Bleeding in Late Pregnancy

Question 1

What is the main cause of APH?

Answer 1

Placental abruption; partial/total separation of a normally implanted placenta before birth of the foetus has occurred.

Question 2

In placental abruption, which results in greater abdominal pain; concealed haemorrhage or clear haemorrhage?

Answer 2

Concealed haemorrhage

Question 3

Name 5 risk factors for placenta praevia

Answer 3

PREVIOUS C-SECTION, smoking, past TOP, multiparty and multiple pregnancy.

Question 4

In cases of painless vaginal bleeding, where placenta praevia is part of the differential, should a digital vaginal examination be performed before an USS?

Answer 4

NO; must determine site of placental attachment first.

Question 5

What test is diagnostic for placenta praevia?

Answer 5

Transvaginal US

Question 6

State the 4Ts of PPH

Answer 6

Tone, trauma, tissue and thrombin

Question 7

What are some intrapartum risk factors for PPH? (4)

Answer 7

Prolonged labour, operative vaginal delivery, c-section and retained placenta.

Question 8

Why is placenta accreta associated with a high maternal morbidity?

Answer 8

Severe bleeding and PPH so may end up requiring a hysterectomy.

Question 9

What is the clinical definition for PPH?

Answer 9

Blood loss >500ml after birth.

Question 10

State 2 manual methods of stopping bleeding in PPH

Answer 10

1) Uterine massage

2) Bimanual compression