Bleeding in late pregnancy Flashcards Preview

Repro > Bleeding in late pregnancy > Flashcards

Flashcards in Bleeding in late pregnancy Deck (39):
1

when is bleeding in early pregnancy

<24 weeks

2

when is bleeding in late pregnancy (antepartum haemorrhage) in the uk

> and equal to 24 hours

3

functions of the placenta

sole source of nutrition form 6 weeks
gas transfer
mtabolism/waste disposal
hormone production
protective filter

4

definition of antepartum haemorrhage

bleeding form the genital tract after 24 weeks of gestation

5

causes of APH

placenta previa 20%
placental abruption 30%
local causes such as polyps, cancer, infection
vasa previa
uterine rupture

6

what is the most comments cause of APH

idiopathic

7

what is placental abruption

separation of a normally implanted placenta partially or totally before the birth of the fetus

8

risk factors for placental abruption

PET/hypertension
trauma
smoking/cocaine/amphetamins
medical such as thromboembolic/renal/DM
polyhydraminios, multiple pregnancy, preterm PROM
abnormal placenta
recurrence rate 10%

9

what are the two types of placental abruption

concealed
revealed

10

what are the clinical features of placental abruption

pain
uterine tenderness/wooden hard
uterus feels larger
difficult to feel fetal parts

sudden onset abdominal pain, vaginal bleeding and uterine tenderness
abnormally frequent contractions and uterine hypertonus

11

ix for placental abruption

CTG

12

what is placental previa

placenta is partially or totally implanted in the lower uterine segment

13

incidence of placenta previa

5% at anomaly scan
1:200 at term

14

classifications of placenta previa old and new

old - lateral/marginal/incomplete centralis and complete centralis

major - over the uterus completely or slightly over the uterus
minor - not over the uterus

15

clinical signs and symptoms of placenta previa
CTG readings

painless recurrent third trimester bleeding
amount of blood variable
uterus soft and non tender
malpositions - breech, transverse, oblique
high head
CTG usually normal

16

dx of placenta previa

US - scan for this at 20 weeks then a scan at 32/34 weeks

17

what should not be done until placenta previa has been excluded

vaginal exam

18

types of delivery with placenta previa

major <2cm from os/covering os -> CS
minor >2cm from os -> vaginal delivery

19

what is placenta accreta

placenta invades myometrium

20

what are the major risk factors for placenta accreta

placenta previa and prior cs

21

what can happen during uterine rupture
what is the common cause

small or a large volume
intra partum - loss of contractions
obstructed labour
fetal head high
fetal distress

previous CS/uterine surgery

22

what is vasa praevia

some of the babies vessels are run across and are unsupported by the placenta so are at risk of rupture

23

dx of vasa praaevia

can be dx antenatally

24

local causes of APH signs

small volume
painless
provoking factor
uterus soft and non tender
no fetal distress
normally sited placenta

25

management of APH

ABCDE for mums safety
fetal safety

26

management for placenta previa

admit
IV access, blood tests/cross match
scan
anti D
steroids
delivery

27

delivery in placenta preview

CS at 37-38 weeks if there is prior bleeding in preg or suspected/confirmed placenta accreta
CS at 38-19 weeks if there has not been bleeding in preg
major bleeding may require preterm delivery

28

antenatal admission criteria and the minimum stay for east

acute bleeding at 23-32 weeks - min stay of 24 hours clear of bleeding

recurrent bleeding after 28 weeks - min stay of 72 hours, consider admitting till delivery

any bleeding after 32 hours - min stay of 72 hours, consider admitting until delivery

major placenta praaevia after 36 weeks with no bleeding - consider shit

29

steroids are given why
how

promotore fetal lung surfactant production
decrease NRDS by 50% if given within 24-48 hours before delivery
administer up to 36 weeks
betamethasone
12mg IM twice 12 hours apart

30

cervical causes management
infection management
Pre term labour
unknown
rupture

colposcopy
swabs/specific rx
steroids +/- tocolysis
conservative
laparotomy/CS

31

planned delivery for suspected or confirmed placenta accreta

CS at 37 weeks
inform blood bank and cross match 6 units of blood
cell salvage should be set up of available

32

post partum haemorrhage how many women
complications

4% of vaginal deliveries

maternal fatigue, feeding difficulties, prolonged hospital stay, delayed lactation, pit infarction, transfusion, haemorrghagic shock, DIC, death

33

PPH definition
primary
secondary
minor
mod
major

>500ml
within 24 hours
>24 hours to 6 weeks
<500ml
500-1500ml
>=1500ml

34

causes for PPH

tone 70%
trauma 20%
tissue 10%
thrombin <1%

35

antenatal risk factors for PPH

anaemia
previous CS
placenta praaevia, parcreta, accrete
previous PPH or retained placenta
multiple pregnancy

36

intrapartum risk factors for PPH

prolonged labour
operative vaginal delivery /CS
retained placenta

37

PPH initial management

uterine massage
5 units IV synctocinon stat
40 units sync in 500mls
hartmanns 125ml/hr

38

persistent PPH management

confirm placenta and membrane comply
urinary caterer
500 mcg ergometrine IV
if vaginal/perineal trauma - repair
transfer for EUA
PGF2 - carbaprost/haemoabate 250mcg IM

39

when should ergometrine be avoided

cardiac disease/hypertension