Management of Undiagnosed APH

Management of Undiagnosed APH

Any bleeding from the genital tract during late pregnancy is dealt with as been due to placental separation until the actual diagnosis is made. Either in the District or Hospital the first Aid management is the same. Hospitalization in imperative either the bleeding is slight or severe because she stands the chance of further bleeding. In all cases:

1.           No vaginal examination is made

2.           Save all soiled linens & pads for Dr’s inspection.

3.           Enquire the cause of bleeding: Fall, coitus, continuous or intermittent.

4.           Abdominal examination is done gently – noting pain, tenderness, uterine contraction and consistency, mal-presentation, high head and fetal heart rate or movement.

5.           Record is made of the name, age, parity, week of gestation, blood loss, BIP, Pulse, urine passed, FH and drugs administered.

6.           Ultrasound scanning to locate the placental site.

7.           No enema is given.

Treatment by Midwife in the District

Put the woman to bed, on her side, reassure the woman, monitor vital signs, send for medical aid immediately, make arrangement to transfer to hospital, give pethidine 100mg or morphine 15mg or omnopon 20gm i.m., transfer in a comfortable transport and a midwife and relations must accompany the woman, to give detail of management.

Treatment in the Hospital

In addition to the First Aid treatment

1.           Blood is taken for – Group and cross matching, Hb estimation, Rhesus factor, clotting time, plasma fibrinogen level and serological test for syphilis (if not already done).

2.           Intravenous administration of blood, glucose, Ringers lactate solution, Oxytocin and fibrinogen

3.           Analgesics or sedation e.g. Pethidine 100mg i.m.

4.           Urinalysis Administer oxygen, to increase oxygen concentration to the fetus.

5.           Vital signs, fetal condition using soniaid, Pulse 5-15mins, FH 10-20min or continuous monitoring B/P 15mins.

6.           Fluid chart record.

7.           Consent for operation.

8.           Reassure the woman and her spouse.

Mild case

Aim is to prolong pregnancy

1.           Give the first Aid Treatment

2.           Shave the vulva.

3.           No enema on admission

4.           Speculum examination after 48hrs bleeding has stopped to rule out cervical causes and confirm diagnosis.

5.           A papanicolaou smear may be taken

6.           She is allowed out of bed after five days of no bleeding.

7.           Discharge after a week of no other obstetrical complications to report if bleeding occurs or in labour.

8.           Monitor fetal wellbeing

9.           Give high protein diet

10.      Maintain hygiene.

Severe case

Aim is to resuscitate and deliver the baby as soon as possible.

1.           Immediate resuscitation is imperative.

2.           No time must be wasted on obtaining blood.

3.           Admit in the special care unit, procedure for slight bleeding is carried out.

4.           Check vital signs, fibrinogen and clotting time.

5.           Sedation for apprehension. Analgics  for pain

6.           I.V. Infusion of Dextrose 5%, Ringers lactate while blood is being cross matched.

7.           Transfuse with fresh blood O-ve.

8.           Monitor Fetal Heart rate 10-15mins on cardiograph

9.           Measure abdominal girth for concealed bleeding.

10.      Further management depends on patient’s condition.