Flashcards in Antepartum Haemorrhage and Obstetric Emergencies Deck (21):
What is antepartum haemorrhage? (1)
Bleeding from genital tract after 24 weeks gestation.
Name 3 causes of APH. (3)
What is placenta praevia? (1)
What are the 2 types of placenta praevia? (2)
Placenta implanted in lower segment of the uterus at term.
Major: completely or partially covering os.
Marginal: placenta in lower segment not covering os.
Name 3 complications of placenta praevia. (3)
Obstruction of engagement of fetus: c/s
Haemorrhage: lower segment less able to contract to constrict blood flow.
Placental accreta (if implants in previous uterine scar)
Hysterectomy if massive haemorrhage
Julie has a low lying placenta on her 20 week ultrasound.
When should she be checked for placenta praevia? (1)
If she remains asymptomatic when should she be admitted? (1)
When should she be delivered? (1)
What symptoms are suggestive of placenta praevia? (2)
Painless antepartum haemorrhage, often multiple, and increasing in frequency and severity.
Define a placental abruption. (2)
When part or all of placenta separates from uterine wall before delivery of the fetus. Occurs in 1% of pregnancies.
How can palcental abruption and placenta praevia be distinguished? (3)
Pain is common in abruption, and not in PP.
Bleeding may be absent or dark in abruption but red and profuse in PP.
Uterine tenderness is common in abruption and rare in PP
Fetus has normal lie and often engaged in abruption, abnormal lie in PP
Fetus will be distressed in abruption but hr normal in PP
USS can diagnosed PP
Name 3 complications of placental abruption. (3)
Disseminated intravascular coagulation
Name 3 major risk factors for placental abruption. (3)
How is placental abruption managed? (2)
Admit, if severe resuscitate with blood
Fetal distress: emergency c/s
Fetus OK: >37 weeks, induce labour
Fetus dead: induce labour
What is shoulder dystocia? (2)
Difficulty in delivering the shoulders after delivery of the fetal head.
name 3 risk factors for shoulder dystocia. (3)
Macrosomic baby, maternal diabetes, maternal obesity, previous shoulder dystocia, induced labour, instrumental delivery
In shoulder dystocia, the obstruction is at the pelvic inlet. Why is excessive traction not appropriate? (2)
excessive traction can damage brachial plexus and cause Erb's palsy, 50% of which are permanent.
How should shoulder dystocia be managed? (2)
Gentle downwards traction
Call for senior help
Hyperflex legs towards the abdomen (increase pelvic dimensions- McRoberts manouevre)
Suprapubic pressure (90% should have delivered by this point)
What is a cord prolapse and why is it an emergency? (3)
After rupture of membranes, the umbilical cord decends below the presenting part.
If untreated this can cause compression of the cord or spasm, resulting in fetal hypoxia.
Name 3 risk factors for cord prolapse. (3)
Preterm labour, polyhydramnios, breech presentation, abnormal lie, multiple pregnancy, artificial amniotomy.
What is a amniotic fluid embolism? (2)
Amniotic fluid enters the maternal circulation and causes anaphylactoid response and cardiorespiratory collapse. Mortality is 37%.
Name 1 risk factor for a uterine rupture? (1)
VBAC (especially after classical caesarean), congenital uterine abnormalities.
What is a uterine rupture? (2)
Primary tear or tear of a uterine from scar, causes extrusion of the fetus and contraction of the uterus causing maternal haemorrhage and fetal hypoxia.