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9 - Obstetric haemorrhage

Published online by Cambridge University Press:  21 August 2009

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
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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.

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Publisher: Cambridge University Press
Print publication year: 2008

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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
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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.
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  • 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
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  • 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
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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
×