Bleeding from the birth canal after 24 weeks gestation until completion of the 2nd stage
Affects 2-5% of pregnancies
Causes include;
‘show’ cervicitis local trauma
malignancy p. praevia* v. praevia*
abruption*
Perform an ABCDE assessment and resuscitate appropriately
Admit for investigation and observation
§Insertion of placenta in lower uterine segment
§Risk factors include previous C-section or placenta praevia, #maternal age and #parity
§Only 3% of p. praevia’s seen at 20/40 persist at term due to lower segment development
§Re-scan in 3rd trimester to confirm placement
§Grade;
§1: placenta <2cm clear of os
§2:placenta reaches edge of os
§3: partially covers os
§4: completely covers os
§Risks to mum = massive haemorrhage, surgical complications, air embolism and PP sepsis
§Risks to foetus = IUGR, malpresentation, anaemia and cord complications
§Presents with painless PV bleeding
§Unprovoked or post-coital
§Diagnosed at 20/40 scan
§On examination uterus is soft, non-tender
§If suspected avoid VE and arrange USS
§Admit for observation and give steroids if <36/40
§Deliver if unstable or continuous bleeding by LSCS
§Premature separation of a normally sited placenta
§May be revealed with PV bleeding, or concealed
§Often no clear cause, but may follow trauma or SROM in polyhydramnios
§Risk factors include maternal HTN, previous abruption, #maternal age, #parity and smoking
§Risks to mum = hypovolaemic shock, AKI, DIC, PPH and feto-maternal haemorrhage
§Risks to baby = IUGR and pre-term delivery, anaemia and coagulopathy
§Presents with abdo pain, +/- PV bleeding, uterine tenderness and fetal distress
§If severe there may be progressive shock, abdominal distension and #SFH
§Diagnosis is clinical, USS may show minor abruption in stable patients
§Management depends on;
severity maternal/foetal condition
gestation associated complications
§Severe abruption requires immediate delivery, after correction of any coagulopathy
§Conservative management involves serial USS and planned IOL/LSCS by 40 weeks
§Be aware of increased risk of PPH following abruption