Antepartum Haemorrhage Flashcards Preview

A1. Women's Health > Antepartum Haemorrhage > Flashcards

Flashcards in Antepartum Haemorrhage Deck (24):
1

Definition of antepartum haemorrhage?

Bleeding during pregnancy from genital tract > 20 weeks gestation

2

What proportion of pregnancies are affected by APH?

2-5%

3

What are the 4 main causes of APH?

Placenta praevia
Placental abruption
Vasa praevia
Unclassified

4

What is the definition of placenta praevia?

Placenta inserted in lower uterine segment

5

Name 5 risk factors of placenta praevia

Age
PMx of placenta praevia
Smoking
Parity
Previous C/S

6

By how much does 1, 2 and 4 C/S increase your risk of placenta praevia?

1 - 0.65%
2 - 2.2%
4 - 10%

7

What is the usual presentation of placenta praevia? At what gestational age do they usually present?

Unprovoked, acute, painless vaginal bleeding
Usually presents around 32-34 weeks, 50% under 36 weeks

8

What test is necessary to diagnose placenta praevia?

U/S (transabdo or transvaginal)

9

What are the 4 grades of placenta praevia? What is a resolved praevia? Which grades of praevia are capable of resolving? Which grades are classified as minor and major praevia?

Grade 1 (low-lying) - edge of placenta within 2.5-3cm of internal cervical os
Grade 2 (marginal) - edge within 2cm of internal os
Grade 3 (partial) - covers a portion of internal os
Grade 4 (complete) - covers entire internal os

Resolved = praevia that has migrated away from internal os. Grade 1-3 capable of resolving

Minor praevia = Grade 1 and 2
Major praevia = Grade 3 and 4

10

Name 5 complications/risks of placenta praevia to the mother

Death - 20% of maternal deaths in developing world
PPH
Anaesthetic and surgical complications (increased C/S rate)
Post-partum sepsis
Placenta accreta more likely in next pregnancy
10% recurrence risk in next pregnancy

11

Name 5 complications/risks of placenta praevia to the foetus

Prematurity
Small for gestational age
FDIU
Malpresentation
Umbilical cord accidents
Congenital malformation

12

What is the definition of placental abruption?

Premature separation of a normally located placenta from uterine wall, before delivery of foetus

13

Name 5 risk factors for placental abruption

HTN
Blunt trauma
PHx
Age
Multiparity
Smoking
Cocaine

14

Name 5 risks/complications of placental abruption to mother

Hypovolaemic shock
Acute renal failure
DIC
PPH
Death
Feto-maternal haemorrhage

15

Name 5 risks/complications of placental abruption to foetus

Small for gestational age
Congenital malformation
Anaemia
Coagulation abnormalities
Death

16

What is the usual presentation of placental abruption? How is it diagnosed?

Sudden onset abdominal/back pain + PV bleeding. Clinical diagnosis based on signs and symptoms (pain + bleeding + uterine contractions)

17

What is a concealed placental abruption? How common is it?

Bleeding only occurs behind placenta = pelvic pain but no PV bleeding. Occurs in 20% of abruptions

18

Name differences of presentation and clinical findings between placental praevia and placental abruption

Praevia - painless, soft abdomen on examination, foetus should be normal
Abruption - painful (abdo/back pain), uterine tenderness and rigid 'board-like' abdo on examination, foetal parts may be hard to palpate and non-reassuring CTG

19

What examination should you not perform on someone with undiagnosed APH and why?

Vaginal examination - might cause more bleeding if they have a placenta praevia

20

Go through standard immediate management of anyone with APH

Want to stabilise maternal condition:
- 16G IV access and fluid replacement
- Take blood for FBC, group and hold +/- crossmatch, coagulation screen and Kleihauer test (for possible feto-maternal haemorrhage)
- Give Anti-D if Rhesus-negative
- Insert urinary catheter (for fluid monitoring)

21

What are the two principles of management for placenta praevia? What are the indications to use one over the other and why?

Expectant management - indicated if bleeding is controlled and mother and foetus are stable. Aim is to wait until foetus is term before delivery at 37-38 weeks. Admit to hospital and monitor until asymptomatic. Consider tocolytics, corticosteroids, mag sulf if preterm. Avoid sexual intercourse. Follow up U/S at 32-34 weeks. Admit to hospital at 34 weeks if a major (partial or complete) placenta praevia.

Immediate delivery (via C/S) - indicated if bleeding uncontrolled, or maternal or fetal condition is compromised.

22

What are the two principles of management for placenta abruption? What are the indications to use one over the other and why?

Expectant management - indicated if bleeding is controlled and mother and foetus are stable. Observe via continuous CTG and serial haematocrit until 38 weeks, then deliver with induction of labour

Immediate delivery - indicated if bleeding uncontrolled, or maternal or fetal condition is compromised. If foetus already dead, aim for vaginal delivery. If foetus alive and mother deteriorating, perform emergency LUSCS (unless patient already fully dilated)

23

What is a vasa praevia? Who is more at risk from a vasa praevia - the mother or fetus? How is the diagnosis made antenatally? What two medical procedures can cause fetal death from vasa praevia? What is the management of it (briefly)?

Foetal vessels that traverse within the membranes over internal cervical os. Fetus at risk, not mother - fetal blood flow can be compromised. Can diagnose w U/S. Amniocentesis or AROM = fetal death
Management - elective C/S at 36 weeks

24

Name 5 Ddx of APH that are lumped under the 'unclassified bleeding' category

Marginal sinus rupture
Show
Trauma
Infection
Cervical polyp
Cervical Ca
Unexplained