Anti-Partum Hemorrhage

Subject: Midwifery I (Theory)

Overview

Anti-partum hemorrhage is described as bleeding from or into the vaginal tract after the 22nd week of pregnancy but before the baby is born. It can happen at any point throughout the second stage of labor. It is also known as postpartum hemorrhage. It is the major cause of perinatal and maternal morbidity. Anti-partum hemorrhage is classified as placental site bleeding (70%), extra-placental bleeding (5%), and unexplained (25%) or 1indeterminate. The general state of the patient is followed during the care of Antepartum Hemorrhage (blood pressure, temperature, pulse, and respiration). In the event of a shock, treat the shock with an urgent transfusion of IV fluids such as normal saline or ringer lactate, initially about 1 liter over 15-20 minutes, and oxygen at 6-8 liters.

Anti-partum hemorrhage is described as genital bleeding that occurs after the 22nd week of pregnancy but before the baby is born (before delivery). It can happen at any time once the second stage of labor is finished. It is also known as postpartum hemorrhage. It is the most common cause of perinatal and maternal morbidity.

Incidence:

  • It affects 3% to 5% of all pregnancies.
  • It is three times more common in multiparous women than in primiparous women.

Causes

  • Obstetric
  • Placenta
  1. Maternal blood
  2. Bloody show
  3. Placental abruption, Previa
  4. Fetal blood- vasa Previa
  • Uterine rupture

Classifications of Anti-partum hemorrhage

Placenta site bleeding (70%)

  • Placenta Previa (unavoidable hemorrhage) 35%
  • Abruption placenta (Accidental Hemorrhage) 35%

Extra placental bleeding (5%)

Local cervical vaginal lesions

  • Cervical polyp
  • Carcinoma of the cervix
  • Varicose vein
  • Local trauma(vaginal trauma)
  • Cervicitis
  • Scar disruption

Unexplained (25%) or indeterminate

Excluding placental bleeding and local lesions

General management of Antepartum Hemorrhage

  1. Call for quick assistance.
  2. The available employees were urgently mobilized.
  3. Observe the patient's general condition (blood pressure, temperature, pulse, and respiration). If the patient is in shock, treat the shock with an immediate transfusion of IV fluids such as normal saline or ringer lactate, initially about 1 liter over 15-20 minutes, and oxygen at 6-8 liters per minute.
  4. Strictly the vitals in the drip and oxygen supplementation and recording
  5. During the shock period, do not undertake a vaginal examination.

References

  • HealthLine. 2005. 2017 http://www.healthline.com/symptom/hemorrhage
  • MedicineNet. 1996. 2017 http://www.medicinenet.com/script/main/art.asp?articlekey=14263
  • Tuitui R. 2002, A textbook of Midwifery A (Antenatal), 3rd edition, Vidyarthi Pustak Bhnadar (Publisher and Distributor), Bhotahity, Kathmandu
  • Postabortion care, a reference manual for improving quality of care, USAID/Nepal, FHD, HMG
Things to remember
  • Anti-partum hemorrhage is described as genital bleeding that occurs after the 22nd week of pregnancy but before the baby is born.
  • It can happen at any time once the second stage of labor is finished.
  • It is also known as postpartum hemorrhage. It is the most common cause of perinatal and maternal morbidity.
  • Anti-partum hemorrhage is classified as placental site bleeding (70 percent), extra-placental bleeding (5 percent), and unexplained (25 percent) or 1indeterminate.
  • The general state of the patient is examined in the care of Antepartum Hemorrhage (blood pressure, temperature, pulse, and respiration).
  • In the event of shock, treat it with an urgent transfusion of IV fluids such as normal saline or ringer lactate, initially about 1 liter over 15-20 minutes, and provide oxygen at 6-8 minutes.
Questions and Answers

Blood loss from or into the vaginal tract that occurs after the 22nd week of pregnancy but before the baby is born is known as an anti-partum hemorrhage (before delivery). It could happen at any point after the second stage of labor is over. Another name for it is post-partum hemorrhage. It is the main factor in maternal and perinatal morbidity.

Anti-partum Hemorrhage Categories

Placenta Site Bleeding (70%)

  • Pregnancy Previa (unavoidable hemorrhage) 35%
  • Placental Abruption 1 (Accidental Hemorrhage) 35%

Extra Placental Bleeding (5%)

cervical vaginal lesions nearby

  1. Polyp on the cervix.
  2. Cervix-related cancer.
  3. Vein varicosity.
  4. Localized harm (vaginal trauma).
  5. Cervicitis.
  6. Disruption of a scar.

Unexplained or Indeterminate (25%)

(Excluding local lesions and placental bleeding)

General Control of Antepartum Bleeding

  • Call for quick assistance.
  • Immediately mobilize the personnel that are on hand.
  • Observe how the patient is feeling overall (blood pressure, temperature, pulse, and respiration).
  • In the event of shock, treat the condition by administering IV fluids like ringer lactate or normal saline immediately. Give oxygen at a rate of 6 to 8 liters per minute.
  • Just the vital signs contained in the drip, oxygen supplement, and record.
  • During the shock phase, avoid conducting a vaginal exam.

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