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Obs Flashcards

1
Q

What is placenta praevia?

A

The placenta lying wholly or partly over the internal os

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2
Q

What percentage of patients will have low-lying placenta when scanned at 16-20 weeks?

A

5%

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3
Q

What is the incidence of placenta praevia at delivery?

A

0.5%

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4
Q

What are the risk factors for placenta praevia?

A
  • Previous uterine scars (C-sections, more c-sections higher risk)
  • Advanced maternal age (>35)
  • Multiparity
  • Multigravity
  • Assisted reproductive technology
  • Maternal smoking
  • Previous placental praevia
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5
Q

Why are c-sections a risk factor for placenta praevia?

A

Because embryos are more likely to implant on a lower segment scar from a previous c-section

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6
Q

When are the highest rates of complications for placental praevia observed?

A

When they are diagnosed at delivery

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7
Q

What is the difference between low lying placenta and placenta praevia?

A
  • Low lying = less than 20mm from the internal os
  • Praevia = covering the os
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8
Q

What are the clinical features of placenta praevia?

A
  • Shock
  • No pain
  • No uterine tenderness
  • Normal fetal heart sound
  • Coagulation problems are rare
  • Small bleeds during 2nd half of pregnancy, prior to larger bleeds
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9
Q

When are patients screened for placenta praevia?

A

During the mid-pregnancy (fetal anomaly) scan at between 18-21 weeks of pregnancy

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10
Q

What is recommended if placenta praevia is suspected after mid-pregnancy scan?

A

A follow-up TV ultrasound at 32 weeks of gestation

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11
Q

What is recommended if placenta praevia is confirmed at 32 week TV ultrasound?

A

An additional TV ultrasound at 36 weeks of gestation to inform discussions about mode of delivery

If grade 1/2, scan every 2 weeks

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12
Q

How does cervical length help facilitate the management of placenta praevia?

A

A short cervical length on TVS before 34 weeks gestation increases the risk of preterm emergency delivery and massive haemorrhage at c-section

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13
Q

What is the classical grading of placenta praevia?

A
  • 1- placenta reaches lower segment but not the internal os
  • 2- placenta reaches internal os but doesn’t cover it
  • 3- placenta covers the internal os before dilation but not when dilated
  • 4- placenta completely covers the internal os
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14
Q

What is the mode of delivery for placenta praevia grade 3/4?

A

Elective caesarean between 37-38 weeks

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15
Q

What is the mode of delivery for placenta praevia grade 1 at 36-37 weeks?

A

Trail of vaginal delivery

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16
Q

What is the management if a placenta praevia patient goes into labour prior to elective c-section?

A

Emergency c-section, due to risk of post-partum haemorrhage

17
Q

What’s the management of placenta praevia with bleeding?

A
  • Admit
  • A-E approach to stabilise
  • If unable to stabilise, emergency c-section
  • If in labour or term reached, emergency c-section
18
Q

What is the major cause of death in women with placenta praevia?

A

Post partum haemorrhage

19
Q

When is antenatal corticosteroid therapy recommended in placenta praevia?

A

Between 34+0 and 35+6 weeks of gestation and is appropriate prior to 34+0 weeks in women at higher risk of preterm birth

20
Q

What investigation should never be performed in suspected placenta praevia?

A

Bimanual/ digital vaginal examination, due to this risk of haemorrhage

21
Q

What investigations should be ordered for someone presenting to a&e with suspected placenta praevia?

A
  • Urgent TV ultrasound (if PP suspected, referral for colour flow doppler ultrasound to screen for placenta accreta)
  • FBC (anaemia)
  • Cross-match and group and save
  • CTG (fetal heartbeat)
22
Q

How would known placental praevia with active bleeding be managed?

A
  • A-E assessment
  • Administration of tranexamic acid
  • Transfusion of RBCs, FFP and platelets
  • Continuous CTG
  • Immediate c-section if bleeding doesn’t subside or evidence of fetal compromise
23
Q

What are tocolytics?

A

Drugs used to relax the uterine smooth muscle and delay labour

  • Prolong pregnancy and allow administration of cortiosteroids
  • Time to transfer to a secondary or tertiary centre
24
Q

What colour is the blood in placental praevia?

A

Bright red

25
Q

What is the management of placenta praevia with no bleeding and not in labour?

A
  • Monitor with ultrasound scans
  • Give advice about pelvic rest (no penetrative sexual intercourse) and go to hospital with significant vaginal bleeding or contractions
26
Q

What is the management of symptomatic major placenta praevia without active bleeding from 34 weeks?

A

Admission to minimise risk in event of further bleeding or initiation of labour

27
Q

What is breech position?

A

Baby’s feet or buttocks present first or horizontally across uterus

28
Q

What is a transverse lie?

A

When the baby is horizontal in the uterus

28
Q

What is external cephalic version?

A

A manouevre to move the baby from breech to posterior position

O&G (11 decks)

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