock – BP (subnormal 0r normal ?) – tachycardia – tender uterus

  9. D/D (what) INVESTIGATIONS: - u/s – test for DIC • Treatment : - • 1)resuscitations • 2)delivery (mode & time) depend on severity and GA • A/ Amniotomy and oxytocin (bleeding not severe, CX dilated,vertex) • B) C/S (severe hge if fetus dead or alive )

  10. C) oxytocin continued after delivery ( post partum heamorrhage liable )

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