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Comment RSSA Case Review : Antepartum Hemorrhage
November 6, 2009 | 1:50 pm | Gynae/Obs, Medical Cases | 8 CommentsCASE REVIEW OF ANTEPARTUM HAEMORRHAGE
A 19 years female primi at 29 weeks period of gestation complained of heavy pv bleeding for 3 hrs,clots+,no lower abdominal pain. she had perceived good fetal movement. she had anc visit in health post, took Iron tablets regularly and had taken 2 doses of Tetanus Toxoid inj.
She had normal menstrual cycle, no use of any contraceptive measures.her past,family and personal history are not significant.
On Examination:
General Condition-fair Pallor Icterus Edema-nil vitals- stable
per abdomen: uterus 24 weeks size , mild contraction +
per vaginum: no active bleeding, clots removed from vagina,os closed,cervix- ballooned up in upper part
Diagnosis- primi at 29 weeks Period Of Gestation with Antepartum Hemorrhage
Investigations:
Hb%- low
USG report- 26-27 weeks single live intrauterine pregnancy,breech,posterior placenta,oligohydraminos,fetal hydracephalus and deformed fetus
Management
Admission
Induction of labour with misoprostol 200micro gm per vaginum
Blood transfusion-
IV antibiotics
Monitoring of vitals and input output
After few hours, patient was shifted to ot for lscs as placenta was felt on p\v examination, diagnosis being central placenta previa
She was totaly transfused 4 units of whole blood to restore her haemoglobin
Image: Grossly malformed fetus
- picture showing congenitally malformed fetus
hydrocephalus, gastroschisis,deformed limbs attached to the neck of fetus
Case Collected and Worked Out By: Dr. Anjali Subedi
Popularity: 38%
Last updated: June 29, 2010
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Hello, from Toronto, Canada
Just a quick hello from as I’m new to the board. I’ve seen some interesting posts so far.
To be honest I’m new to forums and computers in general
Mike
Good Job to save the mothers life. As this was her primi gravida she have no chance of having children. What if we had done USG on 15-16 weeks for anamaly scan ? Will it be justified as regular inestigation?
Good Job to save the mothers life.What if we had done USG on 15-16 weeks for anamaly scan ? Will it be justified as regular investigation?
Thank you Mr Tilak ,
Antepartum hemorrhage – here Placenta praevia was the cause of bleeding but the fetal deformity was present. Survival of the baby was however not possible, but mother will be able to conceive again. The only thing is she has to give importance to her ANC checkups.
Yes,Dating scan and anomaly scan can be used as regular investigations as they can lead to timely diagnoses and prevent future complications.
Is there a role of I.V. therapeutic or prophylactic antibiotics in any case of antepartum haemorrhage? If so, are there any guidelines with regard to this?
Medical student,
Thanks for the interest on the case and for your question.
Points regarding Antibiotic use in Placenta previa :-
Risk factors for placenta praevia include previous uterine infection and/or surgery. This opportunity is taken toreiterate previous recommendations:
• screening for infection before termination of pregnancy and antibiotic prophylaxis to minimise the risk of post abortion infective morbidity;45
• prophylactic antibiotics should be used for emergency caesarean section and considered for elective procedures and manual removal of the placenta ( that may be required in few cases)
Further reading at
http://www.sk-hospital.com/~ob/cpg/Placenta_%20Previa.pdf
http://www.asjog.org/journal/v3issue1/59%20Guideline%20Placenta%20praevia%20is%20a%20condition%20in%20which.pdf
Hope this answers your question
Thanks for the references. It really helped me.
we also used to get number of cases here in AMDA PHCP FOR BR. Especially primigravidae at 32to 34 wks of pog and some cases during the time of labour are diagnosed as Antepartum Haemorrhage.