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235 Pre-Eclampsia > Bleeding in Pregnancy > Flashcards

Bleeding in Pregnancy Flashcards

1
Q

What are the top three causes of maternal mortality?

A
  1. Genital Tract Sepsis
  2. Haemorrhage
  3. Pre-eclampsia/eclampsia
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2
Q

Name two causes of early pregnancy bleeding

A

Miscarriage

Ectopic pregnancy

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3
Q

What are the different types of miscarriage?

A

Missed miscarriage - Foetus not developed/died in utero - Os closed, asymptomatic

Threatened miscarriage - Foetus alive- Os closed, bleeding

Inevitable miscarriage - Foetus may be alive - Os open, bleeding heavier

Complete miscarriage - all pregnancy tissue passed - Os closed, bleeding settling

Septic miscarriage - infeted uterine contents, offensive loss, tender uterus

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4
Q

What regimens are used for evacuation in miscarriage?

A

Mifepristone + Prostaglandin (Misoprostol)

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5
Q

When is Anti-D prophylaxis indicated?

A

All rhesus -ve mothers after all surgical and medical intervention

Within 72 hours of bleed

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6
Q

What tests are done to decide if additional Anti-D is needed?

A

Kleihauer Test after 20 weeks

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7
Q

Where are ectopics most likely to present? and what are the presenting symptoms?

A

Ampulla 70%

Pain, bleeding, faint/collapse

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8
Q

What investigations are done for suspected ectopic pregnancies?

A

Cervical examination

US - TVS (hCG >1500) vs. TAS (hCG>3000)

Serial βhCG → suboptimal rise (<66%)

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9
Q

What are the medical and surgical management plans for ectopics?

A

Methotrexate

Laparoscopy/Laparotomy

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10
Q

What is a molar pregnancy? and how does it present?

A

A non-viable fertilized egg implants in the uterus and will fail to come to term

Presentation: Large for date, ↑↑↑βhCG, hyperthyroid, hyperemesis, US appearance

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11
Q

If untreated, how can a molar pregnancy advance?

A

<1% can become a choriocarcinoma (cancer)

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12
Q

What is the treatment for a molar pregnancy?

A

Suction evacuation

Methotrexate

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13
Q

At what levels of blood loss do the following antepartum haemorrhages correspond to?

Minor

Major

Massive

A

Minor - <50ml, settled

Major - 50-1000ml, no signs of shock

Massive - >1000ml, +/- signs of shock

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14
Q

What are the signs of antepartum haemorrhage?

A

Pale

Confused

Reduced urine output

Foetal heart abnormalities

Increased HR

Bleeding - Obvious/hidden

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15
Q

What is revealed abruption?

A

Blood tracks between the membranes and escapes through the vagina and cervix

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16
Q

What is concealed abruption?

A

Blood collects behind the placenta, with no evidence of vaginal bleeding

17
Q

What is placenta previa? and how does it present?

A

Leading cause of antepartum haemorrhage

Placenta inserted partially or wholly in the lower uterine segment

Asymptomatic, Painless - bright red blood, US scan

18
Q

What is placental abruption? and how does it present?

A

Placental lining separated from uterus of the mother (after 20 weeks, prior to birth)

Vaginal bleeding, abdominal pain, irritable “woody hard” uterus, uterine tenderness, disproportionate shock, foetal distress

19
Q

What are the risk factors for placenta previa and placental abruption?

A

Both: Previous episode, smoking/drug abuse, assisted conception

Placenta previa: older mother, previous TOP

Placental abruption: pre-eclampsia, blunt force trauma

20
Q

What are the following?

Placenta Accreta

Placenta Increta

Placenta percreta

Vasa Praevia

A

Placenta accreta - firmly adherent placenta

Placenta increta - invades the myometrium

Placenta percreta - perforates through to serosa and beyond

Vasa praevia - placental vessels overlie the cervix (high mortality)

21
Q

How are primary and secondary post-partum haemorrhage defined?

A

Primary PPH - <24 hours post-delivery (uterine atony)

Secondary PPH - >24 hours - 6 weeks post-partum - Endometritis

22
Q

Name some risk factors for PPH in terms of the pregnancy and the delivery

A

Pregnancy: Previous PPH, APH, placenta praevia, twins, nulliparity, pre-eclampsia, obesity, old age

Delivery: Emergency LSCS, repeat elective LSCS, operative vaginal birth, induction of labour, labour lasting >12 hours, foetal birthweight >4kg

23
Q

What are the causes of post-partum haemorrhage? 4Ts

A

Thrombin - Placental abruption, bleeding disorders, pre-eclampsia

Tissue - Retained placenta, placenta accreta, retained products of conception

Tone - Placenta praevia, over distension of the uterus

Trauma - C-section, episiotomy (incision of perineum), macrosomia

24
Q

What is the management of post-partum haemorrhage? 4 T’s

A

Thrombin - check coagulation, replace clotting factors

Tissue - empty uterus if not delivered, remove placenta/products

Tone - Empty bladder

Trauma - repair perineal and cervical tears

Laparotomy

235 Pre-Eclampsia (5 decks)

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