Ante partum and Post partum haemorrhage Flashcards Preview

Reproduction > Ante partum and Post partum haemorrhage > Flashcards

Flashcards in Ante partum and Post partum haemorrhage Deck (26):
1

What is a placenta previa?

The placenta is inserted partially or wholly in the lower uterine segment

2

A women who is 30 weeks pregnant presents with bleeding. She describes passing bright red blood on 3 occasions and describes the volume as being the same a heavy period. There was no associated pain.What is the diagnosis?

Placenta Previa

3

A women who is 30 weeks pregnant presents with bleeding. She describes passing bright red blood on 3 occasions and describes the volume as being the same a heavy period. There was no associated pain. What test would you perform?

Ultrasound

4

A women who is 30 weeks pregnant presents with bleeding. She describes passing bright red blood on 3 occasions and describes the volume as being the same a heavy period. There was no associated pain. What test would you definately not perform?

Vaginal examination. Never perform this is late bleeding until postpartum haemmorhage

5

What is placenta accreta?

All or part of the placenta attaches abnormally to the myometrium. The chorionic villi attach to the myometrium rather than being restricted to the decidua basalis

6

A women who is 32 weeks pregnant presents with bruising on her abdomen. She also says she had some quite heavy and painful vaginal bleeding this morning. On examination her uterus is tense and tender and seems larger than her dates. What is the most likely diagnosis?

Placental abruption. (Bruising is concealed blood)

7

What is vasa previa?

Fetal blood vessels cross or run near the external orifice of the uterus. This means that these vessels are at risk of rupture when the supporting membranes rupture. (the vessels lie before the baby in the birth canal, meaning they are in the way of the baby's exit.

8

You diagnose a vasa previa antenatally at 24 weeks. What should the treatment plan be?

An elective cesearean should be performed prior to rupture of the membranes. (Recomended at 35 - 36 weeks)

9

A women who is 36 weeks pregnant presents because her membranes have ruptured and she has had a large amount of painless vaginal bleeding. On CTG there is severe fetal bradycardia. What is the most likely diagnosis?

Vasa previa

10

A women who is 30 weeks pregnant presents with bleeding. She describes passing bright red blood on 3 occasions and describes the volume as being the same a heavy period. There was no associated pain. What should you do?

Placenta Praevia is the most likely diagnosis.
- Admit to ward and gain IV access
- FBC, Coag screen and rhesus status.
- Give steroids and observe
- Deliver baby by caesarean section at 38 weeks (or sooner if there is significant haemmorhage)

11

A women who is 32 weeks pregnant presents with bruising on her abdomen. She also says she had some quite heavy and painful vaginal bleeding this morning. On examination her uterus is tense and tender and seems larger than her dates.

Placental abruprtion
- Admit to ward and gain IV access
- FBC, Coag screen and rhesus status.
- Deliver baby.
(Steroids if expectant management)

12

What volume of blood is lost is a minor PPH?

Less than 500ml

13

What volume of blood is lost in a moderate PPH?

500 - 1500ml

14

What volume of blood is lost in a major PPH?

Over 1500ml

15

A women loses 1000ml of blood 6 hours after delivery.. What kind of PPH is this?

Moderate primary PPH

16

A women loses 1600ml of blood 52 hours after delivery.. What kind of PPH is this?

Major secondary PPH

17

6 hours after deliver a women starts to bleed heavily. What should you do?

- Uterine massage
- 5 units IV Syntocinon
- 40 units Syntocinon in 500ml Hartmans

18

6 hours after deliver a women starts to bleed heavily. You have already given uterine massage and syntocinon. You have confirmed that the placenta and membranes were completely evacuated. What do you do next?

- Insert catheter
- 500mg Ergometrine IV

19

6 hours after deliver a women starts to bleed heavily. You have already given uterine massage and syntocinon and ergometrine IV. You have confirmed that the placenta and membranes were completely evacuated.

- Get senior help
- Transfer to operating theatre
PGF2α IM

20

What is the most common cause of primary post partum haemmorhage?

Atonic Uterus

21

What is an atonic uterus?

Failure of the uterus to contract after childbirth . Closure of the uterus closes of the blood vessels in the placenta and id this doesn't occur excessive bleeding takes place.

22

Describe the two main drugs used to control post partum haemorrhage

- Oxytocin 10 units IV followed by an oxytocin infusion of 40 units in 0.5L of saline over 4 hours.
- Ergometrine 0.25mg IV

23

What is the initial management of post partum haemorrhage?

Uterine massage
5 units IV Syntocinon stat then 50 unitls Syntocinon in 500 ml Hartmans at 125 ml/h

24

What is the reason for performing uterine massage in PPH?

The most common cause of PPH is uterine atony. In this conditions the uterus fails to contract and close the spiral arteries which leads to excessive bleeding. Uterine massage can encourage contraction.

25

What is the reason for giving oxytocin in PPH?

To treat the most common cause of PPH which is uterine atony. It initiates rhythmic contractions of the uterus, compressing the spiral arteries which should reduce bleeding.

26

Why is ergometrine given in PPH?

It is a smooth muscle constrictor so should reduce blood flow