Upload
syahfiq-ismail
View
214
Download
0
Embed Size (px)
Citation preview
7/23/2019 aaahp
1/39
Antepartum
Hemorrhage(APH)
7/23/2019 aaahp
2/39
Antepartum Hemorrhage
Death from hemorrhage still remains a leadingcause of maternal mortality.
Hemorrhage was a direct cause of more than 18percent of 321 pregnancy!related maternaldeaths.
7/23/2019 aaahp
3/39
ANTEPARTUM
HEMORRHAGE Per "agina #lood loss after 2$ wee%s&
gestation.
'omplicates close to $ of allpregnancies and is a *D+'A,**-*/'0
+s one of the leading causes ofantepartum hospitaliation maternalmor#idity and operati"e inter"ention.
7/23/2019 aaahp
4/39
'44/ 'A56*6
Placenta Pre"ia
Placental A#ruption
5terine -upture 7asa Pre"ia
loody 6how
'oagulation Disorder
Hemorrhoids
7aginal ,esion9+n:ury
'er"ical ,esion9+n:ury
/eoplasia
7/23/2019 aaahp
5/39
;ey point to -emem#er
7/23/2019 aaahp
6/39
Placenta Pre"ia
Defned as a placenta implanted in the lowersegment o the ters! presenting ahead othe leading pole o the ets"
1. Total placenta previa.
7/23/2019 aaahp
7/39
Placenta Pre"ia
leeding results fromsmall disruptions in
the placentalattachment duringnormal de"elopmentand thinning of the
lower uterinesegment
7/23/2019 aaahp
8/39
Placenta Pre"ia
Incidencea#out 1 in 3
Perinatal morbidity and mortality are primarilyrelated to the complications o premat!rity"beca!se the hemorrhage is maternal.
7/23/2019 aaahp
9/39
Placenta Pre"ia
Etiology>
Ad"ancing maternal age
M!ltiparity
M!ltietal gestations
Prior cesarean delivery
#mo$ing
Prior placenta pre"ia
7/23/2019 aaahp
10/39
Placenta Pre"ia
7/23/2019 aaahp
11/39
Placenta Pre"ia
Placenta pre"ia may #e associated withplacenta accretaplacenta incretaorpercreta.
'oagulopathy is rare with placenta pre"ia.
7/23/2019 aaahp
12/39
7/23/2019 aaahp
13/39
Placenta Pre"ia
Diagnosis.
Placenta pre"ia or a#ruption should always #e suspectedin women with uterine #leeding during the latter half ofpregnancy.
7/23/2019 aaahp
14/39
Placenta Pre"ia
7/23/2019 aaahp
15/39
Placenta Pre"ia
anagement
Admit to hospital
%& '()I%(L *+(MI%(TI&%%& '()I%(L *+(MI%(TI&%
+7 access
Placental localiation
7/23/2019 aaahp
16/39
Placenta Pre"iaanagement
Severe
bleeding
Caesarean
section
Moderate
bleeding Gestation
>34/52
7/23/2019 aaahp
17/39
Placenta Pre"ia
anagement Deli"ery is #y 'aesarean section
4ccasionally 'aesarean hysterectomy necessary.
7/23/2019 aaahp
18/39
Placental A#ruption
Dened as the premature separation ofthe normally implanted placenta.
7/23/2019 aaahp
19/39
Placental A#ruption
e,ternal hemorrhage concealed hemorrhage
Total
Partial
7/23/2019 aaahp
20/39
Placental A#ruption
hat are the ris% factors for placentala#ruptionE
7/23/2019 aaahp
21/39
Placental A#ruption
+ncreased age and
parity Preeclampsia
'hronic hypertension
Preterm ruptured
mem#ranes
ultifetal gestation
Hydramnios
'igarette smo%ing
7/23/2019 aaahp
22/39
Placental A#ruption
Pathology
Placental a#ruption is initiated #y hemorrhage into the decidua#asalis.
7/23/2019 aaahp
23/39
Placental A#ruption
leeding with placental a#ruption isalmost always maternal.
6ignicant fetal #leeding is more li%elyto #e seen with traumatic a#ruption.
+n this circumstance fetal #leedingresults from a tear or fracture in theplacenta rather than from theplacental separation itself.
7/23/2019 aaahp
24/39
Placental A#ruption
7/23/2019 aaahp
25/39
Placental A#ruption
Shock
Consumptive Coagulopathy
Renal Failure
Fetal Death
7/23/2019 aaahp
26/39
Placental A#ruption
Management:
7/23/2019 aaahp
27/39
5terine -upture
-eported in .3!.8 of all deli"eringwomen #ut .3!1.I among women with ahistory of a uterine scar (from a '96 fore=ample)
13 of all uterine ruptures occur outsidethe hospital
7/23/2019 aaahp
28/39
5terine -upture
'lassic presentation includes "aginal#leeding pain cessation ofcontractions a#sence9 deterioration of
fetal heart rate loss of station of thefetal head from the #irth canal easilypalpa#le fetal parts and profoundmaternal tachycardia and hypotension.
Patients with a prior uterine scar should#e ad"ised to come to the hospital fore"aluation of new onset contractionsa#dominal pain or "aginal #leeding.
7/23/2019 aaahp
29/39
HA< A-*
7/23/2019 aaahp
30/39
5terine -upture
*=cessi"e uterinestimulation
H= of pre"ious '96
7/23/2019 aaahp
31/39
5terine -upture
anagement> *mergent laparotomy
7/23/2019 aaahp
32/39
7asa Pre"ia
-arely reported condition in which thefetal "essels from the placenta crossthe entrance to the #irth canal.
+ncidence "aries #ut most resourcesnote occurrence in 1>3pregnancies.
Associated with a high fetal mortalityrate (?!C?) which can #e attri#utedto rapid fetal e=sanguination resultingfrom the "essels tearing during la#or
7/23/2019 aaahp
33/39
7asa Pre"ia
1. i!lo#ed placenta
2. 7elamentous insertion of the um#ilical cord
3. 6uccenturiate (Accessory) lo#e
7/23/2019 aaahp
34/39
7asa Pre"ia
7/23/2019 aaahp
35/39
7asa Pre"ia
7/23/2019 aaahp
36/39
7asa Pre"ia
-is% Jactors>
ilo#ed and succenturiate placentas
7elamentous insertion of the cord
,ow!lying placenta ultiple gestation
Pregnancies resulting from in "itro fertiliation
Palpa#le "essel on "aginal e=am
7/23/2019 aaahp
37/39
7asa Pre"ia
anagement>
hen "asa pre"ia is detected prior to la#or
the #a#y has a much greater chance ofsur"i"ing.
+t can #e detected during pregnancy with
use of trans"aginal sonography.
hen "asa pre"ia is diagnosed prior to la#or
electi"e caesarian is the deli"ery method of
choice.
7/23/2019 aaahp
38/39
;leihauer!et%e
7/23/2019 aaahp
39/39
Apt test