Obstetrics Simplified - Diaa M. EI-Mowafi
Marginal Haemorrhage
Definition
Bleeding from the edge of a normally situated placenta after 28th weeks’ gestation.
Clinical Picture
Similar to that of placenta praevia.
Symptoms
Vaginal bleeding.
Signs
- General examination:
- The general condition proportionates to the amount of bleeding as all the blood loss is revealed
- Abdominal examination:
- No characteristic signs.
- Vaginal examination:
- Done under the same precautions in placenta praevia.
- There is vaginal bleeding and if the cervix is dilated the placenta is not felt.
Investigations
Ultrasound reveals a normally situated placenta in the upper uterine segment with no retroplacental haematoma.
Treatment
At home
As in placenta praevia.
At hospital
Assessment, resuscitation and ultrasound.
- If the patient is not in labour:
- If the bleeding is severe → caesarean section.
- If the bleeding is slight,
- Gestational age is completed 37 weeks or more® termination of pregnancy by induction of labour or C.S.
- If not completed 37 weeks conservative treatment is carried out as placenta praevia till completed 37 weeks.
- If the patient is in labour:
- Delivery is carried out by amniotomy + oxytocin or C.S if indicated.
Ruptured Vasa Praevia
In velamentous insertion of the cord, some of the foetal vessels in the membranes cross the region of the internal os. When the membranes ruptures, the foetal vessels are torn and bleeding occurs which is usually slight. Foetal heart rate abnormalities are detected .
Investigations
The foetal blood can be detected by:
- Apt’s test: 4-6 drops of the antepartum haemorrhage blood is added to 10 ml of water then 2 ml of sodium hydroxide is added. The foetal blood remains red/ pink for at least 2 minutes and turns green/brown after 10-20 minutes due to resistance to alkali in formation of alkaline haematin. If the blood is maternal in origin it turns green/ brown within 10 seconds.
- Spectrophotometer: Foetal haemoglobin shows different ultraviolet absorption than adult haemoglobin.
- Blood film: Foetal RBCs can be detected by a special cytochemical stain and it may be nucleated.
Treatment
Immediate caesarean section.
Differential Diagnosis of Antepartum Haemorrhage
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Placenta Praevia |
Marginal Haemorrhage |
Abruptio Placentae |
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| (I) History: Bleeding |
- Painless, causeless, recurrent. - Usually starts slight in amount. |
- Associated with abdominal pain. - A cause may be detected. - Usually starts severe in amount. |
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(II) Examination: |
- The degree of shock is proportionate to the amount of blood loss. |
- The degree of shock may be out of proportion to amount of blood loss. |
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(2) Abdominal |
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(3) Vaginal (with the precautions) |
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(III) Investigations |
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