Case

Mrs K, a 25 year old primigravida is admitted to the

Maternity Hospital with complaints of bleeding per vagina at 28 weeks of gestation. She was initially booked at 10 weeks of gestation and had regular checkups. She gives a history of having had painless bleeding at 16 weeks of gestation for which she was hsopitalised and managed conservatively. Her fetal movements are good.

Causes of antepartum haemorrhage

Placenta previa
Abruptio placenta (revealed or concealed) Vasa Previa

Local causes: Carcinoma of cervix

Cervical polyp Cervical erosion (ectropian)

Further questions to be asked

Did the placenta reported as low lying at 16 weeks?
Nature of bleeding, amount, colour, haemodynamic

status? Poscoital bleeding? Pain during bleeding? Premature contractions? Fetal movements?

Investigations
FBC
Urine analysis Abdominal ultrasonogram

Case continued
Ms K has painless vaginal bleeding at 28 weeks

gestation. A rapid ultrasonography confirms major placenta previa. The fetal biometry corresponds to dates. The foetus is in longitudinal lie and breech presentation. She appears pale. Pulse rate is 112/min. Blood pressure is 104/65 mmHg. Uterus is soft and the fetal heart rate is 162/min, longitudinal lie, breech presentation. She appears anxious and vaginal bleeding has soaked her sanitary pad.

Initial management
Airway
Breathing (10L/min) 2 L crystalloid fluids followed by 1.5 litres crystalloids Monitor pulse rate and systolic blood pressure Input/outpout chart is documented Packed cell transfusion if she is anemic Fetal assessment and well-being Counselling

Case continued
Mrs K has an ultrasound examination that shows the

placenta is anteriorly located covering the internal os. It is reported as major placenta previa. The fetus corresponds to 28 weeks and is in breech presentation. She is adequately resuscitated and the vaginal bleeding ceases.

Further management