bleeding in late pregnancy

Question 1

what is antepartum haemorrhage

Answer 1

bleeding in pregnancy >24 weeks

Question 2

causes of antepartum haemorrhage

Answer 2

placenta praevia
placental abruption 
local causes (cervical cancer etc)
vasa previa 
uterine rupture 
unexplained

Question 3

minor haemorrhage volume

Answer 3

<50mls

Question 4

major haemorrhage volume

Answer 4

50-1000mls (no shock)

Question 5

massive haemorrhage

Answer 5

50-1000ml with shock
OR
blood loss >1000mls

Question 6

what is placental abruption

Answer 6

separation of a normally implanted placenta

Question 7

what is placenta paevia

Answer 7

placenta lies low in uterus

Question 8

pathology of placental abruption

Answer 8

vasospasm followed by arteriole rupture into the decidua
blood in amniotic sac/myometrium
causes tonic contraction and interrupts placental circulation

Question 9

where is lower segment of uterus

Answer 9

below utero-vesical peritoneal pounch

Question 10

difference between major praevia and minor/partial praevia

Answer 10

major - lies over cervical os

minor - doesn’t cover cervical os

Question 11

constant painful bleeding
tender uterus
normal lie/presentation
foetal heart absent/distressed

Answer 11

placental abruption

Question 12

painless bleeding
no pain/tender uterus
lie and presentation may be abnormal
normal foetal heart

Answer 12

placental praevia

Question 13

backache, tender uterus, distressed foetal heart

Answer 13

posterior placental abruption

Question 14

management of placental abruption

Answer 14

resuscitation
fluids?
catheter
urgen CS

Question 15

complications of placental abruption to mother

Answer 15

hypovalaemic shock 
anaemia 
PPH
renal failure (tubular necrosis)
coagulopathy
infection thromboembolism

Question 16

foetal complications of placental abruption

Answer 16

foetal death 
hypoxia 
prematurity 
small for gestational age 
foetal growth restriction

Question 17

risk factors for placental abruption

Answer 17

pre-eclampsia
trauma 
smoking/cocaine/amphetamine 
thrombophilia/diabetes/renal
multiple pregnancy
previous

Question 18

risk factors for placental praevia

Answer 18

previous c section/placental praevia
Asian 
smoker
prev TOP
advanced maternal age 
assisted conception 
deficient endometrium

Question 19

what must not be performed until placental praevia has been excluded

Answer 19

vaginal exam

Question 20

how is placental praevia diagnosed

Answer 20

USS

Question 21

what medications can be given before delivery in placental praevia

Answer 21

steroids 24-34+6 weeks

magnesium sulphate 24-32 weeks

Question 22

when should C section be considered in placental praevia

Answer 22

placenta <2cm from os

mispresentation

Question 23

what is placenta accrete

Answer 23

placenta is abnormally adherent to uterine wall

Question 24

risk factor for placenta accrete

Answer 24

multiple c sections

Question 25

risk factors for uterine rupture

Answer 25

previous c section/uterine surgery multiparous use of prostaglandins obstructed labour

Question 26

symptoms of uterine rupture

Answer 26

severe abdo pain shoulder tip pain collapse PV bleed

Question 27

what is vasa praevia

Answer 27

unprotected foetal vessels transverse the foetal membranes over the cervical os

Question 28

risk factors for vasa praevia

Answer 28

placental anomalies history of low lying placenta multiple pregnancy IVF

Question 29

what is post-partum haemorrhage

Answer 29

blood loss equal to or exceeding 500ml after birth of baby

Question 30

primary post partum haemorrhage

Answer 30

within 24 hours of delivery

Question 31

secondary pph

Answer 31

more that 24 hours after delivery

Question 32

minor PPH volume

Answer 32

500-1000ml | no shock

Question 33

major PPH volume

Answer 33

>100mls | signs of CV collapse/ongoing bleeding

Question 34

causes of PPH

Answer 34

``` 4Ts: tone (most likely) trauma tissue thrombin (least likely) ```

Question 35

intrapartum risk factors of PPH

Answer 35

``` prolonged labour operative vaginal delivery C section retained placenta active management in 3rd stage (syntocinon) ```

Question 36

management for minor PPH

Answer 36

``` IV warmed crystalloid infusion uterine massage - bimanual compression expel clots syntocinon Foley's catheter ```