HIGH RISK PREGNANCY

The Definition of Ante-partum Hemorrhage:
Bleeding from genital track after the 28^th week of pregnancy and before the birth of the baby and an alternative definition is bleeding from placenta site Ffrom Obstetric Illustrated, Vaginal Bleeding in Pregnancy by Miller / Callander in 1989, page 214. Is bleeding from the vagina during pregnancy from twenty weeks gestational age to term .

Risk factor of abortion
Spoted of bloods or bleeding the young pregnancy with retencion of conception effort that was dead after 8^th week, Conception effort is not on the cavum uteri, Spread of septic or toxic into blood circulation or peritoneum cavum

Risk factor or Possible cause are:

1. Ectopic pregnancy
2. Trauma
3. Molar pregnancy
4. Local cause: cervicitis, cancer of cervics.

Theatment of Ante-partum Hemorrhage are:

Always admit to hospital for assessment and management à
May need resuscitation measures if shocked
Severe bleeding or fetal distress: urgent delivery of baby irrespective of gestational age
Admit to hospital, even if bleeding is only a very small amount. There may be a large amount of concealed bleeding with only a small amount of revealed vaginal bleeding
No vaginal examination should be attempted at least until a placenta praevia is excluded by ultrasound. May initiate torrential bleeding from a placenta praevia
Resuscitation can be inadequate because of under-estimation of blood loss and misleading maternal response. A young woman may maintain a normal blood pressure until sudden and catastrophic de compensation occurs
Take blood for full blood count and clotting studies. Cross match as heavy loss may require transfusion
Gentle palpation of the abdomen to determine gestational age of fetus, presentation and position
Fetal monitoring
Arrange urgent ultrasound
With every episode of bleeding, a Rhesus negative woman should have a Kleihauer test and be given prophylactic anti-D immunoglobulin

Health education
Is very important to keep wellbeing of mom and fetus condition
Family also need to know about the physically and psychological condition of mom who got pregnancy. The nutrition must to supply adequate. It is important to ask the pregnancy to check the pregnancy to antenatal care. Screening the problems is the major factor of care. So the importance of pregnancy is to safe life the mom and the baby.

Pathos physiology of abdominal pain, burnt waist and the effect of ante partum-hemorrhage
Trauma, hypertension, or coagulopathy, contributes to the avulsion of the anchoring placental villi from the expanding lower uterine segment, which in turn, leads to bleeding into the decidua basalis. This can push the placenta away from the uterus and cause further bleeding. Bleeding through the vagina, called overt or external bleeding, occurs 80% of the time, though sometimes the blood will pool behind the placenta, known as concealed or internal placental abruption.Women may present with vaginal bleeding, abdominal or back pain, abnormal or premature contractions, fetal distress or death.

Islamic view of case
Majority Moslem’s though are not agreeing with the abortion more over illegal practice of abortion. The reason is fetus in the women uteri is very sublime. Although it’s very small fetus is the great creative force from God. Islam is forbid to kill practice just by cause of poor phobia. Allah SWT will give us blessing prosperity. Islam ideology about the pregnancy tells us that all of fetus is the God plan, and not spontaneous happening. So Islam sticks out to keep fetus until the baby born although the baby came from unmerited relationship.

Reference:

1. http://hidayatullah.com/index.php?option=com_content&task=view&id=2363&Itemid=60
2. Nation guide study of Maternity and Neonatal Care by Prof. dr. Abdul Bari Saiffudin, Sp.OG., MPH (POGI, Bina Pustaka Sarwono Prawirohardjo fondation, Jakarta, 2002)
3. Emergency medicine: Abruptio Placentae, emedicine.com, April 5, 2005. This text is available under the terms of the GNU Free Documentation License.
4. Bleeding in Pregnancy Standard of Practice for Integrated MCH/RH services: First edition, June 2005
5. Dr Colin Tidy, www.patienplus.co.uk © EMIS and Patient Information Publications (Ante-partum Hemorrhage)