Antepartum Hge

Question 1

RISK FACTORS OF PLACENTA PREVIA

Answer 1

A. Personal factors:
Age - Parity - Previous Cesarean section
B. Obstetric factors:
- Previous placenta previa
- Anatomical lesions of the uterus e.g. septum, fibroid
- Large placenta e.g. Multifetal pregnancy, bipartite.

Question 2

COMPLICATIONS OF PLACENTA PREVIA. Maternal

Answer 2

• Hemorrhage - - Anemia or Hypovolemic shock.
• Amniotic fluid embolism - - - anaphylactic shock
• Placenta accrete spectrum (PAS)
• Postpartum hemorrhage
• Puerperal sepsis and 2ry postpartum hemorrhage
• Recurrence

Question 3

COMPLICATIONS OF PLACENTA PREVIA
B. Fetal and neonatal

Answer 3

• Preterm labor and PPROM - Fetal distress - IUGR - IUFD - anomalies
• Vasa previa and velamentous umbilical cord
• Neonate: anemia & asphyxia

Question 4

CLASSIFICATION OF PLACENTA PREVIA. American Institute of US in Medicin (AIUM)

Answer 4

A. American Institute of US in Medicin (AIUM)

1) Normal placental: edge > 20 mm from Internal Os
2) Low lying placenta: edge < 20 mm from the Internal Os
3) Placenta previa: covering the Internal Os

Question 5

B. Classic classification of Placenta previa

Answer 5

B. Classic classification:

1) Minor placenta previa
* Low Lying Placenta: Edge of the placenta encroaches on the LUS, but does not reach the margin of the I0
* Marginal: Edge of the placenta reaches but does not cover the margin of the IO.
2) Major placenta previa
* Partial : placenta partially covers the io
* Total: placenta completely covers the io

Question 6

PRECAUTIONS IN ANTENATAL CARE FOR PLACENTA PREVIA

Answer 6

1. Regular Monitoring: Frequent ultrasounds are necessary to track the position of the placenta.
2. Activity Restrictions: Bed rest or activity limitations - Avoiding strenuous activities
3. Hospitalization: If bleeding occurs or if the condition is severe
4. Delivery Planning : CS is often planned around 36-37 weeks
5. Avoiding Vaginal Examinations
6. Maternal and Fetal Monitoring: AFWB - Maternal blood pressure and hemoglobin levels are monitored to detect anemia or other complications

Question 7

COMPLICATIONS OF PLACENTAL ABRUPTION

Answer 7

A.Maternal
1) Hemorrhage → Anemia or Hypovolemic shock.
2) Amniotic fluid embolism→ anaphylactic shock
3) Couvelaire uterus (Uteroplacental Apoplexy)
4) Acute RF
5) Sheehan’s syndrome: due to sudden acute blood loss
6) Consumptive coagulopathy (DIC)
7) Postpartum hemorrhage
8) Puerperal sepsis and 2nd postpartum hemorrhage
9) Recurrence

B. Fetal and neonatal:
Preterm labor and PPROM - Fetal distress - IUGR - IUFD
Neonate: anemia & asphyxia

Question 8

INVESTIGATIONS IN PLACENTAL ABRUPTION

Answer 8

Ultrasound examination → Placental localization (most important).
Laboratory:
CBC - Blood Grouping, Rh type a
Coagulation profile: Fibrinogen level (most important) and FDPs
KFT - LVF → RF and HELLP syndrome.
Urine analysis: To detect proteinuria suggestive of preeclampsia.
AFWB

Question 9

TYPES OF PLACENTAL ABRUPTION

Answer 9

1) Revealed hge
2) Concealed hge
3) Mixed type (MC)

Question 10

RISK FACTORS OF PLACENTAL ABRUPTION

Answer 10

A. Personal factors: Age -Parity - Smoking - cocaine
B. Obstetric factors: Previous abruption - Weak implantation on septum, fibroid
-PROM & chorioamnionitis.
C. Medical disorders: Hypertension M/C - thrombophilias - Hypothyroidism
- Folic acid deficiency
D. Traumatic abruption:External trauma - Obstetric procedures - Traction on the placenta

Question 11

TTT OF PLACENTAL ABRUPTION

Answer 11

• Follow-up of the maternal condition by CBC and examine vital data
• Follow-up of Fetal condition by AFWB.
• Supportive measures were taken, and anti-D was given to Rh-ve women.
• Terminate pregnancy at 34th week by VD unless there is an indication for CS

Question 12

ETIOLOGY OF PLACENTA ACCRETA SPECTRUM

Answer 12

A .Defective decidualization:
1. LUS Placenta previa
2. Previous uterine surgery: mainly CS - Other uterine surgeries (e.g. myomectomy, D&C)
3. Anatomical uterine injuries e.g. CME (e.g. septa), leiomyoma, Asherman’s $
B. Maternal age > 35 years - IVF

Question 13

CLASSIFICATION OF PLACENTA ACCRETA SPECTRUM

Answer 13

• FIGO grade 1 Placenta accreta (attached directly to the superficial myometrium)
• FIGO grade 2 Placenta increta (invading into the myometrium)
• FIGO grade 3 Placenta Percreta (perforating, the serosa)

Question 14

MANAGEMENT OF PLACENTA ACCRETA SPECTRUM

Answer 14

Investigations:
US - Color Doppler - 3D power Doppler - MRI
TTT: CS hysterectomy OR Conservative management: either
Placenta left in situ parenteral antibiotics
Placental resection and trimming the edges

Question 15

ETIOLOGY OF VASA PREVIA

Answer 15

1) Velamentous insertion of cord
2) Bipartite or multipartite placenta
3) Placenta Succenturiat

Question 16

MANAGEMENT OF VASA PREVIA

Answer 16

After ROM: emergency CS
Before ROM: Hospitalization-Steroid administration-CS once mature.

Question 17

D.D. OF ANTEPARTUM HEMORRHAGE

Answer 17

• Placenta previa
• placenta abruption
• Genital trauma
• General causes e.g LF, HTN
• Vasa Previa

Question 18

Bright red painless mild bleeding - at 24 weeks - excessive bleeding with coitus

Answer 18

PLACENTA PREVIA

Question 19

sudden severe progressive pain - absent bleeding - blood pressure > 160/100 - FL > the period -
Difficulty feeling fetal parts

Answer 19

PE COMPLICATED WITH PLACENTAL ABRUPTION CONCEALED TYPE

Question 20

• sudden severe progressive pain - absent bleeding - blood pressure > 160/100 - FL > the period -Difficulty feeling fetal parts

Answer 20

PE COMPLICATED WITH PLACENTAL ABRUPTION CONCEALED TYPE

Question 21

Mild pain - mild dark brown bleeding - blood pressure > 160/100 - FL < the period - Could feel fetal parts

Answer 21

PE COMPLICATED WITH PLACENTAL ABRUPTION REVEALED TYPE

Question 22

mild bleeding - 24th week - Sudden gush of fluid - fetal bradycardia

Answer 22

VASA PREVIA