ANTEPARTUM HEMORRHAGE

Question 1

What is the definition of antepartum haemorrhage (APH)?

Answer 1

APH is defined as bleeding from the genital tract after the 28th week of gestation until delivery.

Question 2

Why is 28 weeks considered the landmark for APH in developing countries?

Answer 2

28 weeks is considered the landmark because it marks viability and the registration of stillbirths in developing countries.

Question 3

List the primary causes of APH.

Answer 3

Causes include placenta praevia, abruptio placenta, local causes, vasa praevia, circumvallate placenta, and indeterminate haemorrhage.

Question 4

What is placenta praevia?

Answer 4

Placenta praevia is when the placenta is wholly or partially located in the lower uterine segment.

Question 5

How is placenta praevia classified?

Answer 5

Placenta praevia is classified into four types based on the extent of attachment to the internal os.

Question 6

What are the differences between minor and major placenta praevia?

Answer 6

Types 1 & 2 are minor placenta praevia, and Types 3 & 4 are major placenta praevia.

Question 7

What are the types of abnormal placentation?

Answer 7

Abnormal placentation includes placenta accreta, increta, and percreta.

Question 8

List predisposing factors for placenta praevia.

Answer 8

Predisposing factors include advanced maternal age, increased parity, previous uterine surgery, and multiple pregnancies.

Question 9

What are the classical symptoms of placenta praevia?

Answer 9

Symptoms include painless, bright red vaginal bleeding, recurrent bleeding, and torrential bleeding closer to term.

Question 10

How is placenta praevia diagnosed?

Answer 10

Diagnosis involves ultrasound, MRI, high presenting part, and contraindicated vaginal examination.

Question 11

What management strategies are used for placenta praevia?

Answer 11

Management includes conservative approaches like bed rest and surgery for major cases.

Question 12

What are the complications of placenta praevia?

Answer 12

Complications include haemorrhage, anaemia, shock, and death.

Question 13

Define abruptio placenta.

Answer 13

Abruptio placenta is the premature separation of a normally situated placenta before delivery.

Question 14

What is Couvelaire uterus?

Answer 14

Couvelaire uterus is when bleeding occurs into the myometrium.

Question 15

What are the primary causes of abruptio placenta?

Answer 15

The primary cause of abruptio placenta is unknown, but hypertension and trauma are significant contributors.

Question 16

What are the risk factors for abruptio placenta?

Answer 16

Risk factors include advanced maternal age, parity, polyhydramnios, and rapid uterine decompression.

Question 17

How is abruptio placenta diagnosed?

Answer 17

Diagnosis is based on painful uterine contractions with vaginal bleeding and absence of fetal heart rate.

Question 18

What is the hallmark symptom of abruptio placenta?

Answer 18

The hallmark symptom is painful uterine contractions with vaginal bleeding in the third trimester.

Question 19

How is abruptio placenta managed?

Answer 19

Management includes conservative methods for mild cases and surgery for severe cases.

Question 20

What are the maternal complications of abruptio placenta?

Answer 20

Maternal complications include haemorrhage, shock, DIC, and maternal death.

Question 21

What are the fetal complications of abruptio placenta?

Answer 21

Fetal complications include hypoxia, anaemia, IUGR, and fetal death.

Question 22

Define vasa praevia.

Answer 22

Vasa praevia is bleeding from unprotected fetal vessels over the cervical opening.

Question 23

What is the incidence of vasa praevia?

Answer 23

Vasa praevia occurs in 1 in 5000 singleton deliveries.

Question 24

What diagnostic test is used for vasa praevia?

Answer 24

The APT test is used to diagnose vasa praevia.

Question 25

What is circumvallate placenta?

Answer 25

Circumvallate placenta is when fetal membranes wrap twice over the fetal side of the placenta.

Question 26

What complications can arise from circumvallate placenta?

Answer 26

Complications include placental abruption and thickening of the placental edge.

Question 27

What is indeterminate haemorrhage?

Answer 27

Indeterminate haemorrhage occurs when the cause is unknown.

Question 28

What local causes can lead to APH?

Answer 28

Local causes include cervical cancer, polyps, cervicitis, and condylomata acuminata.

Question 29

What is friable condylomata acuminata?

Answer 29

Friable condylomata acuminata are fragile growths caused by HPV.

Question 30

What are the degrees of placenta praevia?

Answer 30

Degrees of placenta praevia range from Type 1 (partial) to Type 4 (complete).

Question 31

What are the risk factors for cervical cancer as a cause of APH?

Answer 31

Risk factors for cervical cancer include HPV infection and smoking.

Question 32

How is gentle vaginal speculum examination important in APH?

Answer 32

Gentle vaginal speculum examination helps identify local causes of bleeding.

Question 33

What are the fetal risks associated with APH?

Answer 33

Fetal risks include hypoxia, anaemia, IUGR, and death.

Question 34

What are the maternal risks associated with APH?

Answer 34

Maternal risks include haemorrhage, shock, DIC, and renal failure.

Question 35

What is the role of ultrasound in APH diagnosis?

Answer 35

Ultrasound is crucial for diagnosing placenta praevia and abruptio placenta.

Question 36

When is MRI indicated for APH diagnosis?

Answer 36

MRI is indicated when ultrasound findings are inconclusive.

Question 37

What surgical interventions are used for APH management?

Answer 37

Surgical interventions include cesarean delivery for severe cases.

Question 38

Why is early involvement of haematology important in APH?

Answer 38

Early involvement of haematology is critical for managing coagulopathy in APH.

Question 39

How is blood transfusion used in managing APH?

Answer 39

Blood transfusion restores maternal blood volume and oxygenation.

Question 40

What is the role of corticosteroids in managing APH?

Answer 40

Corticosteroids enhance fetal lung maturity in preterm deliveries.

Question 41

What is the significance of advanced maternal age in APH?

Answer 41

Advanced maternal age increases the risk of APH and complications.

Question 42

How does smoking contribute to APH?

Answer 42

Smoking affects uteroplacental blood flow, increasing the risk of APH.

Question 43

What is the impact of polyhydramnios on APH?

Answer 43

Polyhydramnios can lead to uterine overdistension and abruptio placenta.

Question 44

What are the limitations of clinical assessment in abruptio placenta?

Answer 44

Clinical assessment in abruptio placenta may miss concealed haemorrhage.