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Definition
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Bleeding from the genital tract after the 20th week of gestation and before the onset of labour.
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Bleeding in pregnancy remains a major cause of perinatal mortality.
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Incidence
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Affects 2-5% of pregnancies.
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Causes
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Placental praevia
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- painless bleed from separation of abnormally placed placenta
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Placental abruption
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- bleeding from the separation of a normally situated placenta
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- Diagnosis of placental abruption should be considered in any pregnant woman with abdominal pain with or without PV bleeding, as mild cases may not be clinically obvious.
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Vasa praevia
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- a condition in which blood vessels within the placenta or the umbilical cord are trapped between the fetus and the cervical os / vagina
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- bleeding may result from the rupture of these vessels (e.g. during artificial rupture of the membranes) - this is a rare condition
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Unclassified
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- Heavy show / onset of labour
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- Cervical ectropion / Carcinoma
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Management
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Assessment of patient
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- assess woman's condition, take vital signs
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- take history - any bleeding throughout pregnancy, other relevant history, EDC
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- blood Loss (amount, colour, consistency and note time)
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- abdomen - (Gentle palpation) check fundal height, lie, presentation
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- assess uterine activity (painful contractions, pain associated with bleeding and assess whether uterus feels soft, tense, tender or non-tender)
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- assess fetal wellbeing, monitor fetal heart with CTG
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- IV access. Collect blood for FBC, Group & Crossmatch, coagulation profile, feto-maternal haemorrhage test (FMH test) (Rh negative women only).
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- check placental site on previous ultrasound before any vaginal examination
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- ultrasound for placental location
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- speculum examination ONLY -vaginal examination is contraindicated until placenta praevia has been excluded
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- steroids if gestation is < 34 weeks
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- administer anti-D if Rhesus (D)-negative
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Royal Women's Hospital Clinical Practice Guidelines (CPGs) are intended to provide guidance to health care professionals, based on a thorough evaluation of research evidence, on the practical assessment and management of specific clinical issues or situations. The guidelines allow some flexibility on the part of the health care professional based on the needs of the specific patient for whom they are caring.
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