APH Scenario

What are your initial impressions?

According to JRCALC, how many weeks of gestation does the treatment algorithm change in PV bleeding during pregnancy?

If the patient is unsure of their gestation, what assessment can be used to determine if they are roughly 20 weeks or above?

You recall that any PV bleeding after 20 weeks of gestation could be life threatening and requires time critical transport. You gain a quick set of initial observations including:  78HR, 18 RR, 126/82 BP, 98% Sp02, 36.8 Temp, 4.5 BM. Her NEWS score is 0 and the patient seems comfortable and chatty. You should take this as a reassuring sign? 

Maternal haemodynamic changes (such as tachycardia) may not present until what percentage of circulating volume is lost?

All antepartum haemorrhage emergencies will present as PV bleeding as there is no closed space for internal bleeding to conceal itself? 

The patient is also reporting mild but constant abdominal pain at 3/10 NPS, it is causing nausea, so she is asking for some pain relief. In the context of pregnancy, what is the most appropriate medication to give? 

You recall that IV access should not delay on scene time and the patient should be kept nil by mouth, so you start Entonox as it is quick and easy to give. Should you delay transport and administer IV or IM ondansetron to relieve the patient’s nausea? 

You avoid giving any other medications as per JRCALC guidelines but the nausea eases as the pain starts to be controlled. You get the patient comfortable on your ambulance stretcher and look to mobilise to your preferred destination. Where are you going to convey this patient?

What position should you try to transfer the patient whilst on the stretcher?

Just before you leave, you check the patients’ observations and bleeding and now the pad she placed there is now full of blood. Roughly how much blood will a pad soak up so you can better estimate blood loss?

Is TXA indicated in this scenario if the patient is still bleeding?

What could be some of the causes for antepartum haemorrhage?

With patients who have a history of multiple APH episodes, domestic abuse should be considered as a cause due to trauma?

The royal college of obstetricians and gynaecologists guideline for antepartum haemorrhage states that any blood loss of 50ml or more, with no clinical signs of shock, is classed as a…?