Antepartum Haemorrhage, Alloimunisation

Question 1

Antepartum haemorrhage is?

Answer 1

Any bleeding from genital tract after 20th week before onset of labour of >50ml

Question 2

2 groups of Antepartum haemorrhage

Answer 2

Major

APH

Question 3

Major Antepartum haemorrhage Mx?

Answer 3

DR ABCDEFG

Question 4

DDx for major Antepartum haemorrhage?

Answer 4

praevia
Abrupt ion
Vasa Previa
Cervical and lower genital tract bleeding

Question 5

30% of Antepartum haemorrhage have what?

Answer 5

Placenta praevia

Question 6

Major vs. minor placenta praevia?

Answer 6

Major: covering cervical so
Minor: encroaching on lower uterine segment

Question 7

What increases risk of placenta praevia?

Answer 7

C-section

Question 8

What U/S for placenta praevia?

Answer 8

Transvaginal

Question 9

Does placental praevia ‘move’?

Answer 9

No the lower segment disintegrates in 3rd trimester

Question 10

Placenta praevia presentation?

Answer 10

Painless heavy bleeding

Malpresentation

Question 11

Triggers of placenta praevia?

Answer 11

Digital examination

Intercourse

Question 12

When placenta praevia happens?

Answer 12

3rd trimester

Question 13

Short term prob of placenta praevia?

Answer 13

Haemodynamic instability

Fetal-abnormal cardiotocograph

Question 14

Long term probs with placenta praevia?

Answer 14

IUGR
Preterm, prelabour rupture of membranes
Vasa praevia(the central part disintegrates, have bilobed placenta with vessels right in the middle)

Question 15

placenta praevia Mx?

Answer 15

Major or minor: symptomatic = in-patient care

Major ASYMPTOMATIC = 34 weeks inpatient

Question 16

How to birth placenta praevia?

Answer 16

C-section

Question 17

Vaginal placenta praevia minor threshold?

Answer 17

2cm from cervical OS

Question 18

placenta praevia delivery timeline?

Answer 18

Around 37 weeks

Question 19

placenta praevia bleeding in c-section

Answer 19

More bleeding, can lose a lot fast

Question 20

placenta praevia, with previous c-sections, what risk?

Answer 20

Placenta accreta, increta, percreta

Question 21

Placenta accreta, increta, percreta Risk goes up if?

Answer 21

Previous C-section and have placenta praevia

Question 22

Placenta Abruption Bleeding?

Answer 22

Can be concealed

Question 23

25% of APH is?

Answer 23

Placenta Abruption

Question 24

Placenta Abruption risk factors

Answer 24

HTN
Preeclampsia
Thrombophilia, prev abruption, 
smoking, cocaine use
Chorioamnionitis
Trauma - MVA
Sudden reduction in size of over-distended uterus

Question 25

Placenta Abruption presentation?

Answer 25

Abdo or back pain with bleeding Fetal demise Woman will be in DIC

Question 26

Placenta Abruption Mx?

Answer 26

``` Hx Wide bore I access FBC, coags Kleihauer-Betke to assess feto maternal transfusion Get along monitoring Vitals Anti-D Fluids/bloods ```

Question 27

Placenta Abruption deliver straight away? What give?

Answer 27

If partial: corticosteroids if before 34 weeks | Magnesium sulphate - neuro protection if less than 30 weeks

Question 28

What NOT to give in Placenta Abruption?

Answer 28

NO Tocolytics

Question 29

If Placenta Abruption near term?

Answer 29

Deliver

Question 30

If Placenta Abruption premature 32-37?

Answer 30

Depends: distressed, rock hard uterus, shock: then deliver

Question 31

If less than 32 weeks Placenta Abruption?

Answer 31

Try to push for conservative, but if woman is in danger, deliver

Question 32

Placenta Abruption delivery

Answer 32

Push for normal | C-section if mom or fetus is unstable

Question 33

Placenta Abruption induction?

Answer 33

Yes if fetal demise

Question 34

Vasa praevia def'n?

Answer 34

Umbilical vessels, unsupported by either the umbilical cord or placental tissue, traverse the fetal membranes of the lower segment above the cervix

Question 35

Vasa praevia Dangers

Answer 35

Baby will die in one minute

Question 36

Vasa praevia Mx?

Answer 36

In hospital, any bleeding, code pink with code green c-section

Question 37

Vasa praevia associated with

Answer 37

Vela entrust cord insertion Bipartite placenta Succenturiate lobe

Question 38

Vasa praevia Dx?

Answer 38

Trans vaginal U/S

Question 39

Vasa praevia feel it?

Answer 39

On VE, yes, if feel pulsating, take out finger and call for help.

Question 40

45% of APH?

Answer 40

Vaginal and lower genital tract bleeding

Question 41

Vaginal and lower genital tract bleeding DDx?

Answer 41

``` Heavy show/onset of labour Cervical Ectropion/dysplasia Polyps Varices Trauma: NAI ```

Question 42

Common antibodies alloimmunisation?

Answer 42

Rhesus, D, C, E, c, e | Kell (The WORST)

Question 43

Less common antibodies alloimmunisation?

Answer 43

Kidd Duffy KPA or b S

Question 44

Events that can isoimmunisation a mom?

Answer 44

``` Delivery Abrupt ion Trauma CVS ECV Infection ```

Question 45

How to prevent isoimmunization?

Answer 45

Anti-D, need to give enough if lots of bleeding

Question 46

When give anti-D?

Answer 46

28-34 weeks

Question 47

When not give anti-D?

Answer 47

If already have own active antibodies to anti-D

Question 48

When give anti-D?

Answer 48

Within 72 hours of sensitizing event | 300ug, usually in units

Question 49

How much anti-D give?

Answer 49

625IU at 28 and 34 weeks | 600 post-partum

Question 50

Critical titre for anti D in mother?

Answer 50

1:16/1:32

Question 51

If dad is heterozygous, then how change management?

Answer 51

Take maternal serum, cell-free DNA testing to see if fetus is +ve or neg and changes management

Question 52

If they have Kell, what is titre?

Answer 52

ANY Kell is bad.

Question 53

How to monitor fetal Anaemia?

Answer 53

Look at MCA peak systolic velocity (PSV) | If more than 1.5MoM

Question 54

If MCA PSV if >1.5MoM

Answer 54

Intrauterine blood transfusion

Question 55

How to treat fetal Anaemia?

Answer 55

Intrauterine transfusion, sometimes multiple if needed