Pregnancy COPIED

Question 1

Name a type of headache that can mimic migraine during pregnancy

Answer 1

Cerebral venuos thrombosis

variable presentations; headache, focal neurological deficits, vomiting or seizures.

An important cause of symptoms that can overlap with those of migraine.

CT or MRI venography is used to make the diagnosis. When diagnosed, 6-12 months of therapeutic anticoagulation is required.

Question 2

What anti-emetics can you use in pregnancy?

Answer 2

A lack of teratogenesis with; promethazine, cyclizine, chlorpromazine, prochlorperazine, metoclopramide and domperidone.

Ondansetron is a newer agent, and has been successful in cases of severe hyperemesis.

Acid suppression

There is no evidence of teratogenesis with the use of H2 receptor blockers and proton pump inhibitors.

Question 3

Foetus can “breathe” amniotic fluid into the lungs at what gestational age?

Answer 3

16-22 weeks

• this “breathing” is important for normal lung development (prevents pulmonary hypoplasia).

Question 4

If membranes rupture, baby needs to be delivered quickly. WHY?

Answer 4

Risk of infection

Question 5

Symptoms of Idiopathic intracranial hypertension

Answer 5

Tend to be gradually worsening and worse with position (bending over) or Valsalva manoeuvres.

Papilloedema and visual changes can also occur.

Management options in pregnancy include:

Regular lumbar puncture

Acetazolamide

Question 6

What are the risks of warfarin in pregnancy?

Answer 6

>> chance of fetal intracranial haemorrhaging because warfarin cross the placenta.

Options: switch to LMWH (unless px is very high risk of thrombosis)

Question 7

Eclampsia

Answer 7

Eclampsia is when seizures occur;

usually preceded by hypertension, proteinuria, or the symptoms listed previously (pre-eclampsia symptoms)

Question 8

What is Ergometrine used for in pregnancy?

(Acts on adrenergic, dopaminergic and 5-HT2 receptors)

Answer 8

Increases contraction of uterine smooth muscle

Postpartum to reduce bleeding

Risks: >> peripherial vascular resistance

(use Carboprost if Ergometrine ineffective)

Question 9

What is Toxic shock syndrome? (TSS)

Answer 9

Toxic shock syndrome (TSS) is a multisystem inflammatory response to the presence of bacterial exotoxins.

Associated with tampon use in menstruating women and Group A streptococcal infections - the streptococcal toxic shock-like syndrome (STSS).

Question 10

Management of gestational diabetes mellitus

Answer 10

Diet, exercise

metformin

Fetal:

regular growth scans

monitor for pre-eclampsia

delivery at 38-39 wks

Question 11

What’s the story with rubella (german measles) and pregnancy?

Answer 11

NO WOMAN should try to conceive unless the have had rubella, or been immunised.

Most dangerous in 1st trimester.

Can cause blindess, deafness, cardiac abnormalities, mental retardation.

Question 12

Pre-eclampsia defined

Answer 12

Pre-eclampsia is a multisystem disorder related to inadequate placentation. The definition of the disorder is new onset hypertension and proteinuria which develop after 20 weeks of gestation.

Question 13

If an egg is not fertilized, the corpus luteum eventually decays cand stops secreting progesterone.

What does it decay into?

Answer 13

a mass of fibrous scar tissue; corpus albicans

Question 14

Answer 14

Mean gestational age of onset is 34 weeks

More common in first pregnancy and those with multiple pregnancies

Pruritic, urticarial papules and plaques most commonly on abdomen (but sparing umbilicus) and thighs

Rapid resolution after delivery

No fetal issues

Question 15

Why is there an increased risk of aspiration with pregnant women? (esp. with general anaesthesia)

Answer 15

Reduced gastric motility, in combination with restriction of stomach expansion by the fetus results in gastro-oesophageal reflux, particularly in the third trimester.

Constipation common in pregnancy.

Question 16

RBC and pregnancy - what happens?

Answer 16

Fall in haemoglobin concentration, haematocrit and red cell count (as expansion of plasma volume is greater than the increase in red cell mass)

No change in mean cell volume or mean cell haemoglobin concentration

2-3 fold increase in iron requirements

Iron deficiency anaemia is common and requires iron supplementation

Question 17

What happens to platelets during pregnancy?

Answer 17

These fall progressively throughout gestation

gestational thrombocytopenia

5-10% of pregnant women have platelet count of 100-150 x109/L by term

Question 18

Why to you sometimes get upper right upper side pain with pregnancy/ hypertension?

Answer 18

Liver distension

Question 19

Cardiac output = stroke volume x heart rate

Answer 19

Cardiac output increases by about 40%, as a result of increased stroke volume and reduced systemic vascular resistance, in combination with an increased heart rate.

The cardiac output is greatest at 24 to 28 weeks of pregnancy. The heart is physiologically dilated and myocardial contractility is increased.

Question 20

What is macrosomia?

Answer 20

The term “fetal macrosomia” is used to describe a newborn who’s significantly larger than average

Question 21

What;s the story with (during pregnancy):

Nitrofurantoin

Co-amoxiclav

Trimethoprim

Answer 21

Nitrofurantoin: Haemolytic anaemia in the neonate

Co-amoxiclav: Avoid in women at r_isk of preterm labour (20-36/40)_ - including risk of necrotising enterocolitis in neonate

Trimethoprim: Avoid in first trimester (folate antagonist)

Question 22

What is PPCM?

Answer 22

Peripartum cardiomyopathy (PPCM) ; dilated cardiomyopathy

“deterioration in cardiac function presenting typically between the last month of pregnancy and up to six months postpartum. “

Decrease in left ventricular ejection fraction (EF) with associated congestive heart failure and an increased risk of arrhythmias, thromboembolism.

Question 23

Legal requirements for termination before 24 weeks

• requires two doctors to sign -

For mothers <16 years : Fraser guidelines apply

Answer 23

If it reduces the risk to a woman’s life;

or

If it reduces the risk to her physical or mental health;

or

If it reduces the risk to physical or mental health of her existing children;

or

If the baby is at substantial risk of being seriously mentally or physically handicapped.

Question 24

Normal heart sounds in pregnancy

Answer 24

Normal findings in pregnancy include an ejection systolic murmur, a loud first heart sound, a third heart sound and ectopic beats.

Question 25

What is the first line treatment of moderate 150/100 or severe hypertension 160/110 in pregnancy?

Answer 25

Labetalol

Question 26

What is Gestational Trophoblastic Disease?

Answer 26

**Def: A spectrum of histologially distinct diseases originating from the placenta.** a group of disorders which range from **molar pregnancies** to malignant conditions such as choriocarcinoma. If there is any evidence of persistence of GTD the condition is referred to as **gestational trophoblastic neoplasia (GTN).** Levels of hCG can be of diagnostic value, and ultrasound. referral for follow-up to a **trophoblastic screening centre**

Question 27

Do you need to investigate pruritus in pregnancy?

Answer 27

Liver function tests should be checked, particularly if it is mainly the **palms** and **soles** that are affected and/or it occurs in the **third trimester**. These symptoms make **_obstetric cholestasis_** more likely.

Question 28

Coagulation and pregnancy

Answer 28

Prothrombin time and activated partial thromboplastin time remain unchanged in pregnancy, so do not reflect the profound changes that result in a **hypercoagulable state** Increased factors VIII, IX and X and fibrinogen, reduced fibrinolytic activity and a decrease in antithrombin and protein S all contribute

Question 29

Pre-eclampsia- inadequate placentation; what's the worry?

Answer 29

**Fetal growth restriction** and/or **intrauterine death** can result from pre-eclampsia. **Placental abruption** is also more common.

Question 30

What are ossible causes of shortness of breath in a pregnant woman? (7)

Answer 30

1. Physiological 2. **Anaemia** 3. Asthma 4. **Pulmonary embolism** 5. Pneumonia 6. Pneumothorax 7. **Pulmonary oedema**

Question 31

what is scotoma

Answer 31

a partial loss of vision or blind spot in an otherwise normal visual field

Question 32

When can the foetus perceive sound and light?

Answer 32

sound: 24-26 weeks light: 28 weeks

Question 33

Pregnancy-induced hypertension defined

Answer 33

development of hypertension in the **absence of proteinuria** or other features of pre-eclampsia. Usually occurs **_after 20 weeks gestation_** and resolves within 6 weeks postpartum, (can remain elevated for up to 3 months postpartum).

Question 34

What is hyperemesis gravidarum?

Answer 34

Hyperemesis gravidarum occurs in less than 1% and is when **vomiting** is severe enough to cause **dehydration** and **biochemical derangement.**

Question 35

Immediate management of acute pulmonary oedema during pregnancy

Answer 35

Oxygen diuretics regular ECGs

Question 36

Is glycosuria is diagnostic of diabetes mellitus in pregnancy?

Answer 36

No. Glucose loss during pregnancy is normal

Question 37

Atopic eruption of pregnancy

Answer 37

Commonest pregnancy specific dermatosis, and is associated with atopy. It mainly occurs in the second or third trimester, more commonly in multiparous women. It is characterised by **patches of intensely itchy papules which become excoriated**. Treatment includes emollients, antihistamines and topical steroids.

Question 38

How does pregnancy affect the thyroid gland?

Answer 38

**50% more thyroid hormone is required** to maintain circulating levels of free T4. **Maternal iodine requirements increase** due to increased renal clearance. Usual TFT tests in early pregnancy may suggest hyperthroidism. This is because **HCG is structurally similar to TSH**, thus early pregnancy causes \>\> T4 production and TSH suppression.

Question 39

No limit on gestation time (for termination) if:

Answer 39

Risk to the mother's life. Risk of grave, permanent injury to the mother's physical/mental health Substantial risk that, if the child were born, it would have such physical or mental abnormalities as to be seriously handicapped.

Question 40

Maternal diabetes and fetal health...

Answer 40

Poor glycaemic control in the first trimester is associated with an increased rate of **congenital abnormalities** (particularly neural tube defects and congenital heart disease) and miscarriage. Studies have shown that the rate of congenital abnormalities increases as the **HbA1c increases.** The risk of miscarriage is higher with co-existent renal disease or hypertension.

Question 41

Define **antepartum haemorrhage**

Answer 41

bleeding from the birth canal **after the 24th week of pregnancy.** [bleeding following the birth of the baby is postpartum haemorrhage.]

Question 42

If pre-eclampsia is asymptomatically, what other investigation?

Answer 42

Uterine artery Doppler measurements can aid the identification of women at high risk of pre-eclampsia.

Question 43

What factors affect drug availability during pregnancy?

Answer 43

* **Increased blood volume** (50% increase by 34 weeks) * **Increased clearance** (\> GFR 50% by 24 weeks) * **Increased hepatic metabolism** * vomiting * decreased absorption

Question 44

What are the common causes of maternal death during pregnancy?

Answer 44

medical complications rather than obstetric and include cardiac problems, neurological disease, sepsis and thromboembolism

Question 45

SLE and pregnancy; what's the problem?

Answer 45

If there is **renal involvement** or if **antiphospholipid antibodies** are present, there is an i**ncreased risk of miscarriage,** **fetal death,** **pre-eclampsia** and **preterm delivery.**

Question 46

Pre-eclampsia signs and symptoms

Answer 46

**Hypertension** and **proteinuria, and oedema** Can get swelling of feet, ankles, and hands Symptoms such as headache, **right upper quadrant/epigastric pain** or transient visual disturbance can be reported On examination, abnormalities such as **right upper quadrant tenderness**, hyper-reflexia or clonus may be present The multi-system manifestations result from diffuse vascular endothelial dysfunction

Question 47

What happens to BP in pregnancy?

Answer 47

Blood pressure **decreases** in **first** and **second** trimesters, but increases in the third. By term the blood pressure has returned to the pre-pregnancy level, but does not exceed this.

Question 48

What happens to blood gases in pregnancy?

Answer 48

Increase in tidal volume (from 1st trimester onwards) causing increased PaO₂ and decreased PaCO₂ ## Footnote **Compensatory respiratory alkalosis.**

Question 49

What is a post dural puncture headache?

Answer 49

After epidural; **positional** (worse on standing), and most frequently occur in the frontal and occipital regions. Symptoms such as neck stiffness, tinnitus, photophobia and nausea can be associated. They usually develop in the **five days after the procedure.** Management is **conservative** (hydration, rest, oral analgesia) but occasionally an epidural blood patch is required.

Question 50

How does the pulse change in pregnancy?

Answer 50

The pulse rate increases by 10-20 beats per minute early in pregnancy. A pulse rate of up to 105 beats per minute is regarded as normal in pregnancy. On examination the pulse may be bounding or collapsing in nature.

Question 51

What is placenta praevia?

Answer 51

Placenta praevia exists when the **placenta is inserted wholly or in part into the lower segment of the uterus.** ultrasound diagnosis (transvaginal) * Major, if the placenta covers the internal os of the cervix. * Minor or partial, if the leading edge is in the lower segment but not covering the os.

Question 52

What is one of the main causes of death in pre-eclampsia women?

Answer 52

Cerebral haemorrhage (signs : headaches, visual disturbances, seizures)

Question 53

List the DDs of pulmonary oedema in pregnancy Cardiogenic (3) Non Cardiogenic (2)

Answer 53

**Cardiogenic** * Undiagnosed congenital heart disease * _Peripartum cardiomyopathy_ * Cardiac ischaemia * **Non cardiogenic** * _Pre-eclampsia_ * Iatrogenic – medications such as corticosteroids, tocolytics, non-steroidal analgesia

Question 54

How could toxic shock syndrome present?

Answer 54

* \>\> temperature. **Can progress to life-threatening very quickly.** * Rash * **hypotension**; suppressiong of myocardial contractility by the toxin. * Very **red** mucosal surfaces; palms, soles of feel, tongue * **weakness**, myalgia, nausa, vomiting, diarrhoea * **encephalopathy** symptoms

Question 55

What are some risks factors for UTI in pregnancy?

Answer 55

**GDM** use of **systemic corticosteroids** **history** of UTI **Problem**: untreated can lead to symptomatic UTI or pyelonephritis

Question 56

ECG changes in pregnancy include:

Answer 56

ECG Findings on a ECG performed during pregnancy that are not pathological include: Small Q waves and inverted T waves in lead III ST depression and T wave inversion inferiorly and laterally Left shift of the axis

Question 57

What skin/ hair changes happen in pregnancy?

Answer 57

* pruritus (without a rash - 20% occurence) * hair loss (common between 4-20 wks) * palmar erythema * striae gravidarum * spider naevi * melasma

Question 58

Liver metabolism changes in pregnancy

Answer 58

**Albumin** – decreases, (increased blood volume) Alkaline phosphatase – \>\> 2-4 fold, mostly as a result of the increasing production of **placental alkaline phosphatase**

Question 59

Answer 59

* Heart beats at **4-5 weeks gestation** * After birth, change in PaO₂ causes constriction of **umbilical vessels, ductus arteriosus, foramen ovale, ductus venosus** *

Question 60

New abdo pain in pregnancy. Always consider..

Answer 60

Appendicitis in pregnancy should be suspected when a pregnant woman complains of new abdominal pain

Question 61

Does respiratory rate change with pregnancy?

Answer 61

No Tidal volume increases up to 45%. Functional residual capacity is reduced due to diaphramatic elevation (late pregnancy)

Question 62

HELLP ## Footnote **H** **EL** **LP**

Answer 62

The symptoms and signs of this condition overlap with those of pre-eclampsia Hypertension and/or proteinuria are not present in 100% of cases and are **often mild** Blood tests may show **haemolysis**, **elevated liver enzymes** and **low platelets**

Question 63

What's the story with chickenpox and pregnancy?

Answer 63

**1:10 pregnant women** with chickenpox develop **pneumonia**. 1:100 women die from this condition. Other serious infections possible. Unborn baby: Small chance of developing **Fetal Varicella Syndrome (FVS)** that causes **serious abnormalities.** More common during 2nd trimester. Most **dangerous** time for babies is within **seven days before or after birth**. **iImmunoglobulins** are given to the baby to stop this happening. Babies can catch chickenpox before birth. Aciclovir can be prescribed by specialists.

Question 64

Safe Antihypertensive treatment in pregnancy

Answer 64

Labetalol, nifedipine and methyldopa

Question 65

What are alternatives to labetalol in pregnancy?

Answer 65

methyldopa and nifedipine

Question 66

Glucose and pregnancy, what's the story?

Answer 66

Pregnancy is an **insulin resistant state.** Hepatic glycogen stores are depleted in pregnancy, thus women can become **ketotic quickly.** \>\> blood glucose associated with **maternal age** and family history of diabetes

Question 67

NSAIDs and pregnancy?

Answer 67

exposure to NSAIDs after 30 weeks' gestation is associated with an increased risk of **premature closure** of the **fetal ductus arteriosus**

Question 68

What anti-emetic meds could be used for acute attack of migraine?

Answer 68

metoclopramide or cyclizine

Question 69

Gestational pemphigoid

Answer 69

Can occur any time in pregnancy, but usually in third trimester Often occurs on abdomen (**involving umbilicus)**, spreading to limbs, palms and soles **Associated with low birthweight, preterm delivery and stillbirth** Neonate can be affected by same eruption, which is mild and transient

Question 70

Risk factors of PPCM

Answer 70

Multiple pregnancy Pregnancy complicated by hypertension (pre-existing or pre-eclampsia) Advanced maternal age Afro-Caribbean race

Question 71

Developmental milestones of an embryo

Answer 71

Question 72

What's the story with toxoplasmosis and pregnancy?

Answer 72

* Causes eye and brain damage during first trimester * induces miscarriage later in pregnancy (caused by eating undercooked meat, handling cat feces)

Question 73

Why is glycaemic control difficult in first trimester?

Answer 73

nausea and vomiting Increase in insulin sensitivity Low glycogen stores; ketoacidosis common

Question 74

Why is it important to treat asymptomatic UTI during pregnancy?

Answer 74

Mx: nitrites on urinalysis. Asymptomatic bacteriuria should be treated as this can lead to symptomatic urinary tract infection or pyelonephritis. This can be associated with **low birth weight babies** and **preterm delivery**.

Question 75

What's the story; STi and pregnancy? Syphilis, Genital Herpes, HIV?

Answer 75

* Syphilis; cannot be transmitted to fetus until 18th week, early tx prevents harm. Can can miscarriage. * Genital herpes; Can cross placenta, most infections during birth (C.S. prevents infection) * AIDS; ZDV reduces transmission by 70%, passed through placenta, whilst giving birth, or whilst breast-feeding.

Question 76

Can you get AKI with pre-eclampsia?

Answer 76

Acute kidney injury (AKI) is a common consequence of pre-eclampsia. This ranges from a mild **increase** in **creatinine**, to significant AKI requiring renal replacement therapy (rare) An **elevated serum urate concentration** and **oliguria** can also be seen.

Question 77

What antihypertensives cannot be used in pregnancy?

Answer 77

**ACE inhibitors** are teratogenic and fetotoxic.

Question 78

Presentation of **placenta praevia.**

Answer 78

**Painless bleeding** (pain with 10% of cases) **starting after the 28th week** (although spotting may occur earlier) is usually the main sign: **25% risk of spontaneous labour** in subsequent few days. Suspect if: **vaginal bleeding after 20 weeks of gestation**, bleeding provoked by **sexual intercourse.** **Migration** of the placenta can occur in **2nd and 3ed trimesters**.

Question 79

Future pregnosis of PPCM?

Answer 79

Left ventricular function does not recover in all affected women. **Further pregnancies can cause a recurrence of the cardiomyopathy**, which can lead to significant left ventricular impairment, particularly if left ventricular function did not return to normal after the first affected pregnancy.

Question 80

Which antihypertensives can be used in pregnancy?

Answer 80

* **Methyldopa** - central action * Nifedipine - CCB * Labetalol - α- and β- receptors

Question 81

What is the role of Misoprostol?

Answer 81

Increases contraction of uterine smooth muscle Causes cervical effacement Medical termination of pregnancy

Question 82

What is RDS? (common in premature babies)

Answer 82

**Respiratory Distress Syndrome** Tx: Corticosteroid therapy promotes surfactant production and decreases risk of RDS by 50% NB\> **surfactant** is made by **type II pneumocytes.**

Question 83

What are striae gravidarum?

Answer 83

Stretch marks are caused by tearing of the dermis. (resilient middle tissue layer that helps the skin retain its shape)

Question 84

What does Pyelonephritis increase the chances of ?

Answer 84

pre-term labour.

Question 85

Why give 400IU daily Vit D to pregnant women?

Answer 85

* Vit D is common during pregnancy and post partum causing **transient osteoporosis** of pregnancy. * Vit D def causes **fetal morbities**; growth restriction, skeletal deformities, tooth and bone problems

Question 86

Stages of labour (1-4)

Answer 86

1st stage : contractions 10-15 minutes apart, cervix dilated. 2nd stage: pushing and birth of baby 3rd stage: delivery of placenta 4th stage: postpartum

Question 87

Syntometrine; role in labour?

Answer 87

Oxytocin/ergometrine (trade name Syntometrine) is an obstetric combination drug. **oxytocin** (produced by hypothalamus) and **ergometrine** (an alpha-adrenergic, dopaminergic and serotonin (5-HT2) receptor agonist.) Both substances **cause the uterus to contract**. Given just after the birth of the child to **facilitate delivery of the placenta** and to **prevent postpartum hemorrhage**[ by _causing smooth muscle tissue in the blood vessel walls to narrow._

Question 88

Retained placenta definition

Answer 88

Failure of the placents to deliver within 30 minutes

Question 89

Definition - **Primary haemorrhaging** in pregnancy

Answer 89

Primary postpartum haemorrhage (PPH) is loss of blood estimated to be **\>500ml** from the genital tract within **24 hours of delivery.** (this is the most common obstetric haemorrhage) Minor PPH up to 1000ml Major PPH over 1000ml

Question 90

Definition - **Secondary haemorrhaging** in pregnancy

Answer 90

Secondary PPH abnormal bleeding from the genital tract, from **24 hours after delivey until six weeks postpartum.**

Question 91

What stage of labour does the placenta come away?

Answer 91

third

Question 92

Postpartum haemorrhage defined | (incidence 5% of all deliveries)

Answer 92

**a 10% drop in hemacrit from admission, or bleeding requiring blood transfusion** old definition: an estimated blood loss of \> 500ml NB\> the AVERAGE blood losee after vaginal delivery is 500ml. Blood loss after c.s. averages 1000ml.

Question 93

The causes of PPH have been described as the "four T's" What's the _most common cause_ of primary postpartum haemorrhaging?

Answer 93

**_Uterine atony_** ## Footnote followed by _retained placenta_ * **Tone**: uterine atony, distended bladder. * **Trauma**: lacerations of the uterus, cervix, or vagina. * **Tissue**: retained placenta or clots. * **Thrombin**: pre-existing or acquired coagulopathy.

Question 94

What is uterine atony?

Answer 94

Uterine atony is a **loss of tone in the uterine musculature**. Normally, contraction of the uterine muscles during labor compresses the blood vessels and reduces flow, thereby increasing the likelihood of coagulation and preventing hemorrhage. Clinically, **75-80% of postpartum hemorrhages are due to uterine atony.**

Question 95

Treatment of uterine atony?

Answer 95

**Bimanual uterine compression** to stimulate contraction. **Oxytocin** Ergometrine 0.5 mg slow IV or IM unless there is a history of hypertension

Question 96

What are the most important causes of **_antepartum_** haemorrhage, (\>50% of cases) (two)

Answer 96

Placenta Praevia & Placental Abruption

Question 97

Definition of antepartum haemorrhage

Answer 97

Antepartum haemorrhage is defined as **any vaginal bleeding from the 24th week of gestation until delivery.**

Question 98

How does placenta praevia present?

Answer 98

incidental finding on ultrasound **Painless bleeding starting after the 28th week**; Typically, it is sudden and profuse but usually does not last for long and so is only rarely life-threatening. bleeding during intercourse

Question 99

Facts about **uterine inversion** (rare but serious obstetric complication) - occurs in second stage of labour Big risk factor - multiparity 6+

Answer 99

Presents as: **Postpartum haemorrhage**, which occurs in 65-94% of cases and can be **massive**. **Lower abdominal pain (extreme**), Sudden appearance of a vaginal mass. *"The sudden appearance of a large dark red mass accompanying the placenta is alarming."* **hypovolaemia, hypotension** Chronic cases are unusual and difficult to diagnose. They may present with spotting, discharge and low back pain.

Question 100

What is Placenta accreta? Placenta accreta: **chorionic villi penetrate the decidua basalis to attach to the myometrium.**

Answer 100

These are conditions where the **placenta is morbidly attached to the uterine wall.** All are associated with retained placenta requiring surgical management and have high risk of massive postpartum haemorrhage.

Question 101

What is **Placental abruption**? May present with vaginal bleeding, abdominal pain (usually continuous), uterine contractions, shock or fetal distress.[

Answer 101

Abruption is the **premature separation of a normally placed placenta before delivery of the fetus,** with blood collecting between the placenta and the uterus. It is one of the two most important causes of **antepartum haemorrhag**e (the other being **placenta praevia**).

Question 102

What is uterine rupture? | (rare but high mortality)

Answer 102

A catastropic event where a full-thickness tear develops, opening the uterus directly into the abdominal cavity. Most occur during labour; however, **uterine scars following earlier caesarean may rupture during the third trimester** before any contractions occur. keloid scars in the uterine wall from c.s. causes it to 'unzip'.