O&G Written - Obs Emergencies

Question 1

Risk factors for Placental Abruption

Answer 1

ABRUPTION

Abruption (previously)
Blood pressure - HTN, PET
Ruptured membranes - prolonged, premature
Uterine injury
Polyhydramnios
Twins
Infection - chorioamnionitis
Older maternal age (>35)
Narcotics - cocaine, meth

+ Smoking, multiparity

Question 2

Planning delivery in placental abruption

Answer 2

<34 weeks gestation + both stable –> monitor on ward + give steroids

> 37 weeks + no foetal compromise –> IOL with amniotomy

• close foetal monitoring
• CS if distress

Severe haemorrhage or foetal distress –> EMCS

Foetal death –> IOL + blood products

Question 3

Immediate management in placental abruption

Answer 3

A-E resus + ADMIT

• IV fluids + blood products
• Bloods - X match, clotting, FBC

ICU if severe

• Opiate analgesia
• Catheterisation + hourly urine output

Question 4

Key presenting features of placental abruption

Answer 4

Pain - severe, constant with exacerbations

PV bleed - dark if visible, may be ‘concealed’

Tender, contracting uterus + ‘woody’ if severe

Maternal shock - out of keeping with visible loss (esp. if concealed)

Tachycardia, hypotension in profound - massive blood loss

Foetal HR abnormalities or absence (distress or death)

Question 5

Types of vasa praevia

Answer 5

Type 1 - velamentous umbilicus inserts into foetal / chorioamniotic membranes instead of centre of foetus

Type 2 - bilobed placenta with thin chorion tissue connecting (‘succenturiate’ lobe if 1 is much smaller)

Question 6

Typical presentation of vasa praevia

Answer 6

Painless PV bleed + foetal compromise (bradycardia) at ROM

Question 7

Important rule in investigating PV bleed?

Answer 7

DO NOT perform vaginal exam

• can cause massive haemorrhage
• only if vasa praevia, placenta praevia definitively ruled out!