1. Pregnancy Complication -- Antepartum Haemorrhage Case Senario

2. A 28 years pregnant lady admitted to our antenatal ward for 1 day history of vaginal bleeding A 28 years pregnant lady admitted to our antenatal ward for 1 day history of vaginal bleeding

3. What history will you ask? What history will you ask?

4. What will you look for in the Physical Examinations? What will you look for in the Physical Examinations?

5. Scenario 1 28/F, Para O, gestation: 30 week 28/F, Para O, gestation: 30 week AN uncomplicated AN uncomplicated C/O: small amount of unprovoked painless vaginal bleeding, no abdominal pain or uterine contraction, no ROM, FM +ve C/O: small amount of unprovoked painless vaginal bleeding, no abdominal pain or uterine contraction, no ROM, FM +ve P/E: P/E: BP/P normal, no pallor BP/P normal, no pallor abdomen: FH 30cm, cephalic px, soft non tender, no contraction felt abdomen: FH 30cm, cephalic px, soft non tender, no contraction felt Speculum: small amount of old blood seen, no active bleeding from os, os close tubular, no local lesion Speculum: small amount of old blood seen, no active bleeding from os, os close tubular, no local lesion

6. What are the possible differential diagnosis? What are the possible differential diagnosis? What investigations will you ordered and why? What investigations will you ordered and why?

7. USG: single viable fetus, cephalic px, normal parameters and liqour, placenta: anterior not low, no retroplacental clot USG: single viable fetus, cephalic px, normal parameters and liqour, placenta: anterior not low, no retroplacental clot

8. What is your diagnosis? What is your diagnosis? How will you manage this patient? How will you manage this patient?

9. Scenario 2 28/F, Para O, gestation: 30 week 28/F, Para O, gestation: 30 week AN uncomplicated AN uncomplicated C/O: small amount of unprovoked painless vaginal bleeding, no abdominal pain or uterine contraction, no ROM, FM +ve C/O: small amount of unprovoked painless vaginal bleeding, no abdominal pain or uterine contraction, no ROM, FM +ve P/E: P/E: BP/P normal, no pallor BP/P normal, no pallor abdomen: FH 30cm, cephalic px, soft non tender, no contraction felt abdomen: FH 30cm, cephalic px, soft non tender, no contraction felt Speculum: small amount of old blood seen, no active bleeding from os, os close tubular, no local lesion Speculum: small amount of old blood seen, no active bleeding from os, os close tubular, no local lesion

10. USG: single viable fetus, cephalic px, normal parameters and liqour, placenta: anterior covering os, no retroplacental clot USG: single viable fetus, cephalic px, normal parameters and liqour, placenta: anterior covering os, no retroplacental clot

11. What is your diagnosis? What is your diagnosis? How will you manage this patient? How will you manage this patient?

12. Rescan at 34 weeks in clinic: placenta anterior covering os Rescan at 34 weeks in clinic: placenta anterior covering os How will you manage her? How will you manage her?

13. What will you counsel the patient and prepare for the operation? What will you counsel the patient and prepare for the operation?

14. Scenario 3 28/F, Para O, gestation: 30 week 28/F, Para O, gestation: 30 week AN uncomplicated AN uncomplicated C/O: moderate amount of fresh vaginal bleeding, with abdominal pain & uterine contraction, no ROM, FM +ve C/O: moderate amount of fresh vaginal bleeding, with abdominal pain & uterine contraction, no ROM, FM +ve P/E: P/E: BP 110/60, pulse 110 BP 110/60, pulse 110 abdomen: FH 30cm, breech px, hard and tender uterus abdomen: FH 30cm, breech px, hard and tender uterus Speculum: 200ml blood clot seen, active oozing from os, os close tubular, no local lesion Speculum: 200ml blood clot seen, active oozing from os, os close tubular, no local lesion

15. What is your clinical diagnosis? What is your clinical diagnosis?

16. What is your further investigations and management plan? What is your further investigations and management plan?