Obstetric Hemorrhage

Classification
Antepartum hemorrhage
Placenta previa
Placental abruption

Postpartum hemorrhage
Uterine atony
Genital tract laceration

unningham PG, Leveno KJ, Bloom SL. Williams Obstetric. 22nd edition. E-book.

unningham PG, Leveno KJ, Bloom SL. Williams Obstetric. 22nd edition. E-book.

Predisposing or Worsening
Conditions

Abnormal placentation
Trauma during labor and delivery
Small maternal blood volume
Other factors
Uterine atony
Coagulation defects

unningham PG, Leveno KJ, Bloom SL. Williams Obstetric. 22nd edition. E-book.

Antepartum Hemorrhage
Placenta previa
Placental abruption
Vasa previa

unningham PG, Leveno KJ, Bloom SL. Williams Obstetric. 22nd edition. E-book.

Placenta Previa
Placenta is located over or very near to internal ostium
Classification:
Total
Partial
Marginal
Low-lying

Etiology
Advancing maternal age
Multiparity
Prior caesarean delivery
smoking

Vasa previa vessels instead of placenta

unningham PG, Leveno KJ, Bloom SL. Williams Obstetric. 22nd edition. E-book.

unningham PG, Leveno KJ, Bloom SL. Williams Obstetric. 22nd edition. E-book.

Incidence
More common in multiparity patient
with age >30 yo
In several general hospital in
Indonesia 1,7% 2,9%

TMA. Perdarahan pada Kehamilan Lanjut dan Persalinan dalam Ilmu Kebidanan.
ta: PT Bina Pustaka Sarwono Prawirohardjo

Pathophysiology
Isthmus widening, cervix effacement and
dilatation detachment of implanted
placenta laceration bleeding
Lower segment of uterine has minimal
muscular element minimal contraction
slowly ends bleeding
Progressive forming of lower segment of
uterine new laceration recurrent
bleeding

TMA. Perdarahan pada Kehamilan Lanjut dan Persalinan dalam Ilmu Kebidanan.
ta: PT Bina Pustaka Sarwono Prawirohardjo

Diagnosis
Clinical findings:
Painless hemorrhage, especially after
second trimester

Radiology: sonography, MRI (not

common)
Digital exploration is only permissible
in operating room

unningham PG, Leveno KJ, Bloom SL. Williams Obstetric. 22nd edition. E-book.

Complication

Anemia or shock
Placenta accreta, increta, and
percreta
Rupture of cervix and lower segment
of uterine
Malposition of the fetus
Preterm birth
Solutio placenta, postpartum
TMA. Perdarahan pada Kehamilan Lanjut dan Persalinan dalam Ilmu Kebidanan.
hemorrhage,
DIC
ta: PT Bina
Pustaka Sarwono Prawirohardjo

Management
Those in whom the fetus is preterm
and there is no indication for delivery
Those in whom the fetus is
reasonably mature
Those in labor
Those in whom hemorrhage is so
severe as to mandate delivery
despite fetal immaturity

unningham PG, Leveno KJ, Bloom SL. Williams Obstetric. 22nd edition. E-book.

Management (2)
Blood transfusion
Close observation of mother and
fetus
MSAFP
Mg sulfate
Steroid
USG, color Doppler, MRI

TMA. Perdarahan pada Kehamilan Lanjut dan Persalinan dalam Ilmu Kebidanan.
ta: PT Bina Pustaka Sarwono Prawirohardjo

Delivery
Partial/ marginal placenta previa
induction of labor
Total placenta previa sectio
caesarea

unningham PG, Leveno KJ, Bloom SL. Williams Obstetric. 22nd edition. E-book.

Prognosis
Nowadays, the prognosis for women
with placenta previa is better due
to early detection
Preterm birth is still unavoidable

TMA. Perdarahan pada Kehamilan Lanjut dan Persalinan dalam Ilmu Kebidanan.
ta: PT Bina Pustaka Sarwono Prawirohardjo