Third Trimester Bleeding

Question 1

Placenta Praevia

Answer 1

Major - completely covering os
Minor - covering edge of cervix

CAUTION WITH DIGITAL EXAMINATION

Question 2

Management

Answer 2

Clinical judgement

Placental edge < 2cm from the internal os in the third trimester is likely to need delivery by caesarean section

Question 3

Preterm labour

Answer 3

RF - maternal age, low BMI, cigarette smoking, socio-economic factors, past reproductive hx, multiple pregnancy, infection

Fetal fibronectin (cervical vaginal secretion), actim partum (IGFBP-1) - if positive give steroids (12mg - 2 doses 12 hours apart). Consider tocolysis - nifedipine, atosiban, indomethacin. Consider magnesium sulphate for fetal neuroprotection (cerebral palsy).

Question 4

Placental abruption

Answer 4

Premature separation of the placenta from the uterine wall
RF: maternal thrombophilia, abdominal trauma, PET, smoking, cocaine use
Bleeding (not always present!), abdo pain, uterine tenderness (woody), fetal compromise, maternal shock, coagulopathy
Management depends on severity and complications - if maternal or fetal compromise deliver fetus

Question 5

Uterine rupture

Answer 5

Previous hx of caesarean section
Increased by induction of labour
SIGNIFICANT MORTALITY

Abdo pain, hypovolaemic shock, CTG abnormalities, uterine contractions may stop, palpation of fetus outside uterus

Question 6

Appendicitis

Answer 6

1st tri - pain in RLQ
2nd tri - appendix located at level of umbilicus
3rd tri - diffuse of RUQ

Nausea, vomiting, anorexia, raised WCC. US and MRI used. Surgical management.

Question 7

MEOWS

Answer 7

Modified Obstetric Early Warning Scores - alert clinical staff to an underlying problem but do not know what the problem is

Question 8

Acute Cholecystitis

Answer 8

Gallstones slightly more common in pregnancy

RUQ pain radiating to back, vomiting

Use ultrasound. Blood tests have limited value: alk phos (generally increased in pregnancy), ALT, amylase may be raised

Management: fluids, analgesia, abx, surgery preferably after delivery

Question 9

Kleihauer test

Answer 9

Detects presence of fetal red cells in maternal circulation

Estimated > 5 ml estimated feto-maternal haemorrhage then further dose of anti-D required????