Skip to main content Accessibility help

We use cookies to distinguish you from other users and to provide you with a better experience on our websites. Close this message to accept cookies or find out how to manage your cookie settings.

Close cookie message
×
Hostname: page-component-cd9895bd7-lnqnp Total loading time: 0 Render date: 2024-12-26T12:06:16.862Z Has data issue: false hasContentIssue false

9 - Obstetric haemorrhage

Published online by Cambridge University Press:  21 August 2009

Alexander Heazell  and
John Clift
By
Alexander Heazell
Alexander Heazell
Affiliation:
University of Manchester
John Clift
Affiliation:
City Hospital, Birmingham
Alexander Heazell
Affiliation:
Clinical Research Fellow, Maternal and Fetal Health Research Centre, St Mary's Hospital, University of Manchester, Manchester, UK
Get access

Summary

Introduction

Obstetric haemorrhage is classified with respect to the birth of the infant; antepartum haemorrhage (APH) describes any bleeding pv between the beginning of the 24th week of pregnancy and the delivery of the infant and postpartum haemorrhage (PPH) describes excessive blood loss following delivery. Obstetric haemorrhage may result in massive blood loss endangering the life of the mother, and the infant in the case of antepartum haemorrhage. In the Confidential Enquiry into Maternal and Child Health (CEMACH) 2000–2002, there were 17 maternal deaths directly attributed to haemorrhage. The CEMACH recommends that all obstetric units have a protocol for the management of obstetric haemorrhage; all individuals working in delivery units should be familiar with local guidelines.

Antepartum haemorrhage (APH)

Antepartum haemorrhage is defined as any vaginal bleeding after 24 weeks' gestation. It is a major cause of perinatal morbidity and mortality, including an increased risk of premature delivery. To a lesser extent APH increases maternal morbidity as a result of hospitalisation, operative intervention and coagulopathy. Rare causes of APH include cervical inflammation, cervical polyp, cervical cancer and vaginal trauma. Blood lost due to these causes is from maternal origin and is usually not significant. The four major causes of APH are:

  • Placental abruption

  • Placenta praevia

  • Uterine scar dehiscence

  • Vasa praevia

Placental abruption

Definition

Placental abruption describes premature separation of the placenta from the uterine wall; this may be partial or complete separation and can occur at any stage of pregnancy.

Keywords

antepartum haemorrhageclotting disordersgenital tract traumaobstetric haemorrhageuterine atonyuterine inversionvasa praeviaplacental abruption
Type
Chapter
Information
Obstetrics for Anaesthetists , pp. 107 - 119
Publisher: Cambridge University Press
Print publication year: 2008

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Confidential Enquiry into Maternal and Child Health, Why Mothers Die 2000–2002 – The Sixth Report of the Confidential Enquiries into Maternal Deaths in the United Kingdom (London: Royal College of Obstetricians and Gynaecologists Press, 2004).
Hladky, K., Yankowitz, J. and Hansen, W. F., Placental abruption. Obstet. Gynecol. Surv., 57:5 (2002), 299–305.Google Scholar
Nash, P. and Driscoll, P., ABC of major trauma. Trauma in pregnancy. BMJ, 301:6758 (1990), 974–6.Google Scholar
Ananth, C. V., Berkowitz, G. S., Savitz, D. A. and Lapinski, R. H., Placental abruption and adverse perinatal outcomes. JAMA, 282:17 (1999), 1646–51.Google Scholar
Royal College of Obstetricians and Gynaecologists, Use of Anti-D Immunoglobulin for Rh Prophylaxis. Guideline Number 22 (London: Royal College of Obstetricians and Gynaecologists Press, 2002).
Oppenheimer, L. W., Farine, D., Ritchie, J. W.et al., What is a low-lying placenta?Am. J. Obstet. Gynecol., 165:4 Pt 1 (1991), 1036–8.Google Scholar
Rosen, M. G., Dickinson, J. C. and Westhoff, C. L., Vaginal birth after cesarean: a meta-analysis of morbidity and mortality. Obstet. Gynecol., 77:3 (1991), 465–70.Google Scholar
Lee, W., Lee, V. L., Kirk, J. S.et al., Vasa previa: prenatal diagnosis, natural evolution, and clinical outcome. Obstet. Gynecol., 95:4 (2000), 572–6.Google Scholar
Arts, H. and Eyck, J., Antenatal diagnosis of vasa previa by transvaginal color Doppler sonography. Ultrasound Obstet. Gynecol., 3:4 (1993), 276–8.Google Scholar
Royal College of Obstetricians and Gynaecologists, Management of Third- and Fourth-Degree Perineal Tears. Guideline Number 29 (London: Royal College of Obstetricians and Gynaecologists Press, 2007).
Royal College of Obstetricians and Gynaecologists, Placenta Praevia and Placenta Praevia Accreta: Diagnosis and Management. Guideline Number 2 (London: Royal College of Obstetricians and Gynaecologists Press, 2001).
Bleeding in the latter half of pregnancy. In Enkin, M., Keirse, M. J. N. C., Neilson, J. P., et al. A Guide to Effective Care in Pregnancy and Childbirth, 3rd edn (Oxford: Oxford University Press, 2000), pp. 178–184.
Levy, D. M., Anaesthesia for Caesarean section. Continuing Education in Anaesthesia, Critical Care and Pain, 1 (2001), 171–6.Google Scholar
D. C. Mayer and F. J. Spielman, Antepartum and postpartum haemorrhage. In Chestnut, D. H., ed., Obstetric Anaesthesia (St Louis: Mosby, 2001).
Thomas, C. and Madej, T.Obstetric emergencies and the anaesthetist. Continuing Education in Anaesthesia, Critical Care and Pain, 2 (2002), 174–7.Google Scholar

Save book to Kindle

To save this book to your Kindle, first ensure [email protected] is added to your Approved Personal Document E-mail List under your Personal Document Settings on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part of your Kindle email address below. Find out more about saving to your Kindle.

Note you can select to save to either the @free.kindle.com or @kindle.com variations. ‘@free.kindle.com’ emails are free but can only be saved to your device when it is connected to wi-fi. ‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.

Find out more about the Kindle Personal Document Service.

  • Obstetric haemorrhage
    • By Alexander Heazell, Clinical Research Fellow, Maternal and Fetal Health Research Centre, St Mary's Hospital, University of Manchester, Manchester, UK
  • Alexander Heazell, University of Manchester, John Clift
  • Book: Obstetrics for Anaesthetists
  • Online publication: 21 August 2009
  • Chapter DOI: https://doi.org/10.1017/CBO9780511544569.011
Available formats
×

Save book to Dropbox

To save content items to your account, please confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account. Find out more about saving content to Dropbox.

  • Obstetric haemorrhage
    • By Alexander Heazell, Clinical Research Fellow, Maternal and Fetal Health Research Centre, St Mary's Hospital, University of Manchester, Manchester, UK
  • Alexander Heazell, University of Manchester, John Clift
  • Book: Obstetrics for Anaesthetists
  • Online publication: 21 August 2009
  • Chapter DOI: https://doi.org/10.1017/CBO9780511544569.011
Available formats
×

Save book to Google Drive

To save content items to your account, please confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account. Find out more about saving content to Google Drive.

  • Obstetric haemorrhage
    • By Alexander Heazell, Clinical Research Fellow, Maternal and Fetal Health Research Centre, St Mary's Hospital, University of Manchester, Manchester, UK
  • Alexander Heazell, University of Manchester, John Clift
  • Book: Obstetrics for Anaesthetists
  • Online publication: 21 August 2009
  • Chapter DOI: https://doi.org/10.1017/CBO9780511544569.011
Available formats
×