Antepartum Haemorrhage

Question 1

define antepartum haemorrhage

Answer 1

bleeding from the genital tract from 24 weeks gestation until the second stage of labour

Question 2

what are the causes of antepartum haemorrhage

Answer 2

placenta praevia 
placenta accreta 
uterine rupture
vasa praevia
preterm labour 
local causes - ectropion, infection, cervical cancer

Question 3

what is placenta praevia

Answer 3

low lying placenta either covering the internal cervical os or within 2cm of the cervical os

Question 4

when can placenta praevia be detected

Answer 4

can be in early pregnancy around 18-20 weeks on ultrasound - review again at 32 weeks to see if it has naturally moved itself

Question 5

how does placenta praevia present

Answer 5

painless vaginal bleeding
shock in proportion to the blood loss
high presenting part, malpresentation

Question 6

describe the feeling of the uterus in placenta praevia

Answer 6

uterus not tender

Question 7

what is absolutely contraindicated until placenta praevia is ruled out

Answer 7

vaginal examinations

Question 8

how is placenta praevia managed

Answer 8

keep in hospital until delivery

aim for delivery at 37-38 weeks

Question 9

what are the risk factors for placenta praevia

Answer 9

high parity
maternal age >40
previous placenta praevia

Question 10

what is placental abruption

Answer 10

when part or all of the placenta separates from the wall of the uterus permanently

Question 11

what are the risk factors for placental abruption

Answer 11

previous placental abruption 
pre-eclampsia 
transverse lie 
polyhydramnios 
abdo trauma 
thrombophilias 
multiple pregnancy

Question 12

explain why placental abruption occurs

Answer 12

rupture of maternal vessels in basal layer of endometrium, detached portion is unable to function and leads to foetal compromise

Question 13

explain the difference between revealed and concealed placental abruption

Answer 13

revealed - blood drains through the cervix

concealed - remains in the uterus and forms a clot

Question 14

describe the presentation of placental abruption

Answer 14

painful vaginal bleeding

shock is not proportional to blood loss, especially if concealed

Question 15

describe the examination findings of the uterus in placental abruption

Answer 15

uterus feels hard woody and tender - tonically contracted and circulation has been interrupted causing ischaemia

Question 16

how is placental abruption managed

Answer 16

emergency delivery if maternal or foetal compromise

IOL for haemorrhage at term without compromise

Question 17

what are the risk factors for uterine rupture

Answer 17

previous c-section 
previous uterine surgery 
IOL
obstructed labour 
multiple pregnancy

Question 18

how does uterine rupture present

Answer 18

severe abdo pain
shoulder tip pain
o/e regression of presenting part
significant haemorrhage or shock

Question 19

a prolonged pregnancy is beyond how many week

Answer 19

42 weeks

Question 20

what are the risk factors for prolonged pregnancy

Answer 20

nulliparity
maternal age >40
previous prolonged pregnancy
increased BMI

Question 21

what is the main complication of prolonged pregnancy

Answer 21

stillbirth

Question 22

what are the indicators for prolonged pregnancy

Answer 22

static growth
oligohydramnios 
reduced foetal movements 
presence of meconium 
dry/flaky skin with reduced vernix

Question 23

when is a membrane sweep typically offered

Answer 23

40 weeks if nulliparous

41 weeks if multiparous

Question 24

what are the two options for induction of labour

Answer 24

vaginal prostaglandins to prepare cervix by ripening it

amniotomy where membranes are artificially ruptured with amnihook

Question 25

what is vasa praevia

Answer 25

when foetal blood vessels cross or run near the internal cervical os - vessels are at risk of rupture once the membranes have ruptured

Question 26

what are the risk factors for vasa praevia

Answer 26

placental structural abnormalities
Hx of low lying pregnancy
multiple pregnancy
IVF

Question 27

what is the presentation of vasa praevia

Answer 27

small amount of dark vaginal blood following rupture of membranes
acute foetal bradycardia and decelerations on CTG

Question 28

there is maternal compromise in vasa praevia true/false

Answer 28

false - only risk of foetal mortality

Question 29

how is vasa praevia managed

Answer 29

steroids at 32 weeks
elective c-section before labour around 34-36 weeks
placenta sent to histology for diagnosis