Download - Hge in Late Preg
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Antepartum haemorrhage is defined as
bleeding from or into the genital tract after
the 28th week of pregnancy but before the
birth of the baby.
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Placental Bleeding ( 70% )
-Placenta Praevia ( 35%)
-Abruptio Placentae ( 35% )
Unexplained / Indeterminate ( 25% )
Extra Placental Causes ( 5% )
Local cervico vaginal lesions cervical polyp, carcinoma
cervix, varicose veins, local trauma
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1. Accidental hemorrhage or abruption
placenta
2. unavoidable antepartum hemorrhage
3. Unclassified antepartum hemorrhage
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1.PLACENTA PRAEVIA
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When the placenta is implanted partially or
completely over the lower uterine segment
is called Placenta Praevia.
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Dropping down theory
Persistant chorionic activity
Increased surface area of placenta
Defect in decidua
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Symptoms
Vaginal bleeding
Sudden onset
Painless bleeding
Recurrent
Unrelated activity
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Signs
Size of the uterus according to the period of
gestationUterus feels relaxed, soft, elastic and
tenderness
Malpresentation
Floating head
Presence of fetal heart rate in mild cases
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DIAGNOSIS
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Differential diagnosis
Abruption placenta
Vasa praevia
Local cervical lesion
Circumvallate placenta
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1. Maternal
During pregnancy
Antepartum hemorrhage
Malpresentation
Premature labour
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During labour
Early rupture of membranes
Cord prolapsed
Slow dilatation
Intrapartum hemorrhage
Increased operative deliveries
Post partum hemorrhage
Retained placenta
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Puerperium
15th day of puerperium may be incidence of
sepsis
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Fetal
Low birth weight baby
Asphyxia
Intrauterine death
Birth injuries
Congenital malformation
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At home
Immediate attention
Expectant treatment
Definitive treatment
Nursing management
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Primordial prevention
Primary prevention
Secondary prevention
Teriary prevention
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ABRUPTIO PLACENTA
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It is one form of antepartum hemorrhage
where the bleeding occurs due to
premature separation of normally situatedplacenta
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1. Direct causes
Hypertension
Trauma
Sudden uterine decompression
Short cord
Supine hypotension syndrome
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Sick placenta
Folic acid deficiency
Torsion
Cocaine abuse
Thrombophilia
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1. Revealed
2. Concealed
3. Mixed
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Mild Abruptio placenta
Moderate abruption placenta
Severe abruption placenta
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Grade 0
Grade 1
Grade 2
Grade 3
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Class 0
Class 1
Class 2
Class 3
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Placenta praevia
Rupture uterus
Rectus Sheath hematoma
Apendicular or interstinal perforation
Twisted ovarian tumor
Volvulus
Acute hydramnios
Tonic uterine contractions
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Maternal
In revealed type-maternal risk is proportionate to
visible blood loss. Maternal death is rare.
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In concealed type
Hemorrhage leads to intra peritoneal or
braod ligament hematoma
Shock due to release of thromboplastin in
maternal circulation
Blood coagulation disorders for example
disseminated intravascular coagulopathy
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Oliguria and anuria due to hypovolemia
Post partum hemorrhage due to atony of
uterus
Puerperal sepsis
Ischemic pituitary necrosis
Sheehans syndrome
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Fetal
Prematurity
Anoxia Fetal death in revealed ( 25-30%) and in
concealed type (50-100%)
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Treatment at home
In the hospital
Definitive Treatment
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Preacautions:
Immediate interventions:
Monitoring:
Nursing management
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Differences betweenplacenta praevia abruption
placenta
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Origin
Bleeding due to marginal separation of a
normally sited placenta leading to a
reduced functional reserved.
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COMING INTO DIAGNOSIS
Painless per vaginal bleeding where placenta is in
the upper segment
Amount of bleeding is not profuse
Clinical assessment : fetal parts easily palpableand fetal heart sound easily heard.
Speculum examination No abruption or local lesion
Ultrasound to access the site of placenta
FBC, CTG examination
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PROGNOSIS
Good prognosis for fetus and mother
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Rarest cause of hemorrhage
Onset with membrane rupture
Blood loss is fetal, with 50% mortality
Seen with low-lying placenta,
velamentous insertion of the cord or
succenturiate lobe
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Antepartum diagnosis
Amnioscopy
Color doppler ultrasound
Palpate vessels during vaginal
examination
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Immediate cesarean delivery if fetal
heart rate is non-reassuring
Administer normal saline 10 20 cc/kg
bolus to newborn, if found to be in
shock after delivery