Antepartum haemorrhage
| Bleeding 24/40 onward | |
|---|---|
| History | - Pain - intermittent vs constant? → "Placental abruption should be considered when the pain is continuous. Labour should be considered if the pain is intermittent." - Gestational history, maternal age, previous gynae procedures → risk of placenta praevia/abruption - PMH: thrombophilia - SHx: Domestic violence |
| Examination | Is the patient shocked? Uterus - firm/soft CTG (??????) |
| Diagnostic investigations | FBC, G+S, Coag screen if plts abnormal or Kleihauer in RhD negative patients → dose of anti-D |
| Differentials | Placental abruption, placenta praevia Cervical lesions Genital injury |
| Immediate management | - Impending bleeding doom - Gynae → decision re early delivery |
| Ongoing management | - Domestic abuse in the ED I cannot stress enough - Modifiable risk factors - smoking etc. |
RCOG definitions
Spotting – staining, streaking or blood spotting noted on underwear or sanitary protection Minor haemorrhage – blood loss less than 50 ml that has settled
Major haemorrhage – blood loss of 50–1000 ml, with no signs of clinical shock
Massive haemorrhage – blood loss greater than 1000 ml and/or signs of clinical shock.