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2 min To introduce the INTRODUCTION: Student teacher
topic introduces the
Antepartum haemorrhage or prepartum hemorrhage is genital bleeding
topic to the
during pregnancy from the 24th week (sometimes defined as from the
group with the
20th week) gestational age to term.
help of ppt.
It can be associated with reduced fetal birth weight.
In regard to treatment, it should be considered a medical emergency
(regardless of whether there is pain) and medical attention should be
sought immediately, as if it is left untreated it can lead to death of the
mother and/or fetus.

1 min Defines DEFINITION OF ANTEPARTUM HEMORRHAGE: Student teacher Define antepartum

antepartum It is defined as bleeding from or into the genital tract after the 28th defines hemorrhage.
hemorrhage. week of pregnancy but before the birth of the baby (the first and antepartum
second stage of labor are thus included). The 28th week is taken hemorrhage
arbitrarily as the lower limit of fetal viability. The incidence is about with the help of
3% amongst hospital deliveries. ppt.
2 min Describes the CAUSES OF THE ANTEPARTUM HEMORRHAGE: Student teacher Enlist the causes of
Causes of describes the antepartum
antepartum APH causes of hemorrhage.
hemorrhage. antepartum
hemorrhage
with the help of
Placental bleeding Unexplained (25%) extra placental ppt
(70%) excluding placental - Implantation
Bleeding and local lesions bleed
- cervical polyps
Placenta praevia - carcinoma of
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Abruptio placenta Cervix
-cervical ectropion
- varicose vein
- local trauma

2 min Defines Abruptio DEFINITION OF ABRUPTIO PLACENTA: Student teacher Define abruptio
placenta It is one form of antepartum hemorrhage where the bleeding occurs defines abruptio placenta.
due to premature separation of normally situated placenta. Out of the placenta with
various nomenclatures, abruptio placenta seems to be appropriate one. the help of ppt.
5 min Explain about the TYPE/ VARIETIES OF ABRUPTIO PLACENTA: Student teacher Describe the types of
different type/ (1) Revealed: Following separation of the placenta, the blood explains about the abruptio placenta.
varieties of insinuates downwards between the membranes and the decidua. the different
abruptio placenta Ultimately, the blood comes out of the cervical canal to be visible types/ varieties
externally. This is the commonest type. of abruptio
(2) Concealed: The blood collects behind the separated placenta or placenta with
collected in between the membranes and decidua. The collected blood the help of ppt.
is prevented from coming out of the cervix by the presenting part
which presses on the lower segment. At times, the blood may percolate
into the amniotic sac after rupturing the membranes.
In any of the circumstances blood is not visible outside. This type is
rare.
(3) Mixed: In this type, some part of the blood collects inside
(concealed) and a part is expelled out (revealed). Usually one variety
predominates over the other. This is quite common.
Bleeding is almost always maternal. But placental tear may cause
fetal bleeding.
1 min Discuss about the INCIDENCE OF ABRUPTIO PLACENTA: Student teacher Confer the incidence
incidence of the The overall incidence is about 1 in 200 deliveries. Depending on the discussed about of the abruptio
abruptio placenta extent (partial or complete) and intensity of placental separation, it is a the incidence of placenta.
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significant cause of perinatal mortality (15–20%) and maternal the abruptio
mortality (2–5%). More and more cases of placental abruption are placenta with
being diagnosed in the recent years. the help of the
ppt.
5 min Explain about the ETIOLOGY OF THE ABRUPTIO PLACENTA: Student teacher Enlist the causes of the
etiology of the The prevalence is more with explains about abruptio plcaenta.
abruptio placenta. (a) high birth order pregnancies with gravida 5 and above — three the etiology of
times more common than in first birth the abruptio
(b) advancing age of the mother placenta with
(c) poor socio-economic condition the help of ppt
(d) malnutrition
(e) Smoking (vaso-spasm).
 Hypertension in pregnancy is the most important predisposing
factor. Pre-eclampsia, gestational hypertension and essential
Hypertension, all are associated with placental abruption. The
association of pre-eclampsia in abruptio placenta varies from
10-50 percent. The mechanism of the placental separation in
pre-eclampsia is : Spasm of the vessels in the utero placental
bed (decidual spiral artery) → anoxic endothelial damage →
rupture of vessels or extravasation of blood in the decidua
basalis (retroplacental hematoma).
 Trauma: Traumatic separation of the placenta usually leads to
its marginal separation with escape of blood outside. The
trauma may be due to:
(i) Attempted external cephalic version specially under
anaesthesia using great force
(ii) Road traffic accidents or blow on the abdomen
(iii) Needle puncture at amniocentesis.
 Sudden uterine decompression: Sudden decompression of the
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uterus leads to diminished surface area of the uterus adjacent to
the placental attachment and results in separation of the
placenta. This may occur following—(a) delivery of the first
baby of twins
(b) Sudden escape of liquor amnii in hydramnios and
(c) Premature rupture of membranes.
 Short cord, either relative or absolute, can bring about placental
separation during labor by mechanical pull.
 Supine hypotension syndrome: In this condition which occurs
in pregnancy there is passive engorgement of the uterine and
placental vessels resulting in rupture and extravasation of the
blood.
 Placental anomaly: Circumvallate placenta.
 Sick placenta: Poor placentation, evidenced by abnormal
uterine artery Doppler waveforms is associated with placental
abruption.
 Folic acid deficiency even without evidence of overt
megaloblastic erythropoiesis — this has been observed to be
associated.
 Uterine factor: Placenta implanted over a septum (Septate
Uterus) or a submucous fibroid.
 Torsion of the uterus leads to increased venous pressure and
rupture of the veins with separation of the placenta.
 Cocaine abuse is associated with increased risk of transient
hypertension, vasospasm and placental abruption.
 Thrombophilias inherited or acquired have been associated
with increased risk of placental infarcts or abruption.
 Prior abruption: Risk of recurrence for a woman with previous
abruption varies between 5 to 17%.
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5 min Describes about PATHOPHYSIOLOGY OF THE ABRUPTIO PLACENTA: Student teacher Elucidate the
the Depending upon the etiological factors, describes about Pathophysiology of
Pathophysiology the the abruptio placenta.
of the abruptio Premature placental separation is initiated by hemorrhage into the Pathophysiolog
placenta. decidua basalis. y of the abruptio
placenta with
The collected blood (decidual hematoma) at the early phase hardly the help of ppt.
produces any morbid pathological changes in the uterine wall or on the
placenta.

However, depending upon the extent of pathology, there may be

degeneration and necrosis of the decidua basalis as well as the placenta
adjacent to it.

Rupture of the basal plate may also occur, thus communicating the
hematoma with the intervillous space.

The decidual hematoma may be small and self limited; the entity is
evident only after the expulsion of the placenta (retroplacental
hematoma).
The features of retroplacental hematoma are :
(a) Depression found on the maternal surface of the placenta with a
clot which may be found firmly attached to the area
(b) Areas of infarction with varying degree of organization.
5 min Illustrate about CLINICAL FEATURES OF THE ABRUPTIO PLACENTA: Student teacher List down the clinical
the clinical illustrated about features of the
features of the the clinical abruptio placenta.
abruptio placenta. features with the
help of ppt.
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5 min Explain regarding COMPLICATIONS OF ABRUPTIO PLACENTA: Student teacher Describe about the
the complications explains about maternal
of the abruptio MATERNAL: In revealed type—maternal risk is proportionate to the the complications of the
placenta. visible blood loss and maternal death is rare. complication of abruptio placenta.
In concealed variety—The following complications may occur either the abruptio
singly or in combination. placenta with
(1) Hemorrhage which is either totally concealed inside the uterus or the help of ppt.
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more commonly, part is revealed outside. There may be
intraperitoneal or broad ligament hematoma
(2) Shock may be out of proportion to the blood loss. Release of
thromboplastin into the maternal circulation results in DIC or there
may be amniotic fluid embolism
(3) Blood coagulation disorders
(4) Oliguria and anuria due to—(a) hypovolemia (b) serotonin
liberated from the damaged uterine muscle producing renal
ischemia and (c) Acute tubular necrosis. However, a severe case
may lead to (d) cortical necrosis and renal failure
(5) Postpartum hemorrhage due to — (a) atony of the uterus and (b)
increase in serum FDP
(6) Puerperal sepsis.
The complicating factors those are responsible for increased maternal
death varies from 2–8%. However, with better understanding in the
management of shock, coagulation failure and renal failure, maternal
death has been reduced markedly. Some cases who manage to survive
may develop features of ischemic pituitary necrosis. There is failure of
lactation (Sheehan’s syndrome) later on.

FETAL: In revealed type, the fetal death is to the extent of 25-30%. In

concealed type, however, the fetal death is appreciably high, ranging
from 50-100%. The deaths are due to prematurity and anoxia due to
placental
Separation. With same degree of placental separation, the fetus is put
to more risk in abruptio placenta than in placenta previa. This is due to
the presence of pre-existing placental pathology with poor functional
reserve in the former, in contrast to almost normal placental functions
in the latter. Risk of recurrence in subsequent pregnancy is about
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tenfold with high perinatal mortality.
5 min Explicate the PREVENTIVE MEASURES OF THE ABRUPTIO PLACENTA: Student teacher Describe the
preventive The prevention aims at— explicate the preventive measures
measures of the (1) elimination of the known factors likely to produce placental preventive of the abruptio
abruptio placenta. separation measures of the placenta.
(2) correction of anemia during antenatal period so that the patient can abruptio
withstand blood loss and placenta with
(3) Prompt detection and institution of the therapy to minimise the the help of ppt.
grave complications namely shock, blood coagulation disorders and
renal failure.
Prevention of known factors likely to cause placental separation are
 Early detection and effective therapy of pre-eclampsia and
other hypertensive disorders of pregnancy.
 Needle puncture during amniocentesis should be under
ultrasound guidance.
 Avoidance of trauma—especially forceful external cephalic
version under anaesthesia.
 To avoid sudden decompression of the uterus— in acute or
chronic hydramnios, amniocentesis is preferable to artificial
rupture of the membranes.
 To avoid supine hypotension the patient is advised to lie in the
left lateral position in the later months of pregnancy.
 Routine administration of folic acid from the early pregnancy
— of doubtful value.
5 min Describe about MANAGEMENT OF THE ABRUPTIO PLACENTA: Student teacher Explain the
the management AT HOME: The patient is to be treated as outlined in placenta previa describes about management of the
of the abruptio and arrangement should be made to shift the patient to an equipped the management abruptio placenta.
placenta. maternity unit as early as possible. of the abruptio
IN THE HOSPITAL: Assessment of the case is to be done as regards: placenta with
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(a) amount of blood loss the help of ppt.
(b) maturity of the fetus and
(c) whether the patient is in labor or not (usually labor starts)
(d) presence of any complication and
(e) Type and grade of placental abruption.

Emergency measures:
(i) Blood is sent for hemoglobin and hematocrit estimation,
coagulation profile (fibrinogen level, FDP, prothrombin
time, activated partial thromboplastin time and platelets),
ABO and Rh grouping and urine for detection of protein
(ii) Ringer’s solution drip is started with a wide bore cannula
and arrangement for blood transfusion is made for
resuscitation. Close monitoring of maternal and fetal
condition is done.

Management options are:

(a) Immediate delivery
(b) Management of complications if there is any
(c)Expectant management (rare).

Definitive treatment (immediate delivery): The patient is in labor: Most

patients are in labor following a term pregnancy: The labor is
accelerated
by low rupture of the membranes. Rupture of the membranes with
escape of liquor amnii accelerates labor and it increases the uterine
tone also. Oxytocin drip may be started to accelerate labor when
needed.
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Vaginal delivery is favoured in cases with:
(i) Limited placental abruption
(ii) FHR tracing is reassuring
(iii) Facilities for continuous (electronic) fetal monitoring is
available
(iv) Prospect of vaginal delivery is soon or
(v) Placental abruption with a dead fetus.

The advantages of amniotomy are:

(a) Initiates myometrial contraction and labor process
(b) Expedites delivery
(c) Better compression of spiral artery to arrest hemorrhage
(d) Reduces entry of thromboplastin into maternal circulation and
thereby (e) Reduces the risk of renal cortical necrosis and DIC.

The patient is not in labor:

(i) Bleeding continues
(ii) > Grade I abruption :
Delivery either by
(A) Induction of labor or (B) Cesarean section.

(A) Induction of labor is done by low rupture of membranes.

Oxytocin may be added to expedite delivery. Labor usually
starts soon in majority of cases and delivery is completed
quickly (4-6 hours). Placenta with varying amount of
retroplacental clot is expelled most often simultaneously with
the delivery of the baby. Inj. oxytocin 10.IU IV (slow) or IM or
Inj. Methergin 0.2 mg IV is given with the delivery of the baby
to minimise postpartum blood loss. Oxytocics should be used to
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improve the uterine tone along with blood transfusion.
(B) Cesarean section: Indications are :
(a) Severe abruption with live fetus
(b) Amniotomy could not be done (unfavorable cervix)
(c) Prospect of immediate vaginal delivery despite amniotomy
is remote
(d) Amniotomy failed to control bleeding
(e) Amniotomy failed to arrest the process of abruption (rising
fundal height)
(f) Appearance of adverse features (fetal distress, falling
fibrinogen level, oliguria).
Anesthesia during cesarean section: Regional anesthesia is generally
avoided when there is significant hemorrhage. This is to avoid
profound and persistent hypotension Expectant management in a case
of placental abruption is an exception and not the rule. Cases where
bleeding is slight and has stopped (Grade I abruption), fetus reactive
(CTG) and remote from term, may be considered. The goal of
expectant management is to prolong the pregnancy with the hope of
improving fetal maturity and survival. Continuous electronic fetal
monitoring is maintained. Patient should be observed in the labor ward
for 24-48 hours to ensure that no further placental separation is
occurring. Meanwhile betamethasone is given to accelerate fetal lung
maturity in the event preterm delivery has to be contemplated. Further
separation of placenta at any moment may cause fetal death or
maternal complications. This is the major risk of conservative
management.
Management of complications : The major complications of placental
abruption are:
(a)Hemorrhagic shock.
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(b) DIC.
(c) Renal failure and
(d) Uterine atony and postpartum hemorrhage.
Hypovolemia should be corrected early. Blood pressure may not be a
correct guide to assess shock, as it may be high due to severe degree of
vasospasm. Irrespective of the patient’s general condition, at least one
litre of blood transfusion should be the minimum when the diagnosis of
concealed accidental hemorrhage is made. The best guide to monitor
the patient is the use of central venous pressure (CVP), which is
maintained at
10 cm of water. Hematocrit should be at least 30% and urinary output
> 30 mL/h.
A. Hemorrhagic shock—Classification of obstetric hemorrhagic is
based upon volume deficit.
B. DIC—Release of tissue thromboplastin in placental abruption
causes consumptive coagulopathy. Diagnosis is based on the
coagulation profile assessment. Treatment is to restore the hematologic
deficiency (fibrinogen level > 150 mg/ dL), 1 unit (500 mL) of fresh
blood contains 0.5 mL g of fibrinogen and raises the fibrinogen level
by 12.5 mg/dL. Platelet count
Increases by 10,000–15,000/cu mm to replenish the volume deficit and
to arrest the pathologic process (delivery).
Feto-maternal hemorrhage is common with traumatic variety of
placental abruption. To combat feto-maternal hemorrhage 300 μg of
anti-D immunoglobulin is administered to all Rh-negative women. The
amount of fetal to maternal bleed is usually < 15 mL
5 min Describes about INDETERMINATE BLEEDING: Student teacher Describe about the
the indeterminate The exact cause of vaginal bleeding in late pregnancy is not clearly describes about vasa previa.
bleeding. understood in few cases. The diagnosis of unclassified bleeding should the
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be made after exclusion of placenta previa, placental abruption and indeterminate
local causes. Rupture of vasa previa, marginal sinus hemorrhage, bleeding with
circumvallate placenta, marked decidual reaction on endocervix or the help of ppt.
excessive show may be a possible cause of such bleeding.

VASA PREVIA: The unsupported umbilical vessels in velamentous

placenta, lie below the presenting part and run across the cervical os.
These vessels are torn either spontaneously or during rupture of
membranes.
Color-flow Doppler is helpful for antenatal diagnosis. Fetal mortality is
high (50%) due to fetal exsanguination. Detection of nucleated red
blood cells (Singer’s alkali denaturation test) or fetal hemoglobin is
diagnostic.
Vaginal bleeding is often associated with fetal distress (tachycardia,
sinusoidal FHR tracing).
MANAGEMENT: Management depends on fetal gestational age,
severity, persistence or recurrence of bleeding, and the presumed cause
of bleeding.
A) Pregnancy > 37 weeks and bleeding recurrent — delivery is
recommended. The mode of delivery depends on the state of the fetus,
and other associated factors (cervix).
B) Expectant management can be done in selected cases for fetal
maturity similar to placenta previa. Fetal monitoring must be carefully
done. Intrapartum diagnosis of vasa previa, needs expeditious delivery.
Neonatal blood transfusion may be needed.
10 min Explain about the EXTRA PLACENTAL CONDITIONS OF ANTEPARTUM Student teacher Describe about the
extra placental HEMORRHAGE: explains about extra placental
conditions of the conditions conditions of
antepartum 1. IMPLANTATION BLEED of the antepartum
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hemorrhage. A small vaginal bleed can occur when the blastocyst embed in the antepartum hemorrhage.
endometrium. This usually occurs 5-7 days after fertilization and if the hemorrhage
timing coincides with the expected menstruation this may cause with the help of
confusion over the dating of the pregnancy if the menstrual is used to ppt.
estimate the date of birth.
2. CERVICAL POLYPS
These are small, vascular, pedunculated growths on the cervix, which
consist of squamous or columnar epithelial cells over a core of
connective tissue rich with blood vessels. During pregnancy, the
polyps may be a cause of bleeding but require no treatment unless the
bleeding is severe or a smear test indicates malignancy.
3. CARCINOMA OF THE CERVIX
Carcinoma of the cervix is the most common gynaecological malignant
disease occurring in pregnancy with an estimated incidence of 1 in
2200 pregnancies .The condition presents with vaginal bleeding and
increased vaginal discharge. On speculum examination the appearance
of the cervix may lead to a suspicious of carcinoma, which is
diagnosed following colposcopy or a cervical biopsy.
The precursor to cervical cancer is cervical intraepithelial neoplasia
(CIN), which can be diagnosed from an abnormal papanicolaou (PAP)
smear. Where this is diagnosed at early stage, treatment can usually be
postponed for the duration of the pregnancy. The Pap smear is not
routinely carried out during pregnancy , but the midwife should ensure
that pregnant women know about the National Health Service
Screening Programme(2013), recommending a smear 6 weeks
postnatally if one has not been carried out in the previous 3 years.

Treatment for cervical carcinoma in pregnancy will depend on the

gestation of the pregnancy and the stage of the disease, and full
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explanations of treatments and their possible outcomes should be given
to the woman and her family. For carcinoma in the early stages,
treatment may be delayed until the end of the pregnancy, or a cone
biopsy may be performed under general anaesthetic to remove the
affected tissue. However there is risk of hemorrhage due to the
increased vascularity of the cervix of the cervix in the pregnancy, as
well as the risk of miscarriage. Where the disease is more advanced
and the diagnosis made in early pregnancy, the woman may be offered
a termination of pregnancy in order to receive the treatment, as the
effects of chemotherapy and radiotherapy on the fetus cannot be
accurately predicted at the present time. During the late second and
third trimester the obstetric and oncology teams will consider the
optimal time for birth in order to achieve the best outcomes for both
mother and the baby.
4. CERVICAL ECTROPION
More commonly known as cervical erosion. The changes seen in cases
of cervical ectropion are as a physical response to hormonal changes
that occur in pregnancy. The number of columnar epithelial cells in the
cervical canal increase significantly under the influence of estrogen
during pregnancy to such an extent that they extend beyond to the
vaginal surface of the cervical os, giving it a dark red appearance. As
this area is vascular, and the cells form only a single layer, bleeding
may occur either spontaneously or following sexual intercourse.
Normally, no treatment is required, and the ectropion reverts back to
normal cervical cells during the puerperium.

5 min Elucidate the NURSING MANAGEMENT OF ANTEPARTUM Student teacher List down the points
nursing HEMORRHAGE: elucidates the of nursing
management of 1. ASSESSMENT: nursing management of
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the antepartum Assess for the following clinical manifestation: management of antepartum
hemorrhage.  Scant or profuse vaginal bleeding. the antepartum hemorrhage.
 Uterine irritability, tenderness and rigidity. hemorrhage.
 Abdominal pain that is intermittent or continuous.
 Signs of maternal shock- hypotension, rapid pulse, dyspnoea
 Violent fetal activity followed by inactivity
 FHR- slow to absent
 Late deceleration noted in monitor strip
 May have blood stained amniotic fluid ( port wine stain)
2. ANALYSIS/ NURSING DIAGNOSIS:
 Risk for fetal injury
 Risk for infection
 Ineffective airway clearance
 Actual/ risk for aspiration
 Anxiety
 Anticipatory grieving
 Altered family process
 Actual/ risk for altered parenting
 Health seeking behaviour

3. PLANNING:
 Promote safe care environment
 Monitor for presence of pre existing conditions.
 Assess maternal – fetal status and initiative emergency care
 Provide encouragement and support.
 Administer measures to treat shock and blood loss
4. IMPLEMENTATION:
 Monitor maternal and fetal vital signs.
 Treat shock symptoms
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 Assess vital signs every 5-15 mins
 Administer oxygen by face mask at 7-10 L/min
 Increase IV flow rate
 Administer blood
 Monitor urinary output
 Monitor FHR continuously
 Observe for signs and symptoms of coagulation problems
 Measure abdominal girth
 Remain with woman
 Monitor labor pattern continuously if allowed to progress or
prepare for cessarean section.
5. EVALUATION
 The woman and her spouse understand the treatment plan
 The physiological status of the women and the fetus remains
within the normal limits.
 The women and her spouse verbalizes, decrease of anxiety and
feelings of support.
 The women remain normotensive
 The hemoglobin and Hematocrit levels are within normal
limits.

2 min Summarize the Summarization of the topic:

topic. Antepartum hemorrhage is the bleeding from or into the genital tract
after the 28th week of pregnancy but before the birth of the baby (the
first and second stage of labor are thus included). The 28th week is
taken arbitrarily as the lower limit of fetal viability. The incidence is
about 3% amongst hospital deliveries. It is dividing into many types
under which I’ve covered abruptio placenta, vasa previa, and other
extra placental conditions of antepartum hemorrhage.
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2 min Conclusion of the Conclusion of the topic:
topic. Antepartum hemorrhage is a serious life threatening condition which la
health care professional must be able to identify in order to prevent
serious complications to mother and fetus.

BIBLIOGRAPHY

 Jacob Annamma. A comprehensive textbook of midwifery; 2nd edition. New Delhi; Jaypee publishers/: Pp 311-315
 Datta D.C. Textbook of obstetrics 2010; 7th edition. New Delhi; New Central Book Agency/: Pp 241-259
 Dr.Sharma JB. A textbook of obstetrics; 1st edition. New Delhi; Avichal publishing company/: pp 222-224
 https://en.wikipedia.org/wiki/Antepartum_bleeding
 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3263934/

RITEE COLLEGE OF NURSING

PRACTICE TEACHING
 ON:
ANTEPARTUM
HEMORRHAGE

SUBMITTED TO: SUBMITTED BY:

MS. SHRISTI SOLOMON MS. PARMESWARI SINHA

ASSISTANT PROFESSOR M.SC NURSING 1ST YEAR

RITEE COLLEGE OF NURSING RITEE COLLEGE OF NURSING

TEACHER:- Mrs.Parmeshwari Sinha

TOPIC:- Antepartum hemorrhage

DEPARTMENT:- Obstetrics and Gynaecological Nursing

VENUE:- RITEE college of Nursing,Raipur

DATE:-

TIME:-

GROUP INVOLVED:- B.Sc(N)6th sem students

METHOD OF TEACHING:- Lecture com discussion

A V AIDS USED:- poster , charts, flashcards, pamphlets etc.

GENERAL OBJECTIVES:- At the end of the teaching, student will be able to gain the knowledge regarding Hyper
emesis gravidarum and care of mother
SPECIFIC OBJECTIVES:
 To introduce the topic
 Defines antepartum hemorrhage.
 Describes the Causes of antepartum hemorrhage.
 Defines Abruptio placenta
 Explain about the different type/ varieties of abruptio placenta
 Discuss about the incidence of the abruptio placenta
 Explain about the etiology of the abruptio placenta
 Describes about the Pathophysiology of the abruptio placenta.
 Illustrate about the clinical features of the abruptio placenta.
 Explain regarding the complications of the abruptio placenta
 Explicate the preventive measures of the abruptio placenta.
 Describe about the management of the abruptio placenta.
 Describes about the indeterminate bleeding.
 Explain about the extra placental conditions of antepartum hemorrhage.
 Elucidate the nursing management of the antepartum hemorrhage.
 Summarize the topic.
 Conclusion of the topic.