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O&G: Obstetrics > Antepartum Haemorrhage > Flashcards

Antepartum Haemorrhage Flashcards

1
Q

What is this describing?

Bleeding from the genital tract after 24+0 weeks gestation.

A

Antepartum haemorrhage

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2
Q

What does antepartum haemorrhage increase your risk of?

A

Postpartum haemorrhage

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3
Q

What examination should be avoided in antepartum haemorrhage?

A

PV examination (speculum is okay)

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4
Q

What is the emergency management of severe antepartum haemorrhage?

A
  1. Admit
  2. IV access, bloods (including clotting), raise legs
  3. High flow oxygen
  4. ABO Rh compatible or O- blood if shocked
  5. Catheterise bladder
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5
Q

What are the risk factors for placenta praevia?

A

Twins, high parity, increasing maternal age, history of C-section.

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6
Q

What are the clinical features of placenta praevia?

A
  1. Intermittent, painless bleed.

2. Breech presentation and transverse lie are common.

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7
Q

What are the two classifications of placenta praevia?

A
  1. Marginal (types I-II) - placenta in lower segment, not over os.
  2. Major (types III-IV) - placenta in lower segment, covering os.
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8
Q

How is suspected placenta praevia investigated?

A
  1. TVUSS
  2. Consider MRI to diagnose placenta accreta
  3. If PV bleeding - CTG, FBC, clotting, cross-match
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9
Q

What is this describing?

Placenta implanted in lower segment of the uterus.

A

Placenta praevia

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10
Q

What is the management of placenta praevia if incidental low lying on 16-20 week scan?

A
  1. Rescan at 32 weeks, if still present scan every 2 weeks.

2. Plan C-section by 37/40 if major, if minor aim for normal delivery.

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11
Q

What is the management of placenta praevia if there is bleeding?

A
  1. Admit, resuscitate (transfusion)
  2. Anti-D to RhD -ve
  3. IV access
  4. Steroids if GA <34/40
  5. Deliver by 37/40
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12
Q

What are the risks associated with placenta praevia?

A
  1. Postpartum haemorrhage - hysterectomy may be required
  2. IUGR, prematurity, and recurrence
  3. Requiring blood transfusion
  4. Placenta accreta or placenta percreta
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13
Q

What is placenta accreta?

A

Placenta implants onto previous C-section scar, may prevent placental separation.

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14
Q

What is placenta percreta?

A

Placenta penetrates through uterine wall into surrounding structures.

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15
Q

What is this describing?

Part or all of placenta separates before delivery of the foetus.

A

Placental abruption

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16
Q

What are the risk factors for placental abruption?

A

Pre-eclampsia, smoking, IUGR, multiple pregnancy, autoimmune disease, cocaine, previous history of abruption, HTN.

17
Q

What is this a presentation of?

Pregnant woman, painful dark PV bleeding, tachycardia, uterus is ‘woody’ hard.

A

Placental abruption

18
Q

How is placental abruption diagnosed?

A
  1. Clinical diagnosis - USS can exclude praevia, abdominal exam, speculum
  2. CTG to assess foetal distress
  3. FBC, U&Es, clotting, cross-match
  4. Catheterisation
19
Q

What is the initial management for placental abruption?

A
  1. Admit, resuscitate (blood transfusion)
  2. Anti-D to RhD -ve
  3. IV access
  4. Steroids if GA <34/40
  5. Opioid analgesia
20
Q

What is the ultimate management for placental abruption if there is foetal distress?

A

Emergency delivery by C-section

21
Q

What is the ultimate management for placental abruption if there is no foetal distress and the GA is >37/40?

A

Induction of labour with amniotomy

22
Q

What is the ultimate management for placental abruption if there is no foetal distress and it is preterm?

A

Steroids if <34/40, if symptoms settle then discharge and monitor with serial USS.

23
Q

What is this describing?

Foetal blood vessels run in the membranes, usually due to cord being attached to membranes rather than placenta.

A

Ruptured vasa praevia

24
Q

What is this a presentation of?

Painless, moderate PV bleeding at the rupture of the membranes with major foetal distress (bradycardia).

A

Ruptured vasa praevia

O&G: Obstetrics (36 decks)

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