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Women's health > Bleeding in pregnancy > Flashcards

Bleeding in pregnancy Flashcards

1
Q

Placental abruption : Risk factors

A

Factors which cause vasocontriction of the uterine arteries such as;
1. * Smoking
1. * Chronic hypertension
1. * Cocaine and methamphetamine use
1. * Multiparity and increased maternal age
1. * Trauma

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1
Q

Placental abruption : Pathophysiology

A
  1. Seperation of the placenta from the surface of the uterus leading to bleeding into the myometrium
  2. Caused by degemeration of the uterine arteries which supply blood to the placenta
  3. Diseases vessels rupture, causing haemorrhaging and seperationg of the placenta
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2
Q

Placental abruption : Clinical features

A
  1. Abdominal pain
  2. Mild to severe vaginal bleeding } may not be in proportion to blood loss and blood may accumulate within the myometrium surface
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3
Q

Placental abruption : Clinical signs

A
  1. Tense uterus : Myometrium contracts to reduce bleeding
  2. Fetal bradycardia } intrauterine hypoxia due to loss of placenta
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4
Q

Placental abruption : complications

A
  1. DIC : may lead to excessive vaginal bleeding
  2. Hypovolaemic shock
  3. Sheehan’s syndrome : pituitary necorsis
  4. Premature birth
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5
Q

Placental abruption : Investigation

A
  1. Ultrasound : show retroplacental blood collection
  2. Foetal HR : Deceleration of foetal heart beat
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6
Q

Placental abruption : Management

A

Indication :
Severe haemorrhaging or foetal compromise : Urgent C-section

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7
Q

Placenta previa : Definition

A

Implantation of the placenta in the lower segment of the uterus - close to or covering the cervical os

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8
Q

Placenta previa : Pathophysiology

A
  1. Implantation near or over the cervical os
  2. Uterine segment grow
  3. Distruption of the uterine blood vessels
  4. Resulting in ; Vaginal bleeding
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9
Q

Placenta previa : Classification

A

⦁ I - placenta reaches lower segment but not the internal os
⦁ II - placenta reaches internal os but doesn’t cover it
⦁ III - placenta covers the internal os before dilation but not when dilated
⦁ IV (‘major’) - placenta completely covers the internal os

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10
Q

Placenta previa : Causes

A
  1. Placenta inplants in the lower uterus due to endometrium in the upper uterus not being well vascularised
  2. Secondary to previous endometrial damage
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11
Q

Placenta previa : Risk factors

A
  1. Multiple gestations ie. multiple placenta
  2. Previous C section/Uterine surgery } likely to implant on a lower segment scar from previous C section
  3. Multiparity
  4. Intrauterine fibroids
  5. Materanal age >.35
  6. Smoking
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12
Q

Placenta previa : Clinical features

A
  1. Vaginal bleeding } in proportional to blood loss/haemodynamic stability
  2. Pain free - bleeding frm placenta, not the uterus
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13
Q

Placenta previa : Clinical signs

A
  1. Non tender uterus
  2. Avoid Bimanual exam before US } may provoke haemorrhage
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14
Q

Placenta previa : Diagnosis

A

Transvaginal ultrasound } picked up at 20 weeks routine abdominal US

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15
Q

Placenta previa : Mangement with vaginal bleeding

A

⦁ Admit
⦁ ABC approach to stabilise the woman
⦁ if not able to stabilise → emergency caesarean section
⦁ if in labour or term reached → emergency caesarean section

16
Q

Placenta previa : Mangement w/o bleeding

A

i. If low-lying placenta at the 20-week scan:
ii. rescan at 32 weeks
iii. if still present at 32 weeks

  1. Grade I/II -> scan every 2 weeks
    I. final ultrasound at 36-37 weeks to determine the method of delivery
  2. Grade I : then a trial of vaginal delivery may be offered
  3. Grades III/IV : elective caesarean section between 37-38 weeks
17
Q

Placenta previa : Main complication

A

Post partum Haemorrhage

18
Q

Placenta accreta : Definition

A
  • Attachment of the placenta to the myometrium, due to a defective decidua basalis
  • Chorionic villi attatch to the myometrium
19
Q

Placenta accreta : Pathophysiology

A
  • Adherence of chorinionic villi directly to the myometrium
  • Placenta fails to fully seperate after foetum is delivered
  • Partial/incomplete seperation } induces post partum haemorrhaging
20
Q

Placenta accreta : Clinical signs and symptoms

A
  1. Placenta fails to spontaneiously deliver after foetal birth
  2. Manual seperation } increases bleeding
  3. ‘Boggy/Soft’ uterus unresponsive to uterine massage } 2nd to Myometrium haemorrhaging
21
Q

Placenta accreta : Risk factors

A

i. Previous caesarean section
ii. Placenta praevia

22
Q

Placenta accreta : Complication

A

Post partum haemorrhage

23
Q

Post partum haemorrhage : Definition

A

Excessive blood loss after giving birth
* > 500ml after vaginal delivery
* >100ml after Caesarean delivery

24
Q

Post partum haemorrhage : Types

A

> Primary : within 24 hours after delivery
Secondary : >24 hours but <6 weeks post partum

25
Q

Post partum haemorrhage : Causes

A
  1. Tone : Uterine atony } Most common cause
    ineffective uterine contraction to clamp and stop arterial bloodless
    * Causes : Excessive myometrium stretching (Multiple gestation
    -Polyhydramnios) or fatigue in prolonged labour or full bladder (can interfere with contractions)
  2. Trauma: damage to reproductive structure
    * Causes : incision, uterine rupture, large foetus
  3. Tissue: retained placental fragments
    * Causes : Placenta accrete
  4. Thrombin : impaired clotting
26
Q

Post partum haemorrhage : Secondary haemorrhage causes

A

Retained placental tissue or endometritis

27
Q

Post partum haemorrhage : Risk factors

A
  1. Previous PPH
  2. Prolonged labour
  3. Pre eclampsia
  4. Increased maternal age
28
Q

Post partum haemorrhage : Management - Mechanical

A
  1. Palpate fundus and rub to stimulate contraction
29
Q

Post partum haemorrhage : Management - Medical

A
  1. IV Oxytocin: Stimulates uterine contraction
  2. IV Ergometrine: Vasoconstriction and stimulates uterine contraction
    -Avoid in hypertension
  3. IV Carboprost : Stimulate uterine contraction
    -Prostaglandin analogue : can cause bronchoconstriction
    -Avoid in asthma
  4. Misprostol sublingual: prostaglandin analogue
30
Q

Post partum haemorrhage : Management - Surgical

A

First line : Intrauterine Balloon tamponade

31
Q

Gestational trophoblastic disease : Definition

A

Describes a spectrum of disorders originating from the placental trophoblast:
* complete hydatidiform mole
* partial hydatidiform mole
* choriocarcinoma

32
Q

Complete hydatiform mole : Definition

A
  1. Benign trophoblastic tumor
  2. Empty egg is fertilized by a single sperm that then duplicates its own DNA
  3. Egg : 46 chromosomes of paternal origin
33
Q

Partial hydatiform mole : Definition

A

a normal haploid egg may be fertilized by two sperms, or
by one sperm with duplication of the paternal chromosomes
Usually triploid - e.g. 69 XXX or 69 XXY. Fetal parts may be seen

34
Q

Gestational trophoblastic disease : Clinical feature

A
  • bleeding in first or early second trimester
  • exaggerated symptoms of pregnancy e.g. hyperemesis
  • uterus large for dates
  • very high serum levels of human chorionic gonadotropin (hCG)
  • hypertension and hyperthyroidism* may be seen
35
Q

Gestational trophoblastic disease : Management

A
  1. urgent referral to specialist centre - evacuation of the uterus is performed
  2. effective contraception is recommended to avoid pregnancy in the next 12 months

Women's health (12 decks)

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