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Antepartum bleeding, also known as antepartum haemorrhage (APH) or prepartum hemorrhage, is genital bleeding during pregnancy after the 28th week of pregnancy up to delivery. [ 1 ] [ 2 ] It can be associated with reduced fetal birth weight. [ 3 ]
Antepartum bleeding (APH), also prepartum hemorrhage, is bleeding during pregnancy from the 24th week [7] (sometimes defined as from the 20th week [8] [7]) gestational age up to the birth of the baby. [5] The primary consideration is the presence of a placenta previa which is a low lying placenta at or very near to the internal cervical os.
Clinical Presentation: Varies widely from asymptomatic to vaginal bleeding and abdominal pain. Risk factors: Prior abruption, smoking, trauma, cocaine use, multifetal gestation, hypertension, preeclampsia, thrombophilias, advanced maternal age, preterm premature rupture of membranes, intrauterine infections, and hydramnios.
Velamentous cord insertion is a complication of pregnancy where the umbilical cord is inserted in the fetal membranes.It is a major cause of antepartum hemorrhage that leads to loss of fetal blood and associated with high perinatal mortality.
Bloody show or show is the passage of a small amount of blood or blood-tinged mucus through the vagina near the end of pregnancy.It is caused by thinning and dilation of the cervix, leading to detachment of the cervical mucus plug that seals the cervix during pregnancy and tearing of small cervical blood vessels, [1] and is one of the signs that labor may be imminent. [2]
The following have been identified as risk factors for placenta previa: Previous placenta previa (recurrence rate 4–8%), [13] caesarean delivery, [14] myomectomy [10] or endometrium damage caused by D&C. [13] Women who are younger than 20 are at higher risk and women older than 35 are at increasing risk as they get older.
The risk of placental abruption increases sixfold after severe maternal trauma. Anatomical risk factors include uncommon uterine anatomy (e.g. bicornuate uterus), uterine synechiae, and leiomyoma. Substances that increase risk of placental abruption include cocaine and tobacco when consumed during pregnancy, especially the third trimester.
Before delivery all patients should be screened for risk factors and then assigned a postpartum hemorrhage risk stratification based on the American College of Obstetricians and Gynecologists recommendations. If the woman is at a medium risk, blood should be typed and screened. Those assessed to be high risk should be typed and cross-matched ...