Antepartum Haemorrhage Flashcards
What are the 3 common causes of haemorrhage in 1st trimester?
Miscarriage
Ectopic pregnancy
Hydatiform mole
What are the 3 common causes of haemorrhage in 2nd trimester?
Miscarriage
Hydatiform mole
Placental abruption
What are the 4 common causes of haemorrhage in 3rd trimester?
Placental abruption
Placenta praevia
Placenta abruption
Bloody show
What sort of bleeding does placenta praevia present with? Is there pain?
Bright red blood
Painless
When should placenta praaevia be treated? What is the treatment?
If there is recurrent bleeding, low FHR or maternal collapse.
If asymptomatic praaevia - scan at 36, if still praaevia deliver at 36-37 via c-section
If recurrent bleeding - deliver at 34-36 via c-section
If labour begins with praaevia - emergency c-section
Use steroids for lung maturity.
What sort of bleeding does placental abruption present with? Is there pain?
Dark red or no bleeding.
Painful - tender, woody uterus.
What is the management for placental abruption?
> 36 weeks + happy baby - vaginal delivery
36 weeks + foetal distress - c-section
<36 weeks + happy baby - observe and steroids
<36 weeks + foetal distress - immediate c-section
Foetal death - induce vaginal delivery
What is vasa praevia?
When placental vessels lie over os and are unprotected by umbilical cord.
What is the typical presentation of vasa praaevia?
Membrane ruptures and dark vaginal bleeding follows.
What is the treatment for vasa praaevia?
Antenatal diagnosis:
Steroids at 32 weeks
Admit at 32-34 weeks if high risk
Deliver by c-section 34-36 weeks
Antenatal haemorrhage:
Emergency c-section
Neonatal resuscitation
What are the 3 risk factors for uterine rupture?
Previous c-section, myomectomy (for fibroids), previous rupture.
When does uterine rupture usually happen and why?
During labour
Due to syntocinon use or prostaglandin release
What is the management of uterine rupture?
C-section
Hysterectomy potentially
How does placenta accreta present?
Life-threatening, severe bleeding at the time of manual placental removal.
How should placenta accreta be treated?
Hysterectomy
