PROM, Prem labour and antepartum haemorrhage

Question 1

Within what time period must a mother be given anti-D prophylaxis following a placental abruption (if they are found to be rhesus -)

Answer 1

72 hours

Question 2

When can CTG be carried out on a baby?

What is the alternative?

Answer 2

When they are >26 weeks old

Auscultation of the fetal heart

Question 3

INVESTIGATIONS IN ANTEPARTUM HAEMORRHAGE

a) what bloods?
b) what biochemistry?

Answer 3

a) FBC, G&S, Cross match if you suspect the patient may require a transfusion, Clotting, Kleihauer test
b) Biochem is to rule out pre-eclampsia or HELLP syndrome, LFTs and U&Es

Question 4

What is Kleihauer test

Answer 4

It is a test to assess the amount of blood that has entered the fetal circulation and calculates the amount of anti-D that should be given

Question 5

What are the 3 main types of management of placental abruption?

Answer 5

Conservative, emergency delivery and induction of labout

Question 6

When is emergency delivery considered to be required for the management of placental abruption?

Answer 6

When there is fetal or maternal compromise

May be indicated if there has been fetal death but there is maternal compromise

Unless spontaneous delivery is imminent

Question 7

When is induction of labour considered for the management of placental abruption?

Answer 7

When there is no fetal or maternal compromise and haemorrhage has occurred at term

Question 8

When is conservative management considered for the management of placental abruption?

Answer 8

When the abruption is partial or marginal and there is not maternal or fetal compromise (this is dependent on the gestation and amount of bleeding)

Question 9

Transvaginal ultrasound can be used to assess placental abruption but is should NOT be used to EXCLUDE abruption - why not?

Answer 9

Because it had a poor negative predictive value

The reason why it is useful is because it has a good positive predictive value

Question 10

What is the definition of an antepartum haemorrhage?

Answer 10

A vaginal bleed from week 24 until delivery

Question 11

What is placenta praevia?

What are the 2 types? Describe them

Answer 11

Where the placenta is fully or partially attached to the lower uterine segment

Minor or major
Minor - placenta is low but doesn’t lie over the internal cervical os
Major lies over the internal cervical os

Question 12

What can trigger bleeding in a placenta praevia?

Answer 12

Mild trauma e.g vaginal examination

Question 13

What is the main risk factor for placenta praevia?

Answer 13

C section

Question 14

What are other risk factors for placenta praevia?

Answer 14

High parity
Multiple pregnancy
Maternal age >40
Previous placenta praevia
History of uterine infection (endometritis)
Curettage to the endometrium after miscarriage or termination

Question 15

What is the difference between the terms gravidity and parity?

Answer 15

Gravity is the number of pregnancies, regardless of their outcome
Parity is the number of liveborn children the woman has delivered

Question 16

What are the typical clinical symptoms that placenta praevia presents with?

Answer 16

Painless vaginal bleeding - can vary between spotting to massive haemorrhage
Uterus not tender to palpation
Risk factors pertinent to placenta praevia may be revealed on examination e,g C section scar or multiple pregnancies

Question 17

Placenta praevia may be picked up on ultrasound scan. When would this be and what should the follow up be if

a) minor
b) major

Answer 17

It would be picked up on the 20 week scan
Minor - rescan at 36 weeks (placenta is likely to move superiorly)

Major (rescan at 32 weeks and a plan for delivery made)

Question 18

If a woman has placenta praevia major what should the plan be for delivery?

Answer 18

Elective C section