Vaginal bleeding occurring after the 28 weeks of pregnancy up to 2nd stage of labour
Causes
• Local causes from genital tract
• Placenta praevia: all or part of the placenta is found in the lower segment of the uterus
• Abruptio placentae: premature separation of a normally placed placenta
Clinical features (see table over)
Differential diagnosis
• Ruptured uterus especially in a patient with previous Caesarean section
• Local causes, eg. cervical cancer
Investigations
• Take a good history and do a careful examination
• Ultrasound: to find the site of the placenta
• Blood:
- grouping, cross-matching
- haemoglobin, fibrinogen levels
- clotting time
Clinical features
Placenta praevia |
Abrupto placentae |
• Painless |
• Severe pain |
• Foetal movements usually present |
• Loss of foetal movements common |
• Open bleeding from the vagina |
• Open bleeding may be absent, only serous fluid in some cases (bleeding is behind the placenta) |
• Shock and anaemia, if bleeding is heavy |
• Shock and anaemia, even when no open bleeding |
• Uterus soft and not tender |
• Uterus hard and tender |
• High presenting part (head) or malpresentation (the part in the lower uterus not head) |
• Foetal parts difficult to feel because of hard uterus |
• Foetal heart usually heard |
• Foetal heart often absent |
Management
Set up IV infusion, see p354
HC 3
Refer for further management
