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3 Reproduction and Sexual Health > Bleeding in Late Pregnancy > Flashcards

Bleeding in Late Pregnancy Flashcards

(78 cards)

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1
Q

bleeding in late pregnancy is identified as bleeding >_ weeks

A

24

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2
Q

causes of PPH?

A

atonic uterus

genital tract trauma

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3
Q

don’t give more than _ litres of crystalloid to a pregnant woman as resus

A

2

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4
Q

the placenta becomes the sole source of baby’s nutrition from _ weeks gestation

A

6

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5
Q

functions of the placenta?

A

gas transfer
metabolism/waste disposal
hormone production
prtection

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6
Q

when does APH become PPH?

A

after 2nd stage of labour

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7
Q

local causes of APH?

A

cervical ectropion
polyps
cervical cancer
infection eg cervicitis, STI

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8
Q

placental causes of APH?

A

placenta praevia

placental abruption

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9
Q

what is heavy show?

A

mucus and blood that comes before labour

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10
Q

DDx of APH?

A

heavy show
UTI
haemorrhoids

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11
Q

minor APH is

A

50

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12
Q

major APH is

A

50 to 100

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13
Q

massive APH is >___ml

A

1000

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14
Q

shock is present in ___ APH

A

massive

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15
Q

if the blood from the patient has extended to their feet on the bed it indicates what kind of haemorrhage?

A

minor to major

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16
Q

define placental abruption

A

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

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17
Q

describe the pattern of pain in placental abruption?

A

continuous

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18
Q

pathology of placental abruption?

A

vasospasm -> arteriole rupture into the decidua -> blood escapes into amniotic sac or into myometrium -> causes tonic contraction -> less blood in placenta = hypoxia

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19
Q

placental abruption results in what kind of uterus?

A

couvelaire (haematoma bruises uterus)

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20
Q

symptoms of PA?

A

severe continuous abdo pain
backache if posterior placenta
bleeding
preterm labour

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21
Q

risk factors for PA?

A 
hypertensive cause eg PET
trauma eg RTA
smoking/cocaine/amphetamine
thrombophilias
renal disease
diabetes
polyhydramnios
multiple pregnancy
abnormal placenta
previous abruption
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22
Q

signs of PA?

A 
unwell distressed patient
uterus large or normal
uterine tenderness
woody hard uterus
fetal parts hard to identify
preterm labour with heavy show
fetal heart in bradycardia/absent
CTG shows irritable uterus
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23
Q

irritable uterus on CTG appears like..

A

1 contraction a min

fetal heart in tachycardia, loss of variability, presence of decelerations

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24
Q

Ix of PA?

A 
clinical diagnosis
FBC
clotting factors
LFT
U+Es
crossmatch
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25
Tx of PA
resuscitate mother - fluids, blood, catheter assess and delivery baby manage complications - steroids debrief patients
26
what MDT members are involved in a category 1 CS?
``` midwives obstetrician anasthetists neonatal team theatre nurses haematologist ```
27
how is FH assessed in PA?
CTG | do USS if undetectable
28
complications for the mother in PA?
``` hypovolaemic shock anaemia kidney failure - renal tubular necrosis coagulopathies thromboembolism PPH ```
29
complications for fetus in PA?
``` RDS if lack of steroids given intrauterine death prematurity SGA FGR ```
30
how can you prevent PA in some patients?
if APS: LMWH and LDA smoking cessation LDA
31
define minor and major placenta praevia
MINOR: if leading edge of placenta is in the lower uterine segment but not covering the os MAJOR: placenta lying over the internal os of the cervix - "a low lying cervix"
32
the __ segment of the uterus is thinner and contains less muscle fibres
lower
33
the lower segment of the uterus is about _cm from the internal os
7
34
CS rate in UK?
25-30%
35
risk factors for placenta praevia?
``` previous CS previous PP asian smoking previous ToP esp surgical multiparity age ART ```
36
what can cause a mother's endometrium to become deficient?
``` uterine scar endometritis manual removal of placenta curettage submucous fibroid ```
37
scans are done at what gestation to check the placental position?
20 weeks | 32 weeks
38
why should you not do a digital VE in PP?
putting finger into placenta and triggering bleeding
39
painless bleeding >24 weeks...
PP
40
describe the bleeding in PP and what can cause it
unprovoked/triggered by coitis painless can be spotting or severe
41
signs of PP
condition proportional to bleeding uterus soft non tender presenting part high baby's position abnormal
42
describe CTG in PP
normal
43
Ix of PP
transvaginal USS check previous anomaly scans MRI to exclude placenta accreta
44
Tx of PP
resus mother assess baby conservative mananagement until stable (keep in for 24hrs) avoid sex
45
when should you deliver the baby if you spot a PP in a mother?
36 weeks (planned CS)
46
what extra precautions are taken management wise for Rh negative mothers
kleihauer test | give anti D
47
how many units of blood are given in placental bleeding emergencies?
4-6 units
48
what medication is given in advance ifa PP is known?
steroids from 24-35 weeks | MgSO4 from 24-32 weeks
49
what determines whether you do a vaginal or CS delivery in PP?
CS if placenta <2cm from os | SVD if placenta >2cm from os and baby's position is fine
50
define placenta accreta
morbidly adherent placenta
51
what increases risks of PAcc?
multiple C sections | PP
52
presentation of PAcc?
severe bleeding | PPH
53
Tx of PAcc?
prophylactic internal iliac artery balloon CS hysterectomy resus for expected blood loss
54
blood loss of >_ml is expected in PAcc
3l
55
define uterine rupture
full thickness opening of uterus
56
risks for uterine rupture?
previous CS IOL (induced labour) multiparity use of PGs/syntocinon
57
symptoms of uterine rupture
shoulder tip pain from inflam of diaphragm severe abdo pain collapse of mum PV bleeding
58
why do you get shoulder tip pain in uterine rupture?
inflammation of diaphram (referred)
59
signs of uterine rupture?
``` loss of contractions acute abdomen PP loss of uterine contractions peritonism fetal distress or IUD ```
60
Tx of uterine rupture
resus - IV fluids laparotomy if complete rupture/CS 4-6 units blood anti-D
61
define vasa praevia
unprotected fetal vessels traverse the fetal membranes over the internal cervical os
62
Ix of vasa praevia
doppler TA and TV USS
63
symptoms of VP
sudden bleeding | fetal bradycardia or death
64
risk factors for VP
placental anomalies history of PP in 2T multiple pregnancy IVF
65
Tx of VP
steroids from 32 weeks | deliver by elective CS 34-36wks
66
PPH is blood loss equal to or exceeding ___ml after birth
500
67
what time frame divides primary and secondary PPH
24hrs (if under = primary)
68
name the 4 T's causes of PPH
tone - uterine atony trauma - vaginal tear, cervical laceration, rupture tissue - anything left inside thrombin - coagulopathy?
69
antenatal risk factors for PPH
``` anaemia previous CS/PPH/retained placenta multiple pregnancy polyhydramnios big baby or big mother ```
70
intrapartum risk factors for PPH
prolonged labour operative vaginal delivery CS retained PPH
71
Tx of mother with PPH?
syntocinon/syntometrine IM/IV IV grey/orange cannula for taking bloods and giving warmed crystalloid infusion and blood (6 units) vitals every 15 mins
72
what bloods should always be taken in obstetric emergencies?
``` G+S FBC coag screen LFTs lactate cross match ```
73
how often should vitals be assessed in PPH?
every 15 mins
74
_ units of blood should be given in PPH
6
75
how can you stop the blood in PPH
``` uterine massage by bimanual compression expel clots manually 5 units IV syntocinon misoprostol 800mcg PR transexamic acid 0.5-1mg IV balloons eg rusch balloon IR - arterial embolisation ```
76
surgical Tx of PPH
brace sutures uterine artery/IIA ligation hysterectomy last option
77
Ix of secondary PPH
USS
78
common causes of secondary PPH
retained products of conception (RPOC) | infection

3 Reproduction and Sexual Health (51 decks)

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