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Repro HK > bleeding in late pregnancy > Flashcards

bleeding in late pregnancy Flashcards

1
Q

what is antepartum haemorrhage

A

bleeding in pregnancy >24 weeks

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2
Q

causes of antepartum haemorrhage

A 
placenta praevia
placental abruption 
local causes (cervical cancer etc)
vasa previa 
uterine rupture 
unexplained
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3
Q

minor haemorrhage volume

A

<50mls

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4
Q

major haemorrhage volume

A

50-1000mls (no shock)

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5
Q

massive haemorrhage

A

50-1000ml with shock
OR
blood loss >1000mls

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6
Q

what is placental abruption

A

separation of a normally implanted placenta

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7
Q

what is placenta paevia

A

placenta lies low in uterus

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8
Q

pathology of placental abruption

A

vasospasm followed by arteriole rupture into the decidua
blood in amniotic sac/myometrium
causes tonic contraction and interrupts placental circulation

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9
Q

where is lower segment of uterus

A

below utero-vesical peritoneal pounch

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10
Q

difference between major praevia and minor/partial praevia

A

major - lies over cervical os

minor - doesn’t cover cervical os

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11
Q

constant painful bleeding
tender uterus
normal lie/presentation
foetal heart absent/distressed

A

placental abruption

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12
Q

painless bleeding
no pain/tender uterus
lie and presentation may be abnormal
normal foetal heart

A

placental praevia

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13
Q

backache, tender uterus, distressed foetal heart

A

posterior placental abruption

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14
Q

management of placental abruption

A

resuscitation
fluids?
catheter
urgen CS

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15
Q

complications of placental abruption to mother

A 
hypovalaemic shock 
anaemia 
PPH
renal failure (tubular necrosis)
coagulopathy
infection thromboembolism
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16
Q

foetal complications of placental abruption

A 
foetal death 
hypoxia 
prematurity 
small for gestational age 
foetal growth restriction
17
Q

risk factors for placental abruption

A 
pre-eclampsia
trauma 
smoking/cocaine/amphetamine 
thrombophilia/diabetes/renal
multiple pregnancy
previous
18
Q

risk factors for placental praevia

A 
previous c section/placental praevia
Asian 
smoker
prev TOP
advanced maternal age 
assisted conception 
deficient endometrium
19
Q

what must not be performed until placental praevia has been excluded

A

vaginal exam

20
Q

how is placental praevia diagnosed

A

USS

21
Q

what medications can be given before delivery in placental praevia

A

steroids 24-34+6 weeks

magnesium sulphate 24-32 weeks

22
Q

when should C section be considered in placental praevia

A

placenta <2cm from os

mispresentation

23
Q

what is placenta accrete

A

placenta is abnormally adherent to uterine wall

24
Q

risk factor for placenta accrete

A

multiple c sections

25
Q

risk factors for uterine rupture

A

previous c section/uterine surgery
multiparous
use of prostaglandins
obstructed labour

26
Q

symptoms of uterine rupture

A

severe abdo pain
shoulder tip pain
collapse
PV bleed

27
Q

what is vasa praevia

A

unprotected foetal vessels transverse the foetal membranes over the cervical os

28
Q

risk factors for vasa praevia

A

placental anomalies
history of low lying placenta
multiple pregnancy
IVF

29
Q

what is post-partum haemorrhage

A

blood loss equal to or exceeding 500ml after birth of baby

30
Q

primary post partum haemorrhage

A

within 24 hours of delivery

31
Q

secondary pph

A

more that 24 hours after delivery

32
Q

minor PPH volume

A

500-1000ml

no shock

33
Q

major PPH volume

A

> 100mls

signs of CV collapse/ongoing bleeding

34
Q

causes of PPH

A 
4Ts:
tone (most likely)
trauma 
tissue 
thrombin (least likely)
35
Q

intrapartum risk factors of PPH

A 
prolonged labour 
operative vaginal delivery 
C section 
retained placenta 
active management in 3rd stage (syntocinon)
36
Q

management for minor PPH

A 
IV warmed crystalloid infusion 
uterine massage - bimanual compression 
expel clots 
syntocinon
Foley's catheter

Repro HK (37 decks)

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