Obstetrics Flashcards
(45 cards)
List the 3 main aetiological categories of antepartum haemorrhage
Placenta praevia
Placental abruption
Unclassified
What is antepartum haemorrhage?
Bleeding from the genital tract after 20 weeks gestation up until the onset of labour
What percentage of pregnancies does antepartum haemorrhage affect?
2-5%
Besides placenta praevia and placental abruption, what are some unclassified causes of APH?
Marginal placental bleeding Show Trauma Infection Cervical polyp Cervical carcinoma
What is placenta praevia?
Placenta inserted into the lower uterine segment
How is placenta praevia classified?
Major: placenta covers the internal cervical os
Minor: placenta does not cover the os
What are the risk factors for placenta praevia?
Increasing maternal age Multiparity Smoking Previous placenta praevia Previous CS Prior termination of pregnancy Multiple pregnancy Assisted reproductive technique
How does placenta praevia present?
Unprovoked, painless vaginal bleeding, often between 32 and 34 weeks gestation
How is placenta praevia diagnosed?
TA or TV localisation of placenta
What is placenta accreta?
A placenta that invades the myometrium
What is placental abruption?
Separation of the placenta from the uterus in the antenatal or intrapartum period
What are the risk factors for placental abruption?
Maternal hypertension Blunt abdominal trauma Previous placental abruption Increased maternal age Multiparity Smoking
How does placental abruption usually present?
Sudden onset of abdominal pain, with or without back pain, and vaginal bleeding
What examination findings are expected in placental abruption?
Maternal tachycardia Uterine tenderness Board-like abdomen Difficult to palpate fetal parts Non-reassuring CTG
What are the maternal complications of placental abruption?
Hypovolaemic shock Acute renal failure DIC PPH Death Feto-maternal haemorrhage
What is vasa praevia?
Fetal vessels lying in the membranes in front of the presenting part
What is shoulder dystocia?
Difficulty delivering the fetal shoulders following delivery of the fetal head
How common is shoulder dystocia?
Subjective diagnosis - incidence varies from 0.2-3%
What are the antepartum risk factors for shoulder dystocia?
Prior shoulder dystocia Fetal macrosomia Maternal diabetes Post-term pregnancy Male fetal gender Maternal obesity
What are the intrapartum risk factors for shoulder dystocia?
Prolonged labour
Induction of labour
Augmented labour
Instrumental labour
Name three movements to avoid when managing shoulder dystocia
Rotation of the fetal head
Excessive traction
Fundal pressure
What are the HELPERR principles for management of shoulder dystocia?
H - call for help E - evaluate for episiotomy L - legs in McRoberts position P - pressure suprapubic E - enter R - remove posterior arm (Barnum) R - roll the patient to all fours (Gaskin)
What are the fetal complications of shoulder dystocia?
Bone fracture Transient or permanent brachial plexus palsy Asphyxia Hypoxic ischaemic encephalopathy Death
What are the antepartum indications for CS?
Maternal: 2 prior CS, uterine surgery, pelvic anomaly, prior OASI, prior shoulder dystocia, medical conditions, obstetric conditions
Fetal: fetal anomalies, macrosomia, malpresentation, APH or abruption, severe IUGR, multiples, abnormal presentation
