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

when is bleeding in early pregnancy

A

<24 weeks

2
Q

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

A

> and equal to 24 hours

3
Q

functions of the placenta

A
sole source of nutrition form 6 weeks 
gas transfer 
mtabolism/waste disposal
hormone production 
protective filter
4
Q

definition of antepartum haemorrhage

A

bleeding form the genital tract after 24 weeks of gestation

5
Q

causes of APH

A
placenta previa 20%
placental abruption 30%
local causes such as polyps, cancer, infection 
vasa previa
uterine rupture
6
Q

what is the most comments cause of APH

A

idiopathic

7
Q

what is placental abruption

A

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

8
Q

risk factors for placental abruption

A
PET/hypertension 
trauma
smoking/cocaine/amphetamins
medical such as thromboembolic/renal/DM
polyhydraminios, multiple pregnancy, preterm PROM
abnormal placenta 
recurrence rate 10%
9
Q

what are the two types of placental abruption

A

concealed

revealed

10
Q

what are the clinical features of placental abruption

A

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
Q

ix for placental abruption

A

CTG

12
Q

what is placental previa

A

placenta is partially or totally implanted in the lower uterine segment

13
Q

incidence of placenta previa

A

5% at anomaly scan

1:200 at term

14
Q

classifications of placenta previa old and new

A

old - lateral/marginal/incomplete centralis and complete centralis

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

15
Q

clinical signs and symptoms of placenta previa

CTG readings

A

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

16
Q

dx of placenta previa

A

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

17
Q

what should not be done until placenta previa has been excluded

A

vaginal exam

18
Q

types of delivery with placenta previa

A

major <2cm from os/covering os -> CS

minor >2cm from os -> vaginal delivery

19
Q

what is placenta accreta

A

placenta invades myometrium

20
Q

what are the major risk factors for placenta accreta

A

placenta previa and prior cs

21
Q

what can happen during uterine rupture

what is the common cause

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

previous CS/uterine surgery

22
Q

what is vasa praevia

A

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

23
Q

dx of vasa praaevia

A

can be dx antenatally

24
Q

local causes of APH signs

A
small volume
painless
provoking factor
uterus soft and non tender
no fetal distress
normally sited placenta
25
Q

management of APH

A

ABCDE for mums safety

fetal safety

26
Q

management for placenta previa

A
admit
IV access, blood tests/cross match
scan
anti D
steroids 
delivery
27
Q

delivery in placenta preview

A

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
Q

antenatal admission criteria and the minimum stay for east

A

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
Q

steroids are given why

how

A

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
Q
cervical causes management 
infection management
Pre term labour
unknown 
rupture
A
colposcopy
swabs/specific rx
steroids +/- tocolysis
conservative 
laparotomy/CS
31
Q

planned delivery for suspected or confirmed placenta accreta

A

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

32
Q

post partum haemorrhage how many women

complications

A

4% of vaginal deliveries

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

33
Q
PPH definition 
primary 
secondary 
minor
mod
major
A
>500ml
within 24 hours
>24 hours to 6 weeks
<500ml
500-1500ml
>=1500ml
34
Q

causes for PPH

A

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

35
Q

antenatal risk factors for PPH

A
anaemia
previous CS
placenta praaevia, parcreta, accrete
previous PPH or retained placenta
multiple pregnancy
36
Q

intrapartum risk factors for PPH

A

prolonged labour
operative vaginal delivery /CS
retained placenta

37
Q

PPH initial management

A

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

38
Q

persistent PPH management

A
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
Q

when should ergometrine be avoided

A

cardiac disease/hypertension