• APH is defined as bleeding from the genital tract in pregnancy from the age of viability(24 week’s gestation –WHO but 28wks in Nigeria) and the onset of labour. Bleeding which occurs before 24 weeks is known as early pregnancy bleeding. Thirty percent of maternal deaths are caused by antepartum haemorrhage of which 50% are associated with avoidable factors.2 The causes of antepartum hemorrhage The incidence of APH is reported as 3.5% and varies with age, parity and social status. Causes of bleeding before and during childbirth include cervicitis, placenta previa, placental abruption and uterine rupture. Antepartum haemorrhage flowchart (MOET) IV access Site two large-bore size 14 or 16 gauge IV cannulae Large sample for: Crossmatch FBC Clotting screen At least: Non-invasive BP Pulse oximetry Urinary catheter Medical Surgical Radiological Maintain adequate volume replacement Replace volume Blood sample Monitor appropriately If there are signs of fetal or maternal compromise, consider immediate delivery. Abdominal examination usually finds the uterus non-tender, soft and relaxed. https://medical-dictionary.thefreedictionary.com/antepartum+haemorrhage, The main obstetric causes of death in babies weighing >1 000g were, Insertions were also done in indications like, [3] Antenatally, these include anaemia, multi-fibroid uterus, previous PPH, previous CD, placenta praevia, pre-eclampsia, parity [greater than or equal to] 5, multiple pregnancies and, Twenty-seven days following IUFD confirmation, the patient was admitted to hospital with abdominal cramping and associated small, A case of OH was established if a record indicated a diagnosis of. Overview Obstetrical hemorrhage refers to heavy bleeding during pregnancy, labor, or the puerperium. Called also antepartal and prepartal. Article Contents ::1 Management of APH (Antepartum haemorrhage) and ManagementPlacenta previa (PP)2 Management of Placenta previa (PP)3 RUPTURE VASA PRAEVIA4 Abruptio Placentae5 Etiology6 Grading of ABP7 CLINICAL FEATURES8 Management Management of APH (Antepartum haemorrhage) and ManagementPlacenta previa (PP) Management } b. Define antepartum. Antepartum Haemorrhage (APH)_2015-11-18.docx Page 5 of 9 6. The most important causes of APH are placenta praevia and placental abruption, although these are not the most common. Antepartum Haemorrhage Page 4 of 17 Obstetrics & Gynaecology 6. Antepartum haemorrhage (APH) defined as bleeding from the genital tract in the second half of pregnancy, remains a major cause of perinatal mortality and maternal morbidity in the developed world. Synonyms and Keywords: Antepartum hemorrhage; APH Overview. This rare cause of antepartum haemorrhage occurs when the vessels of the umbilical cord cross the membranes near to the internal os. • Epidemiology Affects 3-5% of all pregnancies 3 times more common in multiparous than primiparous women There may be a risk to the baby, which might be in danger of inadequate blood supply, and to the mother. Saving Lives, Improving Mothers’ Care: Lessons learned to inform future maternity care from the UK and Ireland Confidential Enquiries into Maternal Deaths and Morbidity 2009–12. Management of APH in general There are few high quality clinical trials to guide the management of antepartum haemorrhage or abruption, where there is high quality evidence this is noted below. The most important causes of APH are placenta praevia and placental abruption, although these are not the most common. Blood loss is often underestimated, so it is vital to observe for maternal shock and fetal compromise. Antepartum hemorrhage Is bleeding from genital tract which usually takes place after 24 wks.of gestation ( it is 3rd trimester bleeding ) • It affects 3-5% of all pregnancies • Its 3 times more common in multiparous than primiparous women • Its one of the leading cause of perinatal and maternal mortality worldwide 3. [4] The primary consideration is the presence of a placenta previa which is a low lying placenta at or very near to the internal cervical os. antepartum haemorrhage: Bleeding occurring in pregnancy after about the 24th week. Antepartum hemorrhage is a serious complication of pregnancy occurring within the third trimester.It is associated with significant maternal and fetal morbidity and mortality.Common causes of antepartum hemorrhage are bloody show associated with labor, placental previa, and placental abruption.Rare causes include vasa previa and uterine rupture. In the 2009-2012 UK and Ireland Confidential Enquiries into Maternal Deaths and Morbidities (MBRRACE) Report, the mortality rate due to obstetric haemorrhage, which also includes postpartum haemorrhage, was 4.9 per million maternities[2].
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