APH History | Western Sydney University

University:
Western Sydney University
Course:
MEDI 2003 | Clinical Sciences 2
Academic year:

2024
Views:

121

Pages:

5
Author:

Mariam A. A.

APH History What pregnancy number is this? How long has the bleeding been going on for? Have you had anything like this before? What colour is the blood and how much is there? Is there any pain associated with the bleeding? Have you had any complications in this pregnancy? Are there any changes to fetal movements? Is there any uterine tightening? Have your waters broken? Do you have a fever? Are there any changes to your heart rate or breathing rate? Is there nausea or vomit? Has any trauma occurred? Was it induced or spontaneous? Have you had any previous abortions or miscarriages? If previously pregnant? Were there any complications in previous pregnancies? What are your Rh status? Past medical history Medications Allergies Past surgeries Family history Cervical cancer screening STI history Physical Examination Findings Vitals and hemodynamic stability Abdominal palpation findings Presentation Lie Size Is there nay discharge or fluid? Can any contractions be felt? Can fetal heart rate be detected? What is the colour of the blood and the amount of blood – how many pads is it soaking? CTG exam AVOID VAGINAL EXAM Initial Management Steps Assess vitals If low oxygen -> give oxygen If low BP -> give IV fluids Insert two cannulas FBE, coagulation factors, uric acid, EUC, beta hCG, Rh status (if unknown), blood group and hold Kleihauer for FMH If need IV fluid -> set up IV line Insert urinary catheter -> send for culture and do protein:Cr ratio Insert continuous CTG monitoring Perform an ultrasound -> look for position of placenta, assess for amniotic fluid levels, fetal lie and presentation, look for features of an accompanying placenta abruption, is fetal heart rate present Consider tranexamic acid to stop the bleed Call theatres -> possible need for a C section Need the following people involved in addition to theatres – obstertican , anaetshetics , paediatrics Provisional Diagnosis APH secondary to placenta abruption