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OBGYN 2023 > antepartum haemorrhage - GM > Flashcards

antepartum haemorrhage - GM Flashcards

1
Q

define APH

A

genital tract bleeding from 24 weeks gestation and complicates 3-5% of pregnancies

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2
Q

three most important causes of APH

A

placenta praevia, placental abruption and vasa preavia

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3
Q

less serious causes of APH

A

lower genital tract sources eg. cervical polyps, vaginitis and cervicitis

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4
Q

why does placenta previa increase the likelihood of APH

A

poor attachment of the placenta to the uterine wall

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5
Q

minor placenta praevia

A

grade 1 and 2
the placenta is low but does not cover the internal cervical os

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6
Q

major placenta praevia

A

grade 3 and 4
placenta loes over the internal cervical os

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7
Q

placental abruption define

A

complete or partial detachment of the placenta before delivery

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8
Q

complete and partial placental abruption

A

complete accounts for 7% whilst partial accounts for 93%

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9
Q

aetiology of placental abruption

A

may occur due to trauma or injury to the abdomen

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10
Q

risk factors for placental abruption

A

maternal age greater than 35
multiparity
current pre-eclampsia, HELLP
Hx of hypertension
Hx of previous abruptions
Hx of anti-phospholipid syndrome
Hx of thrombophilia
smoking during pregnancy
use of cocaine during pregnancy
tramua

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11
Q

History of placental abruption

A

abdo pain - posterior placental abruptions may present with back pain
vaginal bleeding
uterine contractions
dizziness and/or loss of consciousness

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12
Q

revealed vs. concealed placental abruption

A

amount of blood loss often correlates poorly with the degree of abruption
abruption may be revealed where blood tracks between membranes and out of the vagina
may however be concealed where the blood accumulates with no obvious external bleeding

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13
Q

clinical findings of placental abruption include

A

woody, tense uterus
fetal heart absent or distressed

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14
Q

imaging for placental abruption

A

US required to identify location of the bleed

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15
Q

lab investigations of placental abruption

A

FBC, U&Es, LFTs, helps exclude hypertensive conditions such as HELLP or pre-eclampsia
clotting profile
kleihauer test
group and save
crossmatch

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16
Q

differential diagnoses for placental abruption

A

placenta praevia
vasa praevia
marginal placental bleed: partial abruption
uterine rupture
local causes: polyps, carcinoma, cervical ectropion, infection

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17
Q

management of placental abruption if the fetus is alive

A

if there is no signs of fetal distress: observe closely and induce and deliver vaginally if over 36 weeks
if there is signs of fetal distress: immediate C-section

18
Q

management of placental abruption if the fetus is dead

A

induce vaginal delivery
if the mother is haemodynamically compromised and/or ongoing massive haemorrhage, delivery should be expadited by c-section to arrest bleeding

19
Q

complications of placental abruption for the mother

A

major haemorrhage: if suspected, the major haemorrhage protocol should be activated
shock: can result in sheehan syndrome
compression of uterine muscles prevents good contraction of muscles during labour
Release of thromboplastin from placental haematoma: can lead to DIC
post partum haemorrhage

20
Q

complications of placental abruption for the fetus include

A

placental insufficiency: results in hypoxia and intrauterine growth restriction (IUGR) due to lack of nutrients
premature birth
stillburth

21
Q

vasa praevia define

A

occurs when foetal blood vessels (the two umbilical arteries and single umbilical vein) are within the fetal membranes and run across the internal cervical os

22
Q

aetiology of vasa praevia

A

normally, the fetal vessels are protected within the umbilical cord or placenta
in vasa praevia, the vessels are exposed which increases the risk of the vessels rupturing following the rupture of supporting membranes

23
Q

types of vasa praevia

A

vasa praevia with velamentous umbilical cord insertion: the fetal vessels insert into the membranes and travel around to the placenta, rather than inserting directly into the placenta
vasa praevia with multi- lobed placenta: the fetal vessels are exposed as they travel to an accessory placental lobe

24
Q

risk factors for vasa praevia

A

IVF pregnancy
multiple pregnancy
low lying placeta

25
Q

Hx of vasa praevia

A

painless vaginal bleeding
rupture of membranes
fetal bradycardia

26
Q

clinical examination of vasapraevia

A

soft non tender uterus
fetal bradycardia

27
Q

differential diagnosis of vasa praevia

A

placenta praevia
placental abruption
uterine rupture
local causes: polyps, carcinoma, cervical ectropian, infection

28
Q

bedside investigations for vasa praevia

A

vital signs: RR, BP, oxygen saturations, pulse and temperature

29
Q

laboritory investigations for vasa praevia

A

FBC, U&Es, LFTs, helps to exclude hypertensive conditions such as HELLP or pre-eclampsia
clotting profile
kleihauer test
group and save
crossmatch

30
Q

imaging for vasa praevia

A

ultrasound scan
cardiotocography is used to monitor the foetus

31
Q

management of vasa praevia

A

if a woman is found to have vasa praevia on US, an elective c-section at 34-36 weeks is required
corticosteroids are given from 32 weeks to promote fetal lung maturity

32
Q

vasa praevia in the event of APH

A

emergency caesarean section is required to deliver the foetus

33
Q

main complication for vasa praevia is

A

major haemorrhage

34
Q

vasa praevia presents usually as

A

painless vaginal bleeding but may also coincide with rupture of membranes

35
Q

other uterine causes of APH

A

circumvallate placenta
placental sinuses

36
Q

lower genital tract sources of APH include

A

cervical polyps
cervical erosions and carcinoma
carvicitis
vaginitis
vulval varicosities

37
Q

which presentation is painful

A

placental abruption is painful
not vasa praevia or placenta praevia

38
Q

which presentation causes a tender uterus

A

placental abruption causes a tender uterus
not vasa praevia or placenta praevia

39
Q

which presentation includes an abnormal lie and/or presentation

A

placenta praevia may cause abnormal lie and/or presentation
vasa praaevia and placental abruption present with normal lie

40
Q

how is fetal heart affected by these presentations

A

fetal heart rate is normal in placenta praeviaa
fetal heart rate is absent or distressed is placental abruption
fetal heart rate is bradycardic in vasa praevia

41
Q

which presentations cause coagulation problems

A

coagulation problems are rare in placenta praevia and vasa praevia
coagulation problems will be present in placental abruption

42
Q
A

OBGYN 2023 (28 decks)

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