Flashcards in Antepartum Haemorrhage, Alloimunisation Deck (55):
Antepartum haemorrhage is?
Any bleeding from genital tract after 20th week before onset of labour of >50ml
2 groups of Antepartum haemorrhage
Major Antepartum haemorrhage Mx?
DDx for major Antepartum haemorrhage?
Cervical and lower genital tract bleeding
30% of Antepartum haemorrhage have what?
Major vs. minor placenta praevia?
Major: covering cervical so
Minor: encroaching on lower uterine segment
What increases risk of placenta praevia?
What U/S for placenta praevia?
Does placental praevia 'move'?
No the lower segment disintegrates in 3rd trimester
Placenta praevia presentation?
Painless heavy bleeding
Triggers of placenta praevia?
When placenta praevia happens?
Short term prob of placenta praevia?
Long term probs with placenta praevia?
Preterm, prelabour rupture of membranes
Vasa praevia(the central part disintegrates, have bilobed placenta with vessels right in the middle)
placenta praevia Mx?
Major or minor: symptomatic = in-patient care
Major ASYMPTOMATIC = 34 weeks inpatient
How to birth placenta praevia?
Vaginal placenta praevia minor threshold?
2cm from cervical OS
placenta praevia delivery timeline?
Around 37 weeks
placenta praevia bleeding in c-section
More bleeding, can lose a lot fast
placenta praevia, with previous c-sections, what risk?
Placenta accreta, increta, percreta
Placenta accreta, increta, percreta Risk goes up if?
Previous C-section and have placenta praevia
Placenta Abruption Bleeding?
Can be concealed
25% of APH is?
Placenta Abruption risk factors
Thrombophilia, prev abruption,
smoking, cocaine use
Trauma - MVA
Sudden reduction in size of over-distended uterus
Placenta Abruption presentation?
Abdo or back pain with bleeding
Woman will be in DIC
Placenta Abruption Mx?
Wide bore I access
Kleihauer-Betke to assess feto maternal transfusion
Get along monitoring
Placenta Abruption deliver straight away? What give?
If partial: corticosteroids if before 34 weeks
Magnesium sulphate - neuro protection if less than 30 weeks
What NOT to give in Placenta Abruption?
If Placenta Abruption near term?
If Placenta Abruption premature 32-37?
Depends: distressed, rock hard uterus, shock: then deliver
If less than 32 weeks Placenta Abruption?
Try to push for conservative, but if woman is in danger, deliver
Placenta Abruption delivery
Push for normal
C-section if mom or fetus is unstable
Placenta Abruption induction?
Yes if fetal demise
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
Vasa praevia Dangers
Baby will die in one minute
Vasa praevia Mx?
In hospital, any bleeding, code pink with code green c-section
Vasa praevia associated with
Vela entrust cord insertion
Vasa praevia Dx?
Trans vaginal U/S
Vasa praevia feel it?
On VE, yes, if feel pulsating, take out finger and call for help.
45% of APH?
Vaginal and lower genital tract bleeding
Vaginal and lower genital tract bleeding DDx?
Heavy show/onset of labour
Common antibodies alloimmunisation?
Rhesus, D, C, E, c, e
Kell (The WORST)
Less common antibodies alloimmunisation?
KPA or b
Events that can isoimmunisation a mom?
How to prevent isoimmunization?
Anti-D, need to give enough if lots of bleeding
When give anti-D?
When not give anti-D?
If already have own active antibodies to anti-D
When give anti-D?
Within 72 hours of sensitizing event
300ug, usually in units
How much anti-D give?
625IU at 28 and 34 weeks
Critical titre for anti D in mother?
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
If they have Kell, what is titre?
ANY Kell is bad.
How to monitor fetal Anaemia?
Look at MCA peak systolic velocity (PSV)
If more than 1.5MoM
If MCA PSV if >1.5MoM
Intrauterine blood transfusion