Bleeding in Late Pregnancy

Question 1

What is bleeding in early pregnancy defined as?

Answer 1

<24 weeks

Question 2

What is bleeding in late pregnnacy known as?

Answer 2

antepartum haemorrhage

Question 3

What is antepartum haemorrhage defined as?

Answer 3

bleeding from the genital tract after 24 weeks gestation and before the end of the second stage of labour

Question 4

What are the causes of APH?

Answer 4

placenta praevia; placental abruption; local causes; vasa previa; uterine rupture

Question 5

What is the differential diagnosis of APH?

Answer 5

heavy show; cystitis; haemorrhoids

Question 6

What is spotting?

Answer 6

staining; streaking or blood spotting noted on underwear or saintary protection

Question 7

What is a minor haemorrhage in APH?

Answer 7

<50ml

Question 8

What is a major haemorrhage in APH?

Answer 8

50-1000ml loss with no signs of shock

Question 9

What is a massive haemorrhage in APH?

Answer 9

> 1000ml and/or chock

Question 10

What is placental abruption?

Answer 10

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

Question 11

How is a diagnosis of placental abruption made?

Answer 11

Clinically

Question 12

How common is placental abruption?

Answer 12

1%

Question 13

What percentage of APH does placental aburption accoutn for?

Answer 13

40%

Question 14

What happens in placental abruption?

Answer 14

vasospasm followed by arteriole rupture into the decidua which causes tonic contraction and interrupts placental circulation

Question 15

What is a complication of placental abruption?

Answer 15

couvelaire uterus

Question 16

what is a couvelaire uterus?

Answer 16

blood from the placental abruption has penetrated the uterine myometrium and is working its way into the peritoneal cavity

Question 17

What are the risk factors for placental abruption?

Answer 17

pre-eclampsia/HT; trauma; smoking/cocaine/amphetamine; medical- thrombophilia/renal/DM; polyhydramnios; multiple prengnacy;

Question 18

What are the symptoms of placental abruption?

Answer 18

severe continous abdo pain; bleeding; preterm labour; maternal collapse

Question 19

What are the signs of placetnal abruption?

Answer 19

uterus LFD; uterine tenderness; woody hard uterus; fetal parts hard to identify; FH- bradycardia/absent; irritable uterus

Question 20

What is an irritable uterus?

Answer 20

1 contraction/min/ FH abnormality

Question 21

Why is placental abruption a clinical diagnosis?

Answer 21

USS will fail to detect 75% of aburptions

Question 22

What is the rate of PPH following placental abruption?

Answer 22

25%

Question 23

What is placenta praevia?

Answer 23

placenta is partially or totally implanted in the lower uterine segment

Question 24

What is the lower segment defined as?

Answer 24

part of the uterus below the utero-vesical peritoneal pouch superiorly and internal os inferioyl

Question 25

What percentage of APH does placenta praevia account for?

Answer 25

20%

Question 26

What is the biggest risk factor for placenta praeiva?

Answer 26

prev C/S

Question 27

What are the risk factors for placenta praevia?

Answer 27

prev C/S; asian; smoking; prev TOP; multiparity; >40yo; mulitple pregnnacy; assisted conception; defieinnt endmetrium

Question 28

What is major praevia?

Answer 28

placenta lies over the internal cervical os

Question 29

what is minor/partial praevia?

Answer 29

leading edgeo f hte placenta is in the lower uterine segment but not covering hte cervical os

Question 30

What is the differnece betwen the bleeding seen with placental abruption and with placenta praevia?

Answer 30

in placenta praevia the bleeding is painless

Question 31

What should not be done before placenta praevia is excluded?

Answer 31

vaginal examination

Question 32

How is placenta praevia diagnosed?

Answer 32

TVUSS

Question 33

What is give nfor neuro-protection between 24-32 weeks?

Answer 33

magnesium sulphate

Question 34

What should couples be told to avoid with expectant mx of placenta praevia?

Answer 34

avoid penetrative sex

Question 35

When should C/S be done with placenta praevia?

Answer 35

placenta <2cm from cervical os

Question 36

When can vaginal deliery be done with placental praevia?

Answer 36

placenta >2cm from os and no malpresentation

Question 37

What is placenta accreta?

Answer 37

morbidly adherent placenta to uterine wall

Question 38

What increases the risk of placenta accreta?

Answer 38

multiple C/S and placenta praevia

Question 39

What is placenta accreta known as if placenta is invading myometrium?

Answer 39

increta

Question 40

What is placenta accreta known if placenta is peentrating uterus to bladder?

Answer 40

precreta

Question 41

What is the blood loss expected with placenta accreta?

Answer 41

>3L

Question 42

What is a Klleihauer test done to asses?

Answer 42

degree of fetomaternal haemorrhage

Question 43

What is the managemtn of placenta accreta?

Answer 43

prophlyactic internal ilac artery balloon; caesarean hysterectomy

Question 44

What is the approximate blood volume in pregnnacy?

Answer 44

100ml/kg

Question 45

What is uterine rupture?

Answer 45

full thickness opening of uterus

Question 46

What are the risk factors for uterine rupture?

Answer 46

prev C/S/uterine surgery; multiparity; IOL; obstructed labour

Question 47

What are the symptoms of uterine rupture?

Answer 47

severe abdo pain; shoulder-tip pain; maternal collapse; PV bleeding

Question 48

What are the signs of uterine rupture?

Answer 48

intra-partum- loss of contractions; acute abdo; presenting part rises; peritnosim; fetal distress

Question 49

What is vasa praevia?

Answer 49

unprotected fetal vessels traverse the fetal membraens over the interal cervical os

Question 50

What is seen with artifical rupture of membranes in vasa praevia?

Answer 50

sudden bleeding and fetal bradycardia/ death

Question 51

What are the risk factors for vasa praevia?

Answer 51

placental anomalies; hx of placental praevia; multiple pregnancy; IVF

Question 52

What is PPH defined as?

Answer 52

blood loss >=500ml after second stage of labour

Question 53

What is primary PPH?

Answer 53

within 24hr of delivery

Question 54

What is secondary PPH?

Answer 54

>24hrs-6/52 post delivery

Question 55

What is minor PPH?

Answer 55

500-1000ml without shock

Question 56

What is major PPH?

Answer 56

>1000ml or signs of CVS collpse or ongoing bleeding

Question 57

What are the 4Ts in PPH causes?

Answer 57

tone; trauma; tissue ; thrombin

Question 58

What are the antenatal PPH?

Answer 58

anaemia; prev C/S; placenta praevia; percreta; prev PPH; multiple pregnancy; polyhydramnios; obesity; macrosomia

Question 59

What are hte intra-partum RF for PPH?

Answer 59

prolonged labour; operative vaginal delivery; C/S; retianed section

Question 60

What should be done to prevent PPH?

Answer 60

active mx of thrid stage

Question 61

What is active mx of the thrid stage of labour?

Answer 61

syntocinon/ syntometrin IM/IV

Question 62

What are hte measures for minor PPH?

Answer 62

IV access; bloods; obs; IV warmed crystalloid infusion

Question 63

How can bleeding be stopped in PPH?

Answer 63

uterine massage- bimanual compression; expel clots; IV syntocinon; foleys catheter; ergoemtrine

Question 64

Who should ergometrine be avoided in?

Answer 64

cardiac disease and HT

Question 65

What fluids are used in PPH?

Answer 65

crystalloid Hartmann's

Question 66

What should be exclusded with secondary PPH?

Answer 66

retained products of conception

Question 67

Waht is likely to play a role in secodnary PPH?

Answer 67

infection

Question 68

What are the 3 important things to remmebr in APH?

Answer 68

Kleihauer; anti-D and steroids