What is APH and PPH

Antepartum haemorrhage (APH) is usually defined as bleeding from the birth canal after the 24th week of pregnancy. It can occur at any time until the second stage of labour is complete; bleeding following the birth of the baby is postpartum haemorrhage.

What is meant by PPH?

Postpartum hemorrhage (PPH) is commonly defined as blood loss exceeding 500 milliliters (mL) following vaginal birth and 1000 mL following cesarean.

What is PPH and causes?

Postpartum hemorrhage is heavy bleeding after the birth of your baby. Losing lots of blood quickly can cause a severe drop in your blood pressure. It may lead to shock and death if not treated. The most common cause of postpartum hemorrhage is when the uterus does not contract enough after delivery.

What causes APH in pregnancy?

Antepartum haemorrhage (APH) is defined as bleeding from or in to the genital tract, occurring from 24+0 weeks of pregnancy and prior to the birth of the baby. The most important causes of APH are placenta praevia and placental abruption, although these are not the most common.

What is APH and symptoms?

Symptoms of antepartum haemorrhage (APH) consist of vaginal bleeding in late pregnancy and before delivery. Along with vaginal bleeding other symptoms may be- (a) In APH due to placenta previa, vaginal bleeding is painless, or bleeding occurs after sexual intercourse.

How do you use Carboprost?

An initial dose of 1 mL of HEMABATE Sterile Solution (containing the equivalent of 250 micrograms of carboprost) is to be administered deep in the muscle with a tuberculin syringe. Subsequent doses of 250 micrograms should be administered at 1½ to 3½ hour intervals depending on uterine response.

What are the 4 T's of PPH?

As a way of remembering the causes of PPH, several sources have suggested using the “4 T’ s” as a mnemonic: tone, tissue, trauma, and thrombosis.

How do you treat APH?

In general, the patient’s usual chronic medications should be continued. In the patient who has APH due to placenta previa, magnesium sulfate may be used as a tocolytic to allow the administration of betamethasone to mature the fetal lung and to allow the obstetrician to better time delivery.

What are types of APH?

• Type I: the placenta is located in the lower part of the uterus but does not come close to the cervix. …
• Type II (or marginal) – the placenta touches but does not cover the cervix.
• Type III (or partial) – the placenta partially covers the cervix.

What is Circumvallate placenta in pregnancy?

Circumvallate placenta is a rare condition that occurs when the amnion and chorion fetal membranes of the placenta fold backward around the edges of the placenta. Sometimes, a doctor may discover a circumvallate placenta using an ultrasound. In other cases, they may not diagnose the condition until delivery.

Article first time published on

What are risk factors for PPH?

Results: Major independent risk factors for PPH included primiparity, prior Caesarean section, placenta previa or low-lying placenta, marginal umbilical cord insertion in the placenta, transverse lie, labour induction and augmentation, uterine or cervical trauma at delivery, gestational age < 32 weeks, and birth weight …

What causes hemorrhage during C section?

Excessive haemorrhage associated with caesarean section, commonly defined as blood loss in excess of 1000 ml, is frequently underestimated, but is documented as occurring in more than 5-10% of caesarean sections. Common causes are uterine atony, abnormal placentation, uterine trauma and sepsis.

What are the complications of PPH?

Complications include sterility, uterine perforation, uterine synechiae (Asherman syndrome), urinary tract injury and genitourinary fistula, bowel injury and genitointestinal fistula, vascular injury, pelvic hematoma, and sepsis.

How can you prevent APH?

Use of aspirin before 16 weeks of pregnancy to prevent pre-eclampsia also appears effective at preventing antepartum bleeding. In regard to treatment, it should be considered a medical emergency (regardless of whether there is pain), as if it is left untreated it can lead to death of the mother or baby.

What is primary and secondary PPH?

Primary postpartum hemorrhage is bleeding that occurs in the first 24 hours after delivery, while secondary postpartum hemorrhage is characterized as bleeding that occurs 24 hours to 12 weeks postpartum.

Who retained placenta?

A retained placenta is when the placenta is not delivered within 30 minutes of the baby’s birth. It is a serious problem since it can lead to severe infection or life-threatening blood loss. Retained placenta is not a common condition, but because it’s serious, it will need to be managed by a medical team.

What is uterine Subinvolution?

Subinvolution is a medical condition in which after childbirth, the uterus does not return to its normal size.

Which medical condition is a contraindication to carboprost?

Contraindication. Contraindicated in severe cardiovascular, renal, and hepatic disease. It is also contraindicated in acute Pelvic Inflammatory Disease. Hypersensitivity to carboprost or any of its components is also a contraindication Exert caution in asthmatic patients as carboprost may cause bronchospasm.

Why is carboprost used?

Carboprost is given by injection to cause abortion. It is an oxytocic, which means it acts by causing the uterus to contract the way it does during labor and also helps the cervix to dilate. Carboprost may also be used for other purposes as determined by your doctor.

What is Syntometrine used for?

Syntometrine is used: to help the delivery of the placenta. to prevent or control bleeding after delivery of your baby.

Can APH cause PPH?

The commonest cause of PPH was uterine atony followed by coagulation failure. Crane et al.16 reported the incidence of PPH in APH to be 19 %. In this study 75% of patients required blood transfusion. Brenner et al.

What is antepartum period?

Antepartum means “before childbirth.” Antepartum depression happens only during pregnancy. It’s also sometimes called maternal depression, prenatal depression, and perinatal depression.

What is chorionic plate?

The chorionic plate is a layer of vascularized chorio- allantois (trophoblast and mesoderm) that comprises. the fetal side of the placental disc. As such, its inner. surface borders, or provides a roof for, the blood-filled.

What is Vasa Previa?

Vasa previa occurs when unprotected fetal blood vessels run through the amniotic membranes and traverse the cervix. Complications include fetal hemorrhage, exsanguination, or death. Diagnosis by ultrasound.

What is a Circumvallate?

Circumvallate placenta is a placental morphological abnormality, a subtype of placenta extrachorialis in which the fetal membranes (chorion and amnion) “double back” on the fetal side around the edge of the placenta. After delivery, a circumvallate placenta has a thick ring of membranes on its fetal surface.

How much blood loss is normal during delivery?

It’s normal to lose some blood after giving birth. Women usually lose about half a quart (500 milliliters) during vaginal birth or about 1 quart (1,000 milliliters) after a cesarean birth (also called c-section).

How long do you bleed after C section?

How long do you bleed for after a c-section? You will have some vaginal bleeding (called lochia) for 2–6 weeks after the birth. Bleeding sometimes lasts longer than this, but it should have stopped by 12 weeks.

What is more painful C section or natural birth?

Recovery times following C-sections are also typically longer than those following natural birth. Ultimately, a natural birth may be more painful than a cesarean section. However, the pain after your cesarean section combined with the heightened risks to you and your baby may outweigh the initial pain of childbirth.

What are the 3 main causes of postpartum hemorrhage?

• Placental abruption. The early detachment of the placenta from the uterus.
• Placenta previa. The placenta covers or is near the cervical opening.
• Overdistended uterus. …
• Multiple pregnancy. …
• Gestational hypertension or preeclampsia. …
• Having many previous births.
• Prolonged labor.
• Infection.

How many C-sections can a woman have?

“So, every patient is different and every case is unique. However, from the current medical evidence, most medical authorities do state that if multiple C-sections are planned, the expert recommendation is to adhere to the maximum number of three.”

What is primary PPH?

Primary postpartum haemorrhage (PPH) is loss of blood estimated to be >500 ml, from the genital tract, within 24 hours of delivery (the most common obstetric haemorrhage): Minor PPH is estimated blood loss of up to 1000 mls. Major PPH is any estimated blood loss over 1000 mls.