Bleeding In Late Pregnancy

Question 1

definition of bleeding in late pregnancy

Answer 1

> 24 weeks

Question 2

definition of antepartum haemorrhage

Answer 2

bleeding from or into the genital tract occurring from 24 weeks gestation prior to birth of the baby

Question 3

causes of antepartum haemorrhage

Answer 3

Placenta praevia
Placental abruption 
Local causes- polyps, cancer, ectropion, infection 
Vasa previa
Uterine rupture

Question 4

minor antepartum haemorrhage

Answer 4

blood loss <50ml that has settled

Question 5

major antepartum haemorrhage

Answer 5

blood loss 50-1000ml, no signs of shock

Question 6

massive antepartum haemorrhage

Answer 6

blood loss >1000ml and/or signs of shock

Question 7

what is placental abruption

Answer 7

separation of a normally implanted placenta partially, or totally, before birth

Question 8

causes of placental abruption

Answer 8

pre-eclampsia 
Trauma 
Smoking/cocaine/amphetamine
Renal disease
diabetes
Polyhydramnios 
multiple pregnancy

Question 9

Pathology of placental abruption

Answer 9

vasospasm followed by arteriole rupture into the decidua- blood escapes into the amniotic sac/myometrium
Causes tonic contraction and interrupts placental circulation which causes hypoxia
Results in couvelaire uterus

Question 10

what is couvelaire uterus

Answer 10

bleeding that penetrates through myometrium into peritoneal cavity
LIFE THREATENING

Question 11

Symptoms of placental abruption

Answer 11

severe abdominal pain- continuous

‘Wooden hard’ abdomen

Question 12

management of abruption

Answer 12

Resuscitate mother

Assessment + delivery of baby

Question 13

what is placenta praevia

Answer 13

placenta is partially or totally implanted in the lower uterine segment
‘low lying placenta’

Question 14

how is placenta praevia classified

Answer 14

major - anything covering the cervix
minor- not covering cervix

Diagnosed via ultrasound

Question 15

biggest risk factor for placenta praevia

Answer 15

previous C-section

Question 16

signs/symptoms of placenta praevia

Answer 16

painless bleeding >24 weeks
Uterus soft + non tender
Malpresentations- breech/transverse/oblique
High head

Question 17

Investigation of placenta praevia

Answer 17

Transvaginal USS

Question 18

management of placenta praevia

Answer 18

Delivery plan at/near term

C-section if major
Consider vaginal delivery if placenta >2cm away from os and no malpresentation

Question 19

what is placenta accreta

Answer 19

placenta invades myometrium

Question 20

symptoms of placenta accreta

Answer 20

severe bleeding

Post partum haemorrhage

Question 21

risk factors for placenta accreta

Answer 21

placenta praevia

Prior C-Section

Question 22

management of placenta accreta

Answer 22

prophylactic internal iliac artery balloon

caesarean hysterectomy

Question 23

what is a uterine rupture

Answer 23

full thickness opening of the uterus

Question 24

what are most uterine ruptures caused by

Answer 24

c-sections

Question 25

symptoms of uterine rupture

Answer 25

severe abdo pain shoulder tip pain bleeding

Question 26

what is vasa praevia

Answer 26

blood vessels within the placenta or the umbilical cord that are trapped between the foetus and the opening to the birth canal

Question 27

why is vasa praevia worrying

Answer 27

can cause fetal death due to blood loss

Question 28

risk factors for vasa praevia

Answer 28

placental anomalies history of low lying placenta IVF multiple pregnancy

Question 29

what would make you think that the cause of antepartum haemorrhage is local

Answer 29

small volume of blood Painless Uterus soft + non tender No fetal distress

Question 30

definition of post partum haemorrhage

Answer 30

Blood loss equal to or exceeding 500ml after the birth of the baby

Question 31

primary post partum haemorrhage

Answer 31

within 24h of delivery

Question 32

secondary post partum haemorrhage

Answer 32

>24h post delivery

Question 33

minor post partum haemorrhage

Answer 33

500ml-1000ml, no shock

Question 34

major post partum haemorrhage

Answer 34

>1000ml or signs of shock

Question 35

causes of Post partum haemorrhage

Answer 35

4 T's Tone Trauma Tissue Thrombin

Question 36

risk factors for post partum haemorrhage

Answer 36

``` anaemia C-section Placenta praevia/accreta prolonged labour retained placenta ```

Question 37

initial management of post partum haemorrhage

Answer 37

assess Stop the bleeding - uterine massage, 5 units IV syntocinon fluid replacement - crystalloid Hartmann's 0.9% saline

Question 38

Treatment of vasa praevia

Answer 38

C-section

Question 39

Treatment of placenta accreta

Answer 39

Hysterectomy

Question 40

why is betamethasone given before delivery in placenta praevia

Answer 40

promote fetal lung surfactant production- decreased risk of neonatal RDS

Question 41

What drug can be given to delay the delivery of a baby by a short period of time

Answer 41

tocolysis