Placental abruption is a separation of the placenta most often accompanied by vaginal bleeding, uterine tenderness, and increased uterine activity. Purpose and scope Antepartum haemorrhage (APH) is defined as bleeding from or in to the genital tract, occurring from 24+0 weeks of pregnancy and prior to the birth of the baby. Age, parity, previous obstetric history (history of lower segment caesarean section or medical termination of pregnancy by dilation and curettage) was noted down. What are the types of antepartum haemorrhage? Antepartum haemorrhage. It occurs in 2-5% of pregnancies and is an important cause of fetal and maternal death. Found inside – Page iThis book provides useful information for daily practice as well as preparation for rarely encountered and potentially life-threatening events. Concentrations of endogenous prostaglandins increase during labor, but levels do not peak until the time of placental separation. Hemoglobin concentration measurement may be indicated after a bleeding episode. Investigators have noted strong associations between abruption, fetal growth restriction, and preeclampsia, and all three conditions share similar risk factors.49 Naeye et al.50 prospectively studied more than 53,000 deliveries and found that decidual necrosis at the placental margin and large placental infarcts were the most common abnormalities among patients who suffered placental abruption and fetal demise. The most important causes are placental abruption (most common), placenta previa (2nd most common), vasa previa, and uterine rupture. If rupture has occurred antepartum, fetal compromise is likely. Infection. Data demonstrating lower oxytocin dose requirements than previously assumed and awareness of the dangers of high-dose administration call into question the common practice of injecting 10 to 40 IU of oxytocin into a 1-liter crystalloid solution and infusing the solution at an unspecified rate, often “wide open” (i.e., gravity-dependent flow). David A Miller. The foetal and maternal status will depend on the amount, duration, and cause of bleeding. 1st edn. Women with placenta previa may remain hospitalized for some time prior to delivery, and at least one intravenous catheter should be maintained if bleeding is recurrent or imminent delivery is anticipated. An antepartum haemorrhage (APH) is bleeding from the vagina that occurs after the 20th week of pregnancy and before the birth of your baby. Obstetric and anesthetic management depends on assessing the status of both the mother and fetus . Placental abruption is defined as complete or partial separation of the placenta from the decidua basalis before delivery of the fetus. High-quality images aid the reader in coming to an understanding of difficult topics. Completely rewritten and updated, this text features the most current information available. Rarely, vasa previa can be diagnosed via digital cervical examination or amnioscopy. Found insideThe goal of this book is to emphasize some of the more unusual presentations and diagnostic and management aspects of embolic complications. The pathophysiologies and prevention strategies in unique patient populations are also emphasized. Some authors advocate hospitalization of the patient between 30 and 32 weeks’ gestation to ensure prompt delivery if rupture of membranes should occur; consideration should be given to the administration of a corticosteroid to promote fetal lung maturity.28 Timing of delivery reflects a balance between the risks of preterm delivery and the risk for vessel rupture if the pregnancy is allowed to continue. Chicago, American College of Surgeons, 2008. Several decades ago, vaginal bleeding during the second and third trimesters was associated with perinatal mortality rates as high as 80%. There is the possibility that abruptio placentae may be present. However, induction of general anesthesia in a parturient entails risk for failed ventilation, failed tracheal intubation, and/or aspiration of gastric contents. Either crystalloid or colloid may be used; the choice is less important than adequate restoration of intravascular volume. The majority of hemorrhage-related adverse outcomes are considered preventable.5,16,17 Common provider-related shortcomings include failure to recognize risk factors, failure to accurately estimate the extent of blood loss, and failure to initiate treatment in a timely fashion. Antepartum Haemorrhage (APH)_2015-11-18.docx Page 6 of 9 8. The present study was conducted at a tertiary health care hospital Mumbai India. Spinal, combined-spinal epidural, or epidural anesthesia may be administered in stable patients in whom intravascular volume status is adequate and coagulation studies are normal. Similar anesthetic considerations pertain to the administration of neuraxial anesthesia for cesarean delivery. Rare causes include vasa previa and uterine rupture. Common causes of antepartum hemorrhage are bloody show associated with labor, placental previa, and placental abruption. injuries have minimal consequence, but some puerperal lacerations and hematomas are associated with significant hemorrhage, either immediate or delayed. In some cases, the patient requires transfusion before completion of the blood crossmatch, and type-specific blood or type O, Rh-negative blood must be administered. Unrecognized bleeding may manifest initially as tachycardia; worsening hypovolemia eventually leads to hypotension (see Table 38-1). Found inside – Page iThe first section of the book discusses evidence-based medicine methodology in the context of the two specialties. In this article, we shall look at the pathophysiology, clinical features and management of placenta praevia. Uterine tetany creates shearing forces that cleave the placenta from the uterine wall through the layer of the uterine decidua (see Figure 4-3). Study maternal and perinatal outcome in APH. Conservative aggressive management of placenta praevia. Equipotent doses of halothane, sevoflurane, and desflurane depress uterine contractility equally and in a dose-dependent manner. Unique plaza, opposite Jakat Naka above Siddhi Vinayak, Mumbai, India, Tel 9892899579, Received: January 21, 2015 | Published: November 5, 2015, Citation: Wasnik SK, Naiknaware SV. In Gabbe SG, Niebyl JR, Simpson JL, editors. General anesthesia is preferred for most cases of urgent cesarean delivery accompanied by unstable maternal status, a nonreassuring FHR pattern, or both. No consensus exists on the need for blood product availability in these patients, but it seems prudent to order at least a blood type and screen. Found insideVolume 3 focuses on developments since the publication of DCP2 and will also include the transition to older childhood, in particular, the overlap and commonality with the child development volume. The concentration of nitrous oxide can be reduced or omitted in cases of severe maternal hemorrhage or fetal compromise. The common causes of bleeding during pregnancy are cervical ectropion, vaginal infection, placental edge bleed, placenta praevia or placental abruption. What is the most common cause of placental abruption? After removal of the placenta, uterine tone should be augmented with oxytocin and the patient should be observed for evidence of recurrent hemorrhage. This new edition of Fetal and Neonatal Brain Injury brings the reader fully up to date with all advances in clinical management and outcome assessment. At my institution, my colleagues and I administer prophylactic oxytocin at a rate of 0.3 IU/min (the ED90) and increase the rate to 0.6 IU/min (twice the ED90) if there is inadequate response. Treatment of ergot-induced vasoconstriction and hypertension may require administration of a potent vasodilator such as nitroglycerin or sodium nitroprusside. Multiple pregnancy. Up to one-fifth of very preterm babies are born in association with APH . Antepartum haemorrhage is a major cause of maternal and perinatal morbidity and mortality which could be prevented by early registration, regular antenatal care, early detection of high risk cases, and early referral to higher centre. The first episode of bleeding characteristically stops spontaneously and rarely causes maternal shock or fetal compromise. DOI: 10.15406/ogij.2015.03.00072. The most . Mean age of patients presented with APH in this study is 26-30 years which is similar to the result reported by Das et al.8 Abbasi et al.9 also reported the mean age 30 years in a study from tertiary care hospital in Sindh.9 Incidence of APH is more in multigravida (72%) than in primigravida (28%) in our study. The dose of oxytocin required to generate satisfactory uterine tone after delivery is lower than previously thought (see Chapter 26). The diagnosis of vasa previa can be confirmed through examination of the shed blood for evidence of fetal hemoglobin (e.g., Kleihauer-Betke test); however, when bleeding occurs, the emergency nature of vasa previa usually precludes such diagnostic confirmation. Propofol may precipitate severe hypotension in patients with unrecognized hypovolemia; ketamine and etomidate may represent better options for the patient with unknown or decreased intravascular volume. If hemorrhage and atony persist despite aggressive administration of multiple classes of uterotonic drugs, invasive techniques must be considered. Bleeding in the first trimester (weeks one through 12) might occur, and most women who experience bleeding during pregnancy go on to deliver healthy babies. Prolonged labor. Antepartum haemorrhage is defined as bleeding from the vagina after 24weeks. Bleeding vessels should be ligated. 3. Found insideThe Safety and Quality of Abortion Care in the United States offers a comprehensive review of the current state of the science related to the provision of safe, high-quality abortion services in the United States. High concentration of volatile halogenated anesthetic agent. Found insideThey kindly shared their personal experience and lessons learned over the years. This book is beneficial for all the professionals working in the prenatal diagnosis. The incidence of APH was 39% in the age group 26 - 30 years and 22% in age more than 30 years. The number of high-affinity receptors for oxytocin increases greatly near term; alternative uterotonics are more effective in the first and second trimesters of pregnancy. Use of aspirin before 16 weeks of pregnancy to prevent pre-eclampsia also appears effective at preventing antepartum bleeding.. All bleeds during pregnancy are associated with increased risk of fetal death. In this article, we shall look at the pathophysiology, clinical features and management of placental abruption. Found insideA new edition of the proven guide to providing emergency care for mothers-to-be in acute medical distress Now in its sixth edition, Critical Care Obstetrics offers an authoritative guide to what might go seriously wrong with a pregnancy and ... Neonatal outcome with placenta previa. Antepartum haemorrhage is an obstetric emergency contributing to a . the vagina or . Found insideThis book is comprised of 27 chapters and broken down in three key sections: I. General Considerations in Pregnancy and Lactation II. Complications Unique to Pregnancy III. Conflicting definitions of postpartum hemorrhage exist; however, the most commonly accepted definition is more than 500 mL blood loss after vaginal delivery or more than 1000 mL after cesarean delivery.1,65 These values may have low clinical utility because they are only slightly higher than the average blood loss for each type of delivery. Out of the total number of women presenting with APH (124), 75 had preterm delivery (60.5%). The end result of the cascade is conversion of fibrinogen to fibrin and stabilization of the blood clot (see Chapter 44). Reducing Maternal and Neonatal Mortality in Indonesia is a joint study by the U.S. National Academy of Sciences and the Indonesian Academy of Sciences that evaluates the quality and consistency of the existing data on maternal and neonatal ... Neonatal mortality was 3% when the vasa previa was diagnosed antenatally and 56% when it was not. An indwelling arterial catheter is useful for patients with hemodynamic instability or for those who require frequent determination of hematocrit and blood gas measurements. Emergency situation. Surveys of obstetric anesthesiologists show that neuraxial anesthesia is preferred in patients with placenta previa without active bleeding or intravascular volume deficit.35 Patients who have placenta previa—without active preoperative bleeding—remain at risk for increased intraoperative blood loss for at least three reasons.
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