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Reproduction and sexual health > Antepartum haemorrhage > Flashcards

Antepartum haemorrhage Flashcards

(51 cards)

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1
Q

When does bleeding in early pregnancy occur

A

<24 weeks

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2
Q

When does bleeding in late pregnancy occur

A

> =24 weeks

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3
Q

At which week of gestation is the foetus said to be viable

A

24 weeks

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4
Q

Define antepartum haemorrhage APH

A

bleeding from the genital tract after 24/40 and before the end of the second stage of labour

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5
Q

Aetiology of APH

A 
Placental: previa, abruption 
Uterine: rupture 
Indeterminate 
Foetal: vasa previa 
Local causes: cervical, vaginal
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6
Q

How much blood is seen in spotting

A

streaks, stains or upon wiping

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7
Q

How much blood is lost in minor APH

A

<50 ml

settled

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8
Q

How much blood is lost in major APH

A

50-1000ml

NO shock

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9
Q

How much blood is lost in a massive APH

A

> 1000ml

+/or shock

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10
Q

What is placental abruption

A

separation of a normally implanted placenta - partially/totally before the birth of the foetus

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11
Q

Placental abruption needs imaging to confirm the diagnosis, true or false

A

FALSE

Placental abruption is a clinical diagnosis

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12
Q

What is the pathophysiology behind placental abruption

A

vasospasm followed by arteriole rupture into the decidua
blood escapes into amniotic sac or further under the placenta into the myometrium
causes tonic contraction
interrupts placental circulation –> hypoxia

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13
Q

What is Couvelaire uterus and in which condition is it seen

A

“blue” uterus from extravasation of blood into uterus

seen in placental abruption

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14
Q

List risk factors for placental abruption

A 
HTN/PET 
smoking 
trauma 
cocaine / amphetamine 
thrombophilias 
DM / renal disease 
polyhydramnios 
multiple pregnancy 
PPROM 
abnormal placenta 
previous placental abruption
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15
Q

What are the symptoms of placental abruption

A 
Continuous severe abdominal pain 
backache if placenta lies posteriorly
Maternal collapse 
Bleeding (may be concealed)
Pre term labour
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16
Q

What are signs of placental abruption

A 
Distressed patient 
Appearance of patient may not match up to how much blood they have lost 
Normal / LFD uterus 
Tender uterus 
Woody hard uterus 
Difficult to identify foetal parts 
Foetal HR - bradycardia / absent 
CTG shows irritable uterus
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17
Q

Management of placental abruption

A 
RESUSCITATE mother 
2 large bore IV access 
FBC, clotting, U+E, LFT, crossmatch 4-6 units
Kleihauer - Rh -ve 
IV fluids 
Catheterise
assess foetus and foetal HR 
category 1 c-section
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18
Q

In which groups of patient should care be taken in administering IV fluids

A

Those with pre eclampsia or heart conditions –> pulmonary oedema

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19
Q

What are maternal complications of placental abruption

A 
infection 
hypovolaemic shock 
anaemia
PPH 
renal failure - renal tubular necrosis 
DIC 
VTE 
PTSD
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20
Q

List foetal complications of placental abruption

A

IUD
hypoxia
pre term delivery
SGA + FGR

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21
Q

Define placenta previa

Study These Flashcards
A

placenta lies directly over internal cervical os

22
Q

Define low lying placenta

Study These Flashcards
A

> 16/40

placental edge is <20mm from internal cervical os on TVUSS/TAUSS

23
Q

List risk factors for developing placenta previa

Study These Flashcards
A 
previous c-section 
previous placenta previa 
smoking 
assisted conception treatment 
previous TOP 
multiparity 
age >40 
damaged endometrium
24
Q

Is placenta previa screened for and if so what is the process

Study These Flashcards
A

Yes
screened at 20 week anomaly scan
If abnormal, repeat scan at 32 + 36 weeks

25
Which method is better for diagnosing placenta previa, TVUSS or TAUSS
TVUSS
26
If placenta accreta is suspected, what imaging should be done
MRI
27
Symptoms of placenta previa
painless bleeding > 24 weeks unprovoked or post-coital patients condition directly proportional to amount of bleeding seen
28
Signs of placenta previa
uterus is soft and non-tender presenting part high malpresentation Normal CTG
29
It is ok to perform a digital PV/PR exam for placenta previa, true or false
FALSE! | This should not be done until you have excluded placenta previa as a diagnosis
30
management of placenta previa in stable mother
``` Resuscitate mother assess foetus anti-D if Rh- prevent and treat anaemia avoid sex antenatal steroids magnesium sulphate 24-32 weeks neuroprotection ```
31
management of placenta previa in unstable mother
``` resuscitate mother assess foetus 2 large bore IV access FBC, clotting, LFT, U+E, crossmatch 4-6 units Kleihauer - Rh- --> anti D major haemorrhage protocol IV fluids/blood transfusion ```
32
in placenta previa, when should a symptomatic mother consider delivery
34-36+6 weeks
33
in placenta previa, when should an asymptomatic mother consider delivery
36-37 weeks
34
in placenta previa, what is the indication for a c-section
the placenta directly covers the internal cervical os | or is < 2 cm from os
35
in placenta previa, what is the indication for a vaginal delivery
placenta >2cm from internal cervical os and there is no malpresentation
36
Define placenta accreta
morbidly abnormal adherent placenta to the uterine wall
37
What increases the risk of placenta accreta
multiple c-sections | placenta previa
38
symptoms of placenta accreta
bleeding | PPH
39
define placenta percreta
penetrating uterus to bladder
40
define placenta increta
invading myometrium
41
what is the management for placenta accreta
prophylactic iliac artery balloon by IR | caesarean hysterectomy
42
Define uterine rupture
full thickness (including serosa) opening of the uterus
43
what increases the risk of uterine rupture
previous c-section or uterine surgery multiparity use of syntocin obstructed labour
44
symptoms of uterine rupture
severe abdominal pain shoulder tip pain maternal collapse PV bleeding
45
signs of uterine rupture
``` loss of uterine contractions in labour acute abdomen presenting part rises peritonism foetal distress IUD ```
46
Management of uterine rupture
``` Resuscitate 2 large bore IV access FBC, U+E, LFT, crossmatch 4-6 units, clotting Kleihauer - Rh- --> anti D major haemorrhage protocol IV fluids / blood transfusion ```
47
Define vasa previa
rupture of unprotected foetal vessels that traverse the membrane below the presenting part but over the internal cervical os during labour or ARM/amniotomy
48
there is screening for vasa previa, true or false
FALSE
49
how is vasa previa diagnosed
TAUSS + TVUSS
50
risk factors for vasa previa
bi-lobed/succenturiate placenta low lying placenta in 2nd trimester multiple pregnancy IVF
51
Management of vasa previa
antenatal steroids 32-34 weeks elective c-section before labour emegency c-section if diagnosed during labour placenta for histology

Reproduction and sexual health (46 decks)

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