Brainscape's Knowledge GenomeTM


Top Flashcards (Certified)
All Flashcards

repro > obstetric haemorrhage > Flashcards

obstetric haemorrhage Flashcards

(47 cards)

Start Studying
1
Q

define PPH

A 
BLOOD LOSS OF 500MLS OR MORE  FROM THE GENITAL TRACT WITHIN 24HRS AFTER DELIVERY
MINOR 500-1000MLS
MAJOR  (>1000MLS)
MODERATE  (1000-2000MLS)
MASSIVE  (>2000MLS  OR 150MLS/MIN)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

most common form of obstertic haemorrhage

A

PPH

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

causes of antepartum haemorrhage

A 
- Previous PPH
Placenta-Abruption praevia/accreta
Grand multiparity
Anaemia,medical
Obstetric Cholestasis,PET,HELLP
Over distended uterus due to polyhydraminos, multiple pregnancies, fibroids effect contractility of delivery baby and placenta
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

intrapartum causes of heamorrhage

A 
Prolonged 1st, 2nd stage
Oxytocin use
Precipitate labour
Operative vaginal delivery-Episiotomy
Second stage caesarean section - c section after full dilatation
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

postpartum causes of haemorrhage

A

Uterine atony MOST COMMON CAUSE
Retained products
Trauma
Thrombin

secondary

  • retained POC
  • endometritis
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

what is placenta praevia

types

A

placenta attaches low down on the uterus and may cover all or part of the cervix

low lying placenta -> >16w placental edge <20mm from the internal os via transabdominal/transvaginal scanning

if this is found at the fetal anomaly scan a follow-up ultrasound examination
including a TVS is recommended at 32 weeks

low lying
marginal
partial
complete

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Complications forms placenta praevia

A

hypovolaemic shock

VTE

Placenta accreta - placenta into endometrial part

increta into the myometrial part

Percreta - outside of the uterus outside of serosa into bladder or other organs

Fetal haemorrhage, prematurity, intrauterine asphyxia or birth injury.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

what is vasa praevia

A

presentation of umbilical vessels lacking Wharton’s Jelly below the presenting part. Rupture of a vessel causes bleeding from the baby.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

what is placental abruption

A 
separation of placenta
concealed or visible bleeding
Painful Bleeding - due to separation and contractility
Reduced/absent FM
Tense tender abdomen uterus like wood
Coagulopathy - DIC
PPH
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

antentatal haemorrhage Mx

A
  • OPTIMISE HAEMOGLOBIN ANTENATALLY
  • TREAT w iron IF HB<10.5 (EXCLUDE HAEMOGLOBINOPTHIES)
  • RISK OF HAEMORRHAGE – HOSPITAL DELIVERY
  • HB CHECK AT BOOKING THEN 28/40 +/- 36 weeks
  • CROSSMATCHING ( ESPECIALLY THOSE WITH ATYPICAL ANTIBODIES)
  • PATIENT’S WHO DECLINE BLOOD PRODUCTS
    Prophylactic 10 Units oxytocin i/m at delivery
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

intrapartum haemorrhage Mx

A

CANNULATION

  • FULL BLOOD COUNT
  • Coagulation screen- fibrinogen
  • GROUP AND SAVE
  • pulse, respiratory rate and blood pressure - every 15 minutes
  • commence warmed crystalloid infusion.

between 24 and 34 +6 weeks - administer steroids

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Mx of PPH

A
  • ABC including two peripheral cannulae, 14 gauge
  • IV syntocinon (oxytocin) 10 units or IV ergometrine 500 micrograms
  • IM carboprost
  • if medical options failure to control the bleeding then surgical options will need to be urgently considered
  • the RCOG state that the intrauterine balloon tamponade is an appropriate first-line ‘surgical’ intervention for most women where uterine atony is the only or main cause of haemorrhage
  • other options include: B-Lynch suture, ligation of the uterine arteries or internal iliac arteries
    if severe, uncontrolled haemorrhage then a hysterectomy is sometimes performed as a life-saving procedure
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Mx of placental abruption

A

Fetus alive and < 36 weeks

  • fetal distress: immediate caesarean
  • no fetal distress: observe closely, steroids, no tocolysis, threshold to deliver depends on gestation

Fetus alive and > 36 weeks

  • fetal distress: immediate caesarean
  • no fetal distress: deliver vaginally

Fetus dead
- induce vaginal delivery

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

dose
mode
MOA
oxytocin

A

5 units IV
10 units IM
40 units in 36mls infusion

15-30 mins

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

dose
mode
MOA
ergomtrine

A

0.25 mg (0.5mg) IV or IM

1-2 hours

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

dose
mode
MOA
syntometrine combination of oxytocin and syntometrine

A

1 amp IM

1-2 hours

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

dose
mode
MOA
misoprostol

A

PGs analogue

400-600mcg oral
800 – 1000mcg rectal

1-2 hours

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

dose
mode
MOA
carboprost

A

PG alpha analogue

0.25mg IM or IMM
IMM not licensed and not recommended
4-6 hours

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

adverse effects and CI of oxytocin

Study These Flashcards
A

Hypotension, flushing, water intoxication, nausea, vomiting, hypertension, vasospasm

none

20
Q

adverse effects and CI of ergomtrine

Study These Flashcards
A

Nausea, vomiting, hypertension, vasospasm

PET, Hypertension, Cardiovascular disease

21
Q

adverse effects and CI of syntometrine

Study These Flashcards
A

Nausea, vomiting, hypertension, vasospasm

PET, Hypertension, Cardiovascular disease

22
Q

adverse effects and CI of misoprostol

Study These Flashcards
A

Nausea, diarrhoea, shivering, pyrexia

None

23
Q

adverse effects and CI of carboprost

Study These Flashcards
A

Vomiting, diarrhoea, flushing, shivering, vasospasm, bronchospasm

Cardiovascular disease, asthma

24
Q

if immediate transfusion required what do u do

Study These Flashcards
A

give emergency group O
RhD-
K negative red cell units
switch to group-specific red cells ASAP

25
how much crystalloid do u give
up to 2 isotonic crystalloid
26
how much colloid do u give
upto 1.5 colloid until blood arrives
27
when do u administer FFP
If PT or APTT are prolonged and haemorrhage is ongoing administer 12-15ml/kg of FFP if haemorrhage continues after 4 units of RBCs adn haemostatic tests are unavailable, administer 4 units of FFP
28
when do you administer platelet concentrates
administer 1 pool of platelets if haemorrhage is ongoing and platelet count less than 75x10^9/L
29
when do you administer cryoprecipitate
administer 2 pools of cryoprecipitate if haemorrahge is ongoing and fibrinogen less than 2g/l
30
Mx of massive obstetric haemorrhage
- ACTIVATION OF MOH PROTOCOL MDT - senior anaesthetist, midwife, obstetrician, blood banks, porter, coordinators - TRANSFER TO THEATRE Think of 4 Ts Tone - uterine massage, bimanual compression ``` Trauma - repair Tissue Thrombin CORRECT COAGULOPATHY HAEMOCUE TEG ```
31
continual Haemorrhage regardless of initial Mx
``` no Tissue no Trauma Atony UTERINE TAMPONADE BAKRI BALLOON REMOVAL OF PACK ``` last 6-8 hours of even next morning
32
if balloon fails what do u do
- UTERINE HAEMOSTATIC SUTURES - INTERNAL ILIAC LIGATION if nothing available do this SELECTIVE ARTERIAL OCCLUSION OR EMBOLIZATION BY INTERVENTIONAL RADIOLOGY If haemorrhage is too extensive skip first two steps HYSTERECTOMY **** HAEMOSTATIC DRUGS TRANEXAMIC ACID/RECOMBINANT FACTOR VII *****CELL SALVAGE ONCE PATIENT STABLE INFORM BLOOD BANK
33
Risk factors of placenta praevia
1. previous placenta praevia 2. previous C sections 3. previous termination of pregnancy 4. multiparity 5. advanced maternal age >40 years 6. multiple pregnancy 7. smoking 8. deficient endometrium - uterine scar - endometritis - manual removal of placenta - curettage - submucous fibroid 9. assisted conception
34
RFs for palcental abruption
1. previous abruption 2. pre-eclampsia 3. fetal growth restriction - first trimester bleeding - maternal thrombiphilias 4. breech 5. polyhydraminos 6. advanced maternal age 7. multiparity 8. low BMI 9. pregnancy following assited techniwues 10. intrauterine infection 11. PROM 12. abdominal trauma 13. smoking and drug use
35
maternal complicaitons of APH
- anaemia - infection - maternal shock - renal tubular necrosis - consumptive coagulopathy - postpartum haemorrhage - prolonged hospital stay psycholoigcal sequeale - complications of blood transfusion
36
RFs of primary postpartum haemorrhage
- previous PPH - prolonged labour - pre-eclampsia - increased maternal age - polyhydraminos - emergency C-section - placenta praevia, placenta accreta - macrosomia - ritodrine (beta 2 adrenergic receptor agonist)
37
Mx of minor PPH
1. IV access (one 14 gauge cannula) 2. urgent venepuncture (20ml ) for: - group and screen - FBC - coagulation screen, including fibrinogen 3. pulse, resp rate, and BP every 15 minutes 4. commence warmed crystalloid infusion
38
Mx of major PPH
 A and B – assess airway and breathing  C – evaluate circulation  position the patient flat  keep the woman warm  transfuse blood as soon as possible, if clinically required  until blood is available, infuse up to 3.5 l of warmed clear fuids, initially 2 l of warmed isotonic crystalloid. Further fluid resuscitation can continue with additional isotonic crystalloid or colloid (succinylated gelatin). Hydroxyethyl starch should not be used.  the best equipment available should be used to achieve rapid warmed infusion of fluids  special blood filters should not be used, as they slow infusions
39
what measures are taken to reduce blood loss at delivery
- oxytocin - --- deliverign vaginally - in the 3rd stage of labour - --- C section
40
Mechanical and pharmcological measure sto manage PPH
- palpate fundus to stimulate contraction - bladder empty - foley - oxytocin 5 iu sloe IV - ergometrine 0.5mg by slow IV or IM - oxytocin infusion unless fluid restriction is necessary - carboprost 0.25mg by IM max 8 doses repeated at intervals - misoprostol 800 micrograms sublingually
41
Surgical measures to arrest the bleeding
intrauterine balloon tamponade - uterine atone FIRST line haemostatic brace sutures uterine devascularisation and internal iliac artery ligation hysterectomy
42
Mx of secondary PPH be managed
- high vaginal and endocervical swabs pelvic US - exclude retained products of conception surgical evacuation of reaitend placental tissue
43
fetal complications of placental abruption
``` IUGR hypoxia death small for gestational age and fetal growth restriction prematuritiy ```
44
clinical features of placental abruption
``` shock out of keeping with visible loss pain constant tender, tense uterus normal lie and presentation fetal heart: absent/distressed coagulation problems beware pre-eclampsia, DIC, anuria ``` extreme pain and cold to touch
45
RFs of placental abruption
``` proteinuric hypertension cocaine use multiparity maternal trauma increasing maternal age ```
46
Maternal Ix of APH fetal Ix during a APH
FBC - coag screen only if platelets are abnormal U&Es LFTs group and save kleihauer test in rhesus D negative women US for praevia CTG, US if fetal viability cannot be detected
47
Mx of placenta praevia
antenatal sterodis 34-35+6 weeks Tocolysis for women presenting with symptomatic placenta praevia or a low-lying placenta may be considered for 48 hours to facilitate administration of antenatal corticosteroids. cross-match c sections between 36-37 weeks

repro (28 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2025 Bold Learning Solutions. Terms and Conditions