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Antepartum Haemorrhage

Anggita Nur AzizaCoass OBGYN RS AL

Pembimbing : dr. Arie Widyasa, Sp.OG

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Definition

Bleeding from genital tract in the second half

of pregnancy

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Causes

Antepartum Haemorrhage

Placental Abruption

Placenta Previa

Vasa Previa

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Placental Abruption

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Definition

Premature separation of normally situated

placenta from uterine wall

Haermorrhage before delivery of the fetus

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Epidemiology

5.9 to 6.5 per 1000 singleton births

12.2 per 1000 twin births

Perinatal mortality : 119 per 1000 births

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Etiology

Haemorrhage into the decidua basalis

Haematoma Hydrostatic pressure

Separation of the adjacent

placenta

Precise cause unknown

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Classification

Abruptio Placenta

MILD

MODERATE SEVERE

Grade 1Clinical manifestation (-)Retroplacental clot (+)

Grade 2Classical sign (+)Fetus aliveFetal distress

Grade 3Fetus is deadCoagulopathy may be present

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Signs & Symptoms

• Vaginal bleeding• Abdominal pain• Uterine contractions • Tenderness • Irritable uterus• Maybe fetal distress • Fetal heart +/-• Blood loss are out of proportion to the amount of

vaginal bleeding

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Diagnosis

Abruptio placenta

Clinical finding

Other examination

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Management

Suspected

Stabilization of mother

3 practical options :1. Expectant2. Immediate CS3. Rupture the membrane and vaginal delivery

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Abruptio placenta

Mild

Bleeding may stop

Symptoms gradually resolve

Moderate & severe

Resuscitation

Delivery of the fetus

Observation Correction blood loss

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Placenta Previa

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Definition

Placenta that lies wholly or partly within

the lower uterine segment

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Epidemiology

4 or 5 per 1000

pregnancies

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Classification

• Placenta enroaches into the lower uterine segment

Type I

• Placenta reaches the cervical os but doesn’t cover it

Type II

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• Placenta covers partially os

Type III

• Placenta is centrally located over os

Type IV

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Sign & Symptoms

• Painless vaginal bleeding • Contractions are typically absent

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Placenta Previa

Symptoms

Sign

USG

Diagnosis

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Risk Factors

Maternal parity

Advance maternal age

Placental size

Endometrial damage

Previous CSPrevious PP

Uterine scarsSmoking

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ManagementInitial

haemorrhage

Often small Tend to stop

spontaneously

Severe, recurrent bleeding

Delivery

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Delivery

Caesarean section

Major (type III,IV)

Vaginal delivery

Minor (type I,II)

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Vasa Praevia

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Definition

Unsupported fetal vessels below the fetal presenting

part

Disastrous, if not diagnosed

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Epidemiology

Rare

1 per 6.000 deliveries

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Diagnosis

Digital examination below the

presenting part

Speculum reveal the vessels

Apt test presence of the

fetal blood

Doppler Endovaginal ultrasound

Difficult before the deliveries

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Management

Fetal blood confirmed in the vaginal bleeding

Immediate CS

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