ANTEPARTUM HEMORRHAGE
INTRODUCTION:
Antepartum hemorrhage is defined as vaginal bleeding from 24 weeks to delivery of the baby or any bleeding occurring in the antenatal
period after 20 weeks gestation .It complicates 2-5% of pregnancies .It is associated with increased risks of fetal and maternal morbidity and
mortality.
CENTRAL OBJECTIVE:
Help the students to gain more knowledge and understanding about antepartum hemorrhage and develop attitude and skills with practicing
in various health care settings.
define antepartum hemorrhage
describe the causes of antepartum hemorrhage
enlist the types of antepartum hemorrhage
list out the etiology of APH
explain the clinical feature
discuss about the diagnostic evaluation
enumerate the management
describe about the complication of APH
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objectives activities activity
1. 3 mins Define Definition: Ppt, charts, Teaching Listening What is APH
antepartum Antepartum hemorrhage is defined as videos, poster,
hemorrhage bleeding from or into the genital tract after the documentation
20th week of pregnancy but before the birth of
the baby.
2. 3mins Describe the Causes: Ppt, charts, Teaching Listening What are
causes of videos, poster, cause
antepartum documentation
hemorrhage
3. 5 mins Types of [Link] previa: Ppt, charts, Teaching Listening List out the
antepartum When the placenta is implanted partially videos, poster, types
hemorrhage or completely over the lower uterine segment documentation
(over and adjacent to the internal os)is called
placenta previa.
[Link] accreta(adherent placenta):
Placenta accreta is the invasion of placenta
directly to the myometrium without any
intervening decidual basalis.
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[Link] placentae:
It is one form of APH where the bleedin
occurs due to premature separation of normally
situated placenta.
[Link] previa:
The unsupported (without wharton
jelly)umbilical vessels in velamentous
placenta,lie below the presenting part and run
over the cervical os.
4. 5 mins Etiology of Placenta previa: Ppt, charts, teaching lisening Explain the
APH ● Multiparity videos, poster, etiology
● Maternal age >35 years documentation
● Prior cesarean delivery
● Race -asian women
● Maternal factors -infertility treatment
● Presence of uterine scar
● Prior curettage
● Prior placenta previa
● Pregnancy following ART
● Placenta size and abnormality-
Succenturiate lobes,big placenta.
● Smoking
Abruptio placentae:
● Prior abruption
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Hypertension in pregnancy
● Trauma
● Sudden uterine decompression
● Short cord
● Sick placenta
● Torsion of uterus
● Thrombophilia
● Hyperhomocysteinemia
5. 5 mins Explain the Clinical features: Ppt, charts, Teaching Listening What are the
clinical features placenta previa: videos, poster, clinical
● Painless and recurrent vaginal bleeding documentation feature
● Bright red bleeding
● Relaxed soft uterus
● Stallworthy‘s sign
● Persistence of malpresentation
● Visible bleeding
Abruptio placentae:
● Abdominal discomfort or pain followed
by vaginal bleeding
● Bleeding is dark in color
● Uterine contractions
● Tenderness
6. 5 mins Discuss about Diagnostic evaluation: Ppt, charts, Teaching Listening Explain the
the Diagnostic ● History collection videos, poster, Diagnostic
evaluation ● Physical examination documentation evaluation
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o objectives activities activity
Examination of placenta following
vaginal delivery
Ultrasonography:
Trans abdominal ultrasound
Transvaginal ultrasound
Transperineal ultrasound
Color Doppler flow study
3D power Doppler study
Magnetic resonance imaging (MRI)
7. 5 mins Enumerate the Management: Ppt, charts, Teaching Listening Explain the
mansgement videos, poster, management
documentation
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8. 5 mins Describe the Complications: Ppt, charts, Teaching Listening List out the
complication Maternal complications: videos, poster, complication
● Mal presentation documentation
● Premature rupture of membrane
● Cord prolapse
Slow dilatation of cervix
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Intra partum hemorrhage
● Postpartum hemorrhage
● Retained placenta
● Sepsis
● Sub involution
● Premature labor
● Hemorrhagic shock
● Renal failure
Fetal complications:
● Low birth weight
● Fetal growth restriction
● Asphyxia
● Intrauterine death
● Birth injuries
● Fetal hypoxia.
