Bleeding in pregnancy Flashcards
When can bleeding in pregnancy occur?
Early Pregnancy
Late Pregnancy
Post Partum
What are three causes of early pregnancy bleeding?
- Miscarriage
- Ectopic
- Molar Pregnancy
What are the investigations for miscarriage?
Speculum
Pregnancy test
BHCG
What are some types of miscarriage (five) and what do they mean?
- Complete - all the tissue is out.
- Incomplete - Tissue still inside so not complete evacuated.
- Missed/Silent - Fetus is dead but still inside
- Threatened - Bleeding but still alive and closed OS. Can progress to inevitable.
- Inevitable - bleeding and open OS
What are the three management options for miscarriage?
Conservative
Medical - Mifeprostone, misoprostol, Anti D
Surgical - Mothers choice or if excessive bleeding
What are the two causes for late pregnancy bleeding?
Placenta previa
Placental abruption
What are the symptoms of placenta previa?
None
Fresh blood
What are the symptoms of placenta abruption?
Old/new blood
Abdo pain
Hard, woody uterus
Fetal distress
What are some risk factors for placenta previa and placental abruption?
Previous
Smokin
What are some risk factors for placenta previa?
Endometrial dysfunction
Assisted contraception
What are some risk factors for placenta abruption?
Pre eclampsia
Drugs eg cocaine
Multiparity
Trauma
What are the types of post partum haemorrhage?
Primary - Over 500ml in first 24 hours
Secondary - 24 hours - 6 weeks
What are some risk factors for PPH?
Pregnancy related:
- >40
- Pre eclampsia
- Multiparity
- GDM
- Placenta pravia
- Obesity
Birth related:
- Prolonged labour
- Induced labour
- Macrosomia
- Emergecy C-Section
What are the 4 Ts for causes of PPH?
Trauma - C-section, episitomy
Thrombin - New old old coagulation disorders
Tissue - Placenta remaining in uterus
Tone - Previous, macrosomia, placenta precvia
What is the treatment for PPH?
Treat underlying cause
What is the last resort treatment for PPH?
Laparotomy:
Hysterectomy
Internal iliac ligation
Aortic Compression
Tampanade (baloon)
