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Flashcards in Bleeding in late pregnancy Deck (40)
1

What is the term of bleeding n late pregnancy

Antepartum haemorrhage

2

What is the definition of late pregnancy bleedin

After 24 weeks (in UK)

3

What are the main causes for bleeding in late pregnancy

Placenta previa
Placental abruption
Local -polps, infction, cancer
Vasa previa -RARE
Uterine rupture
Show
40 percent no apparent cause

4

What is placental abruption

A separation of a normally implanted placental either partially or totally before birth of the fetus

5

What is the main risk factor for placental abruption

Pre-eclampsia/Hypertension

6

What other risk factors are there for placental abruption

Trauma
Smoking and drugs
Medical - thrombophilia, renal, diabetes
Poly-hydramnios, multiple pregnancies
Abnormal placenta

7

What is the recurrenc rate if abrutopn

10 percent

8

What are the clinical features of placental abruption

Small or large volume blood loss
PAINFUL
Uterine tenderness/wooden hard
Uterus feels larger
Difficult to feel fetal parts

9

What is the difference between revealed/concealed placental abruption

Revealed - blood come out of genital tract
Concealed- blood pools behind placenta

10

What is couvelair uterus

A lifethreatening complication of placental abruption whereby there is bleeding that penetrates into the uterine myometrium forcing its way into the peritoneal cavity.

11

Name other complications of placental abruption

PPH
DIC
Death- maternal or fetus

12

What is placenta previa

Placental partially or totally implabted in the lower uterin segment

13

How common is placenta previa

5 percent of women at anomaly scan
1:200 at term

14

What are the classifications of placenta previa

Lateral - 1
Marginal- 2
Incomplete centralis - 3
Complete centralis -4

3 and 4 are over cervix
Major/minor - distance from cervix on ultrasound

15

What are the clinical features of placenta previa

Painless, ‘causeless’, recurrent 3rd trimesteric bleeding
Amount of blood variable
Uterus soft non tender
Malpresentations – Breech/Transverse/Oblique
High head
CTG usually normal

16

How is PP diagnosed

ULTRASOUND
Check anomaly scan!

20 week scan and 32/34 week scan should be done to decide type/extent of placent previa

17

What should no be performed in PP

vaginal examination
ALWAYS EXCLUDE PP beforehand

18

When would you consider a vaginal delievery in PP

If minor degree of PP ie more than 2cm from Os

19

When must a C section be done in PP

if placental less than 2cm from Os or covering Os

20

What is placenta accreta

Placenta invades myometrium

21

What is placenta percreta

Placenta has reached serosa

22

What is the risk factors for placenta accreta

Placenta previa
Prior C section

23

what is vasa previa

is an obstetric complication in which fetal blood vessels cross or run near the internal orifice of the uterus. These vessels are at risk of rupture when the supporting membranes rupture, as they are unsupported by the umbilical cord or placental tissue

24

When should you deliver in PP

Major bleeding may require preterm delivery
Caesarean Section at 37 - 38 weeks if there has been prior bleeding in pregnancy or suspected/confirmed placenta accreta
Caesarean Section at 38-39 weeks if there has not been bleeding in pregnancy

25

What type of delivery should be done in PA

C section
Vaginal if stillbirth

26

When should you admit a pregnant woman t hospital

Any history of acute bleeding 23 – 32 weeks
–Min stay of 24 hours clear of bleeding
Recurrent bleeding after 28 weeks
–Min stay of 72 hours
–Consider need to be admitted until delivery
Any bleeding after 32 weeks
–Min stay of 72 hours
–Consider need to be admitted until delivery
Major placenta praevia after 36 weeks with no bleeding
–Consider the social circumstances
–Consider other obstetric factors
–Consider need for admission until delivery
–Consultant decision

27

Why are steroids given

Promote fetal lung surfactant production
↓ neonatal respiratory distress syndrome (RDS) by up to 50% if administered 24-48h before delivery

28

When are steroids given in AP and PP

Administer up to 36 weeks. Only significant effects up to 34 weeks. Proven benefit up to 1 week

29

Which steroid is preferred

Betamethasone 12mg IM x 2 injections 12 hours apart

(rather than dexmehtasone)

30

When should you cross match a women with PV bleeding in pregnancy

cross match 2-4 units with a ny bleedin more than 1 tsp

31

what is kleihauer test

a blood test used to measure the amount of fetal hemoglobin transferred from a fetus to a mother's bloodstream.[1] It is usually performed on Rh-negative mothers to determine the required dose of Rho(D) immune globulin (RhIg) to inhibit formation of Rh antibodies in the mother and prevent Rh disease in future Rh-positive children.[2]

32

Should you give enoxaparin for DVT prophylaxis

NO - TEDS, mobilization and hydration only

33

What is the definition of PPH

loss of more than 500 ml of blood
Primary - in first 24 hrs
Secondary- more than 24hrs -6 weeks

34

What would a moderate or major PPH be

between 500ml - 1500ml
Major more than 1500ml

35

What are the four Ts of PPH

Tone - most common
Trauma
Tissue
Thrombin

36

What are the complications of PPH

Maternal fatigue, feeding difficulties, prolonged hospital stay, delayed lactation, pituitary infarction, transfusion, haemorrhagic shock, DIC, death

37

What are the risk factors for PPH antenatally

anaemia
–previous caesarean section
–placenta praevia, percreta, accreta
–previous PPH or retained placenta
–Multiple pregnancy

38

What are the intrapartum risk factors of PPH

–prolonged labour
–operative vaginal delivery / caesarean section
–retained placenta

39

What three intial things should be done to manage PPH

Uterine massage
5 units iv Syntocinon stat
40 units Syntocinon in 500ml

40

How sould persistant PPH be managed

Confirm placenta and membranes complete
Urinary Catheter
500 micrograms Ergometrine IV
(Avoid if Cardiac Disease / Hypertension)
? Vaginal / perineal trauma - ensure prompt repair