Bleeding in Pregnancy Flashcards by Clare Matheson

What is considered “early pregnancy”

<24 weeks

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What 4 main infections put pregnant woman at risk of miscarriage

Cytomegalovirus (CMV)
Rubella
Toxoplasmosis
Liseria

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In miscarriage is the bleeding usually greater than the pain or the pain greater than the bleeding?

Bleeding > pain

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What is a complication of miscarriage

Cervical shock

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What conditions can cause recurrent miscarriages

Antiphospholipid Syndrome
Thrombophilia
Balanced translocation
Uterine abnormality

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Where is the most common place to get an ectopic pregnancy

Ampullary

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Where is referred pain during an ectopic pregnancy sometimes felt?

Shoulder-tip pain

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What drug is used in the medical management of ectopic pregnancy?

Methotrexate

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Histologically, placental tissue shows chorionic villi swollen with fluid giving picture of “grape like clusters”. What does this indicate?

Molar pregnancy

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What is the difference between incomplete and complete molar pregnancies

Complete = egg without DNA + 1 or 2 sperm (paternal contribution only)

Incomplete = haploid egg + o 1 sperm (reduplicating DNA material) or 2 sperms fertilising egg, result in triploidy (69XXY)

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Which of the 2 types of molar pregnancies may also include a fetus?

Incomplete

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What does a complete molar pregnancy look like on ultrasound?

A snowstorm appearance

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What cancer does molar pregnancy put you more at risk of?

Choriocarcinoma

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What is the definition of an antepartum haemorrhage?

Bleeding from the genital tract after 24 weeks gestation and before the end of the second stage of labour

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What test should be given to RhD negative women who present with antepartum haemorrhage

Kleihauer test - to quantify fetomaternal

haemorrhage in order to gauge the dose of anti-D immunoglobulin required

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What drug should be given to babies between 24-34 weeks at risk of preterm birth

Corticosteroids

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What is the definition of placental abruption?

Separation of a normally implanted placenta before the birth of the fetus

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What are the risk factors for placental abruption?

Pre-eclampsia/ Hypertension
Trauma
Smoking/Cocaine/Amphetamine
Medical Thrombophilias/Renal diseases/Diabetes
Poly-hydramnios
Multiple pregnancy
Premature rupture of membranes (PROM)
Abnormal placenta
Previous Abruption = recurrence 10%

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How does the uterus feel in placental abruption?

Woody hard uterus

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How do you diagnose placental abruption?

It’s a clinical diagnosis - you don’t have time to look for the clot that caused the vasospasm/rupture

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What are the risk factors for placental praevia?

Previous c-section
Smoking
Assisted reproduction
Previous TOP
Multiparity
> 40 years
Multiple pregnancy
Deficient endometrium (uterine scar, endometritis etc)

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What does the placenta cover in placental praevia?

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The internal os

What other cause of antepartum haemorrhage is associated with placental praevia?

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Placenta accreta

What examination should you not do in placental praevia?

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Vaginal examination

What is the difference between placenta accreta, placenta increta and placenta percreta?

Accreta = placenta adherent to uterine wall Increta = placenta invading myometrium Percreta = placenta penetrating to uterus and bladder

What are the risk factors for placenta accreta?

- Placenta praevia | - Multiple c-sections

What are the risk factors for uterine rupture?

* Previous c-section / uterine surgery * Multiparity * Use of prostaglandins/ syntocinon * Obstructed labour

Describe briefly the pathophysiology behind placental abruption

Vasospasm causes arteriole rupture. Blood escapes under placental and into myometrium which causes contraction and interruption of placental circulation. Baby becomes hypoxic

Describe the pain of placental abruption

Severe and continuous (labour pain is intermittent)

If a placenta is posterior and placental abruption occurs, what symptom may be present that would not be present with an anterior placenta

Backache

If a patient presents with severe continous abdominal pain and a woody hard uterus but only minimal bleeding, what would you be concerned about?

That it is placental abruption but the bleeding is concealed

What would the CTG show during placental abruption?

Abnormal fetal heart and irritable uterus

A complication of placental abruption is a couvelaire uterus. Describe this

A haematoma bruised uterus - a life-threatening condition in which placental abruption causes bleeding that penetrates into the uterine myometrium forcing its way into the peritoneal cavity

How severe is the painless bleeding in placenta praevia?

Any severity from spotting to severe

Bleeding in placenta praevia is usually unprovoked. What is the one thing that is likely to provoke it?

Penetrative vaginal sex

If a woman with placenta praevia is not bleeding, what is the management?

- No sex - Corticosteroids between 34+0 and 35+6 weeks - Mg SO4 for neuro-protection at 24-32 weeks - Delivery via planned c-section at 36-37 weeks

If a woman with placenta praevia is bleeding, what is the management?

- Conservative management if stable / ABCDE - Anaemia prevention / treatment - Steroids and magnesium sulphate - • Delivery – 34+0 to 36+6 weeks

What drug can be used to conservatively manage placenta accreta?

Methotrexate

What is the last resort if bleeding from placenta accreta cannot be controlled?

Caesarean hysterectomy

Where can the pain be felt in uterine rupture?

Severe abdominal pain +/- shoulder-tip pain

What will a CTG show during uterine rupture?

Loss of contractions and fetal distress

What happens to the presenting part in uterine rupture?

It rises

What treatment should be given to RhD negative women who present with antepartum haemorrhage

ABCDE + anti-D + steroids

What drug can be used to conservatively manage ectopic pregnancies?

Methotrexate

What is implantation bleeding?

bleeding from fertilised egg when it implants in the uterine wall at around 10 days post ovulation

What is a chorionic haematoma?

Pooling of blood between endometrium and the embryo due to separation

What is the treatment of chorionic haematoma?

Surveillance - usually self-limiting

What is a complication of chorionic haematoma?

Miscarriage

What is vasa previa?

Unprotected fetal vessels traverse the membranes below the presenting part over the internal cervical os

What are the symptoms of vasa previa?

Waters breaking + sudden dark read bleeding and fetal bradycardia

What is the mortality rate of vasa previa?

60%

What are the 4 Ts of PPH?

- Tone - Trauma - Tissue - Thrombin

What is the timeline of primary vs secondary PPH?

``` Primary = within 24hrs of delivery Secondary = 6 weeks post delivery ```

What uteri-tonic agents can be given in uterine atony causing PPH

Syntocinon, misoprostol, ergometrine (not in cardiac disease)

Bleeding in Pregnancy Flashcards

(54 cards)