Antepartum Heamorrhage APH

Antepartum haemorrhage APH
APH is usually define as bleeding form the birth canal after the 24 to 28 weeks of  pregnancy.It can occur at any time until the second stage of lobour is complete; bleeding following the birth of the baby is postpartum haemorrhage=Miscarriage
Or 
Any ammount of bleeding from genital tract after 28 weeks to before of bleeding
28wk ..... Delivery time....6wk
APH_________IPH_________PPH
ETIOLOGY ---
Idiopathic/unknown
2types   
1) Placenta previa (pp)
2) Abrupto previa (AP)
Placenta previa=in lower uterin segement
Implantation posterior wall of bady of uterus near the fundus
Abrupto precisa=premature separation of placenta
Most common risk of APH
Dropping down theory=
Drop down in lower uterine segments
Implantation
Due to less endometrial reactions
Increase that cilliary active of fallopian tube
A)Types of placenta previa
1)Types 1 (PP) low lying placenta precisa
Majar part of placenta in upper uterine segment and small part in lower uterine segment
Don't cover then interanl OS
Noraml veginal delivery is possible
2)Types 2 Marginal (PP)
Most placenta part in lower uterin segment and small part in upper uterine segment
A) Types 2 anterior pp
Implantation of placenta towards the symphysis pubis
Vaginal delivery possible
B)Types 2 posterior pp
Implantation towards that secral promomentry
Decrease the anteroposterior(APD) dimeter of inlet 
Compress the fetal head
Decrease FHR
It is also know Dangerous placenta previa
3)Types 3 incomplete and partial pp
Implantation of placenta over the internal OSs partially and incompletely
Don't cover fully to internal OS
Vaginal delivery not possible
4)Types 4 complete pp
Complete internal os cover by the implantations placenta
Noramal vaginal not possible
Sign/Spmtoms--
Painless vaginal bleeding
Covseless bleeding
Bleeding is not associated with activity
Uterus become soft
Bleeding in rasting condition
Bright red in colour
Diagnosis--
Placebtogrophy
Examination of placenta under the USG
Per veginal (p/v) is contraindicated decrease
Double set up examination (p/v)in OT
Mangment=
1) Expected magment=
Femal is hemodynamically stable 
     If less than 37 weeks gestation
Try to till up to 37 weeks continue
   If greater than 37 weeks terminate
2) Active mangment=unstable
Types 1
Types 2 anterior
Oxytocin induction of labour
Pre mature rapture of labour
Vaginal delivery
Types 2 posterior
Types 2
Types 3,4
Surgery (CS)
It before 34weeks gastantion age 
Betamethason 12 to 24 mg 
To mature lungs
If distance in between placenta nad inaternal os is more than 3cm 
Vagianl delivery
PP position=reverse trandleleberg
Fetal head descent down word and compress then bleeding sign =bleeding stop
B) Abruption placenta (APH)
Most common cause of APH
Premature separation of placenta
Etiology
Like as trouma
Infection and hypertension (HTN)
Pregnancy induce hypertension
Blood vessels (vasoconstriction)
Decrease that placenta perfusion
Slowly progress of (AP) /Ablation placenta/premature ablation placenta (PSP)

TYPES 
1) Reveled=some amount of blood expelled by vaginal tract
2) Concealed=blood collect just behind the saperated placenta don't expelled out through the vaginal
It may invade in myometrium ik know as conuveileire uterus and uteroplacenta apoplexy
3)Mixed=some amount of blood expell out by the vagina and some is  collected behind the placenta
Clinical bleeding=
Grading zero=no any sypmtom present
Vagianl bleeding absent
Only confirmative diagnosis show the disease condition
Grading one=mild veginal bleeding
Fetal head rate noraml
No complications
Absent of shock
3) Grading second=moderate vaginal bleeding
Most common clinical bleeding of abruptio placenta
FSR decrease
Shock is absent
4) Grading third=sever vaginal bleeding present
FHR absent
Shock present
More than 30%of total blood loss
Diagnosis
USG
Pianfull bleeding
Firm uterus
Sing/symptoms
Painfully vaginal bleeding present
Cause present HTN
Uterus is firm 
Dark vaginal bleeding present
Recurrent and bleeding present
Placenta in upper segament
Managment
Termination of pregnancy to irrectptive of gestational age
Before 34weekz bethamethosn 
Induction of labour, oxytocin


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