Bleeding, Rh disease + liver Flashcards
(29 cards)
what are the causes of APH in 1/3 and 3/3?
1/3 = miscarriage, molar, ectopic
3/3 = placenta previa, vasa previa, placental abruption
What are the 2 types of haemorrhage?
antepartum (APH)
Postpartum (PPH)
Bleeding from 24 weeks to birth:
minor?
major?
<50ml
50-100ml
PPH types?
1^ = <24hrs
2^ = 24hrs - 6 weeks
OF BABY DELIVERY NOT PLACENTA
What is minor, moderate and severe blood loss in PPH?
Minor = 500-1000ML
Mod = 1000-2000ml
Severe = 2000+ ml
C section blood loss to be a PPH must be?
1000ml
RF for PPH?
Polyhydromnios, prolonged labour, pHx c section, APH, Recent bleeding Hx, Twins, uterine fibroid, multi-parity
4 causes of PPH?
MC = Tone (UTERINE ATONY)
Tissue (retained tissue)
Thrombin (DIC)
Trauma (perineal tears, uterine rupture)
Why does uterine atony cause PPH?
Low tone = less pressure on spiral arterioles therefore more dilation
+ blood filling —> bleed (long labour)
Tx for atony?
Fundal massage + empty bladder (inc catheterise)
2 x 14G large bore (grey) cannulae for IV fluid + transfusion (after group + save)
IV oxytocin (inject then infuse) then IV ERGOMETRINE (Uterotonics)
Fails = surgical
What are the surgical options for atony?
Intrauterine balloon tamponade
B Lynch sutures
Umbilical artery ligation
Hysterectomy
Tx for retained tissue?
surgical D+C
What to do in major PPH?
ABCDE
1. Call for help
2. cross match group + save & have blood transfusion ready
Complication of Haemorrhages?
DIC
Shock = death
Sheehan syndrome
What is sheehan syndrome?
sx?
hypopituitarism due to ischemic necrosis anterior pituitary in major PPH
Sx: 2^ amenorrhoea, agalactorrhoea, low T4
What is rheumatic disease in pregnancy?
Prior sensitisation in Rh - mum from Rh + child
2nd child = T2 hypersensitivity
Results in IgG transplacental RhIgG causing fetal distress in utero
RF of Rh disease?
caucasian
having Rh + before (as Rh-)
How can you become Sensitised?
APH, Placental abruption
intrauterine death, miscarriage, TOP
Ectopic
delivery
Rh+ transfusion from Rh- women
amniocentesis/CVS
What are the Sx of Rh disease?
Erythroblastosis fetalis - yellow amniotic fluid due to high bilirubin (haem anemia)
Hydrops fetalis - portal htn, pul htn, congestive HF therefore Widespread oedema + resp distress
Dx for Rh disease?
+ve COOMBS
+ve KLEIHAUER (fetomaternal haemorrhage size - gives idea of DOSE
Increased reticuloblasts
Amniocentesis/CVS - Yellow amniotic fluid aspirate
Tx Rh disease?
prevention?
Tx for baby?
Prevent - RhoGAM (28 wk + 34wk to Rh- mums), give intrapartum + in miscarriage/TOP (IM injection)
Tx = ABCDE + Transfusion (+ jaundice)
What are the 2 liver issues in pregnancy?
obstetric cholestasis
acute fatty liver of preg
What is obstetric cholestasis?
time?
> 24 weeks
impaired bile flow = accumulation of bile acids
Sx of obstetric cholestasis?
pruritus palms + soles
GI Sx
abdo pain 3/3
around 34 weeks
worse at night, look well
