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Management of antepartum haemorrage

NB - Emergency
NON- SPECIALIST HOSPITAL trolley ready at all
times (Checked by
sister at every shift &
• History by doctor daily)
• Vital signs/Pain assessment
The serious causes of APH are: • Estimate blood loss
Placenta Praevia • Abdominal palpation (gentle)
Placenta Abruption • *Emergency trolley
Vass Praevia (rare) • IV Cannula (16g)
• Collect blood for: Hb, Group & cross Match
• IV Fluids if necessary
Is there danger to mother or fetal distress?
YES NO

• Resuscitate
• Communicate and transfer to specialist • 24 hours observation of mother and baby in hospital
hospital promptly • Refer to Specialist Hospital for further assessment and care
• Accompanied by doctor / Midwife • Advise patients regarding;
9 Importance of further investigation in Specialist Hospital (E.g.: Ultrasound examination)
9 Warning signs-
Decrease fetal movements.
Further bleeding
Abdominal pain
NB - Emergency trolley
SPECIALIST HOSPITAL ready at all times
(Checked by sister at
every shift & by doctor
Assessment daily)
History
Vital signs/Pain assessment
The serious causes of APH are: Estimate blood loss
ƒ Placenta Praevia Abdominal palpation (gentle) o *Emergency trolley
ƒ Placenta Abruption o IV Cannula (16g)
ƒ Vass Praevia (rare) o Collect blood for: Hb, Group & X Match
o FMH test in Rh neg (Ideal)
Is there danger to mother or fetal distress?
Yes NO
YES

Summon help Management –according to gestation and diagnosis


ƒ Obstetrician /Registrar ƒ Clinical history and examination
ƒ Blood bank officer/Haematologist ƒ Consider analgesia
ƒ Anaesthetist ƒ Ultrasound to confirm placental site
ƒ ICU ƒ Speculum (If no Placenta Praevia)
ƒ Pediatrician ƒ If RH negative: *FMH test (Ideal) /Anti D if required
*NB: Kleihauer now Different diagnosis:
known as: Assessment
o Placenta praevia
of Feto-Maternal
Resuscitation (Concurrent management) Haemorrhage (FMH) o Placental abruption
IV cannula16G; Saline, or Hartman Use 9ml EDTA blood o Other causes

Collect blood: collection tube.


o Full blood count Ongoing management is individualized according to gestation,
o Group & Cross-match diagnosis and patient condition.
o Coagulation profile Principles may include:
o *FMH test (Ideal) for Rh negative women-Anti-D if required 20-24 Weeks
o If significant blood loss- increase fluid/blood/blood products Admission
o Oxygen Rest in bed
o Indwelling urinary catheter Maternal monitoring
o Monitor fetal heart rate (available)/continuous Paediatric consultation
Cardiotocography (CTG) 24-36Weeks
o Ongoing maternal monitoring: vital signs, blood loss Consider corticosteroids (usually 24-34 weeks)
Continued fetal surveillance
Confirm diagnosis/gestation Anti D if RH negative
Ultrasound Paediatric consultation
Speculum examination (If no
praevia) 36 weeks
Praevia
Expectant management
Mother & Fetus stable? Yes Elective C.S.
No Yes Abruption
Expectant management
Consider induction 37 weeks+, earlier if fetal
Timing and mode of delivery or maternal distress
determined by gestation and
maternal /fetal status
Sri Lanka College of Obstetrics and Gynaecology
Health sector development Project
Low Risk
Documentation at every step is mandatory Guidelines- Management of antepartum haemorrage
High Risk