13: Antepartum haemorrhage in Visual Studio .NET Paint PDF417 in Visual Studio .NET 13: Antepartum haemorrhage

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13: Antepartum haemorrhage using visual studio .net toassign quick response code in web,windows application Radio-frequency identification 70 80% of cases, qr-codes for .NET although the amount of revealed bleeding correlates poorly with the degree of abruption. In about 50% of cases vaginal bleeding occurs after the 36th week of gestation, and as labour is a precipitating factor nearly 50% of patients with placental abruption are in established labour.

Abdominal pain probably indicates extravasation of blood into the myometrium, and in some cases pain can be sudden, sharp and severe. Patients may present with symptoms of shock, including nausea, thirst, anxiety and restlessness. At times pain due to placental abruption can be difficult to differentiate from uterine contractions, which in placental abruption are frequent, with a rate of over 5 in 10 min.

In addition to the above symptoms, the patient may complain of absent or reduced fetal movements. Examination, in severe cases, may demonstrate features of hypovolaemic shock with marked tachycardia. Pre-existing hypertension may mask true hypovolaemia, therefore blood pressure reading in itself is not a reliable sign.

Abdominal palpation may reveal a woody-hard, tender uterus, with highfrequency, low-amplitude uterine contractions. There may be difficulty in palpating the fetus and locating the fetal heart in such cases. Depending upon the degree of placental separation, the fetal heart rate may be normal, show signs of distress, or be absent where the fetus is dead.

The cardiotocogram can show recurrent variable or late decelerations, reduced variability, a sinusoidal pattern, or even bradycardia. Stillbirths have been reported where there is greater than 50% placental separation [32]. Vaginal examination is likely to reveal blood and the presence of blood clots; in cases complicated with coagulopathy (35 38%), there may be dark-coloured blood with an absence of clotting.

With ruptured membranes, blood-stained liquor can be seen and, more often, labour tends to proceed rapidly.. varying from hyp erechoic to isoechoic when compared to the placenta. As the clot resolves, appearances become hypoechoic within a week and sonolucent within 2 weeks. Another study has shown ultrasound sensitivity of 80% and specificity of 92% for the diagnosis of abruption [44].

The appearances include pre-placental collection under the chorionic plate, jelly-like movement of the chorionic plate with fetal activity, retroplacental collection, marginal haematoma, subchorionic haematoma, increased heterogenous placental thickness of more than 5 cm in perpendicular plane, and intra-amniotic haematoma.. Management options As the clinical presentation is variable, management options need to be individualized and are guided by the severity of abruption, gestational age, and the maternal and fetal condition. Whilst aggressive management is needed for more severe cases, a conservative approach should be adopted for milder forms. After the general management described earlier in this chapter, specific measures to be considered are as described below.

. Expectant management In mild abruptio n presenting between 24 and 34 weeks gestation, and where the maternal fetal condition is stable, conservative management should be the option of choice. Preterm delivery is a major cause for perinatal death, and if possible all attempts should be made to prolong the gestation at delivery. These patients need close monitoring for signs of worsening abruption and deterioration in fetal wellbeing.

Steroids should be administered for fetal lung maturity and serial ultrasound scans performed to assess fetal growth, and in cases with retroplacental clot, the size of the haematoma. For expectant management, initial hospitalization and assessment of the maternal and fetal condition is reasonable; further outpatient management has a role provided the maternal fetal condition remains stable. Timing of delivery depends upon vaginal bleeding, fetal condition and the gestational age.

With recurrent bleeding episodes and a satisfactory fetal assessment, induction at 37 38 weeks gestation is recommended. Delivery should be organized at centres with appropriate neonatal facilities and the parents should be counselled regarding the potential treatments and outcomes for the neonate..

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