Antepartum Haemorrhage, Alloimunisation Flashcards Preview

Jason's MD3 Women's > Antepartum Haemorrhage, Alloimunisation > Flashcards

Flashcards in Antepartum Haemorrhage, Alloimunisation Deck (55):
1

Antepartum haemorrhage is?

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

2

2 groups of Antepartum haemorrhage

Major
APH

3

Major Antepartum haemorrhage Mx?

DR ABCDEFG

4

DDx for major Antepartum haemorrhage?

praevia
Abrupt ion
Vasa Previa
Cervical and lower genital tract bleeding

5

30% of Antepartum haemorrhage have what?

Placenta praevia

6

Major vs. minor placenta praevia?

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

7

What increases risk of placenta praevia?

C-section

8

What U/S for placenta praevia?

Transvaginal

9

Does placental praevia 'move'?

No the lower segment disintegrates in 3rd trimester

10

Placenta praevia presentation?

Painless heavy bleeding
Malpresentation

11

Triggers of placenta praevia?

Digital examination
Intercourse

12

When placenta praevia happens?

3rd trimester

13

Short term prob of placenta praevia?

Haemodynamic instability
Fetal-abnormal cardiotocograph

14

Long term probs with placenta praevia?

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

15

placenta praevia Mx?

Major or minor: symptomatic = in-patient care
Major ASYMPTOMATIC = 34 weeks inpatient

16

How to birth placenta praevia?

C-section

17

Vaginal placenta praevia minor threshold?

2cm from cervical OS

18

placenta praevia delivery timeline?

Around 37 weeks

19

placenta praevia bleeding in c-section

More bleeding, can lose a lot fast

20

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

Placenta accreta, increta, percreta

21

Placenta accreta, increta, percreta Risk goes up if?

Previous C-section and have placenta praevia

22

Placenta Abruption Bleeding?

Can be concealed

23

25% of APH is?

Placenta Abruption

24

Placenta Abruption risk factors

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

25

Placenta Abruption presentation?

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

26

Placenta Abruption Mx?

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

27

Placenta Abruption deliver straight away? What give?

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

28

What NOT to give in Placenta Abruption?

NO Tocolytics

29

If Placenta Abruption near term?

Deliver

30

If Placenta Abruption premature 32-37?

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

31

If less than 32 weeks Placenta Abruption?

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

32

Placenta Abruption delivery

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

33

Placenta Abruption induction?

Yes if fetal demise

34

Vasa praevia def'n?

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

35

Vasa praevia Dangers

Baby will die in one minute

36

Vasa praevia Mx?

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

37

Vasa praevia associated with

Vela entrust cord insertion
Bipartite placenta
Succenturiate lobe

38

Vasa praevia Dx?

Trans vaginal U/S

39

Vasa praevia feel it?

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

40

45% of APH?

Vaginal and lower genital tract bleeding

41

Vaginal and lower genital tract bleeding DDx?

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

42

Common antibodies alloimmunisation?

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

43

Less common antibodies alloimmunisation?

Kidd
Duffy
KPA or b
S

44

Events that can isoimmunisation a mom?

Delivery
Abrupt ion
Trauma
CVS
ECV
Infection

45

How to prevent isoimmunization?

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

46

When give anti-D?

28-34 weeks

47

When not give anti-D?

If already have own active antibodies to anti-D

48

When give anti-D?

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

49

How much anti-D give?

625IU at 28 and 34 weeks
600 post-partum

50

Critical titre for anti D in mother?

1:16/1:32

51

If dad is heterozygous, then how change management?

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

52

If they have Kell, what is titre?

ANY Kell is bad.

53

How to monitor fetal Anaemia?

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

54

If MCA PSV if >1.5MoM

Intrauterine blood transfusion

55

How to treat fetal Anaemia?

Intrauterine transfusion, sometimes multiple if needed