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Obstetric Haemorrhage
Are based on
1. Extent of separation: Partial vs complete
2. Location of separation: Marginal Vs central
3. Clinical presentation: Revealed, concealed and
mixed
4. Clinical Severity: Mild, Moderate and Severe
Clinical Severity
Class 1 Mildest form: Class 2: moderate -approx
approx 48% of all cases. 27% of all cases.
Hypertensive Disease
Multiple pregnancy
Trauma
PPROM
I. Abruptio placenta: Risk factors
Anaemia
Polyhydramnios – sudden ↓intrauterine
pressure
Short cord
Uterine leiomyoma: esp if located behind
the placental implantation site, predispose
to abruption
Abruptio Placenta: Features
Shock
Acute renal failure
Cause: ?seriously impaired renal perfusion 2°
to ↓CO and intrarenal vasospasm as in
preeclampsia
DIC
Consumptive coagulopathy 2° to
hypofibrinogenemia along with elevated levels
of fibrinogen–fibrin degradation products
Placental Abruption: Complications
Fetal distress/demise
PPH
Couvelaire Uterus:
Widespread extravasation of blood into the uterine
musculature and beneath the uterine serosa.
Sheehan syndrome
Puerperal sepsis
Placental Abruption: Management
1. Delivery
Resuscitation
FFP, whole blood, IV fluids
Monitor BP
ARM
Induce/Augment labour
Oxytocin infusion or prostaglandin if
necessary to induce contractions
Bed site clotting time
Done regularly
Placental Abruption: General Management
2. Caesarean Section
Indications for Caesarean Section
salvageable baby,
Severe vaginal bleeding,
Poor progress,
Transverse lie, inadequate pelvis
Post delivery -watch out for PPH
Why?
Myometrial myofibrin loose contractility
Failure to clot
PLACENTA PRAEVIA - DEGREES
4. Low-lying placenta
The placenta is implanted in the lower uterine
segment such that the placental edge actually
does not reach the internal os but is in close
proximity to it.
PLACENTA PRAEVIA: Predisposing factors
Multiparity
Advanced maternal age
Prior C/S or other uterine surgery
Prior placenta previa
Placenta Previa: Diagnosis
Painless vaginal bleeding in 2nd/3rd trimester
Confirmed by ultrasound
Up to 10% may have simultaneous abruption
Maternal shock is uncommon with 1st
presentation of bleeding
Placenta Previa: Obstetric Management
Carcinoma of cervix
Trauma
Cervical polyp
Bilharzia of cervix
Cervicitis