ANTEPARTUM HEMORRAGE

How is Antepartum Hemorrhage (APH) defined in terms of gestational age?

Bleeding from or into the genital tract occurring from 24 weeks of pregnancy and prior to the birth of the baby.

Distinguish between the bleeding characteristics of Placenta Previa, Placental Abruption, and Vasa Previa.

Placenta Previa: Painless, recurrent bleeding.Placental Abruption: Painful bleeding with a tense/tender uterus.Vasa Previa: Painless bleeding specifically occurring upon rupture of the membranes, often followed by fetal distress.

What are the four grades of Placenta Previa?

Grade 1 (low-lying): Edge <2cm from internal os but doesn't reach it.Grade 2 (marginal): Reaches the internal os but doesn't cover it.Grade 3 (partial): Covers the internal os when closed/asymmetrically situated.Grade 4 (complete): Centrally covers the internal os.

Why is a digital vaginal examination strictly contraindicated in cases of suspected Placenta Previa?

It carries a high risk of provoking severe, life-threatening bleeding.

What is the most predictive risk factor for Placental Abruption?

An abruption in a previous pregnancy (recurs in 4.4% in a second pregnancy and 19-25% after two).

What is the difference between a "Revealed" and a "Concealed" placental abruption?

Revealed (~80%): Blood escapes through the cervix (visible vaginal bleeding).Concealed (~20%): Blood is trapped between the membranes and decidua (no visible bleeding, but severe focal pain and uterine rigidity).

Explain the pathophysiology of Vasa Previa and why it is so fatal to the fetus.

It occurs with a velamentous cord insertion where fetal vessels travel unprotected through the membranes over the cervical os. When membranes rupture, these vessels can tear, causing the fetus to exsanguinate within minutes.

What is the "Apt Test" used for in the context of APH?

It differentiates fetal blood from maternal blood in vaginal bleeding (often used to diagnose bleeding from Vasa Previa). Fetal hemoglobin stays pink, while adult hemoglobin turns yellow-brown when mixed with NaOH.

What is the classic clinical presentation of a Uterine Rupture during labor?

A sudden tearing abdominal pain, cessation of contractions, profound maternal tachycardia/hypotension, and easily palpable fetal parts (protuberance of the abdomen).

In a massive obstetric hemorrhage, what clinical parameter is the best sign of adequate fluid volume replacement?

Urine output.

What is the difference between Placenta Accreta, Increta, and Percreta?

Accreta: Attached directly to the myometrium (no invasion).Increta: Invades into the myometrium.Percreta: Penetrates through the myometrium and invades the serosa/adjacent organs (like the bladder).

According to past papers, does the presence of abdominal tenderness 100% rule out Placenta Previa?

No. While Previa is typically painless, abdominal tenderness does not definitively rule it out.

What is the "Sentinel Bleed" in Placenta Previa?

The initial hemorrhage is usually minor (a warning sign), but subsequent bleeding episodes can become increasingly severe.

If a woman presents with an APH and a compromised, dead fetus (IUFD), what is the preferred method of delivery?

Vaginal delivery (specifically via forewater amniotomy if not in active labor) is safer for the mother. A Cesarean section is not indicated for an already dead fetus.

Why are tocolytics (drugs to stop labor) generally contraindicated in major APH?

They should not be used to delay delivery in a woman with a major APH, hemodynamic instability, or evidence of fetal compromise (strictly contraindicated in abruption).