Obsetric haemorrhage Flashcards
1
Q
A woman comes in 30+ weeks pregnant and is also bleeding. What’s your differential?
A
- praevia (low lying placenta 1-4) (no pain)
- abruption (early placental detachment) (constant abdomen pain)
- vasa praevia (PROM + instant bleeding + foetal brady)
- Lower genital tract causes - vaginitis, cervical polyps
2
Q
How would you investigate a case of antepartum haemorrhage?
A
- abdo exam - tender= abruption, non= praevia
- Bloods - FBC, Cross match and G&S, clotting
- TVUSS - diagnose praevia but not rule out abruption
- CTG - foetal heart rate monitoring
- maternal BP
3
Q
How do you manage APH?
A
- ABCD + resus
- foetal and maternal distress - emergency C section
- PPH is expected in APH women
- offer antenatal steroids as expected preterm delivery
4
Q
What are the 4 Ts of PPH?
A
- Tone - uterine atony
- Tissue - retained products (placenta)
- Trauma - laceration/rupture
- Thrombin - coagulopathy
5
Q
What points in a history would make you suspected uterine atony for PPH?
A
- multiparous (weak uterus)
- prolonged labour (tired uterus)
- active management of 3rd stage of labour (oxytocin - might have given too much and tired the uterus out)
6
Q
What is the ladder of escalation in the treatment of PPH?
A
- IM carboprost
- bimanual compression
- RUSH balloon catheter
- artery ligation
- Haemostatic brace suture
- hysterectomy
7
Q
How do you define a PPH?
A
> 500 ml lost after delivery within 24 hours
8
Q
How do you define a secondary PPH? What causes it?
A
> 24 hours - 12 weeks
retained placental products or endometriosis
