101. Bleeding in Late preganancy Flashcards
What is meant by bleeding in late pregnancy?
Bleeding from 24 weeks until delivery
What are the different types of bleeding in an antepartum haemorrhage
Spotting Minor haemorrhage (bleeding that has settled) Major haemorrhage (Heavy bleeding) Massive haemorrhage (heavy bleeding and shock)
What are the maternal causes of APH?
Local
Uterine or placental bleeding
Blood disorders
What are the foetal causes of APH?
Vasa praevia
What is meant by local bleeding in APH?
What are the causes?
Vulva, vaginal or cervical bleeding
May be caused by cervicitis or vaginitis,
cervical polyps,
vaginal varicosities,
cervical cancer
What is meant by blood disorders in APH
Idiopathic thrombocytopenia Von wilibrands disease Leukaemia Hodgkin's disease Anti-phospholipid syndrome
What are the risk factors of palcenta previa
Smoking Multi parity Multiple pregnancies Previous caesarean Increasing maternal age Previous placenta pregnancy
How does placenta previa present?
Painless, fresh vaginal bleeding
Malpresentation
High fetal head
How do you manage placenta previa
May deliver if low grade (grade I/II)
Elective caesarean at 37-38 weeks unless major haemorrhage prior
What is a major complication of placenta previa?
Post partum heamorrhage
What is a placental abruption
Retroplacental haemorrhage typically with early placental separation.
What are risk factors of placental abruption
Pre eclampsia Multi parity Increasing maternal age Trauma Polyhydroaminos Infection Smoking Drug misuse
What is the management of placental abruption?
If light bleeding then just normal delivery
If heavy?
What is the presentation of major placental abruption
Abdominal pain
Woody hard tender uterus
Signs of shock
Signs of fetal distress
What are the complications (apart from death)
Hypoxic ischaemic encephalopathy (fetus)
Death (both)
DIC (mother)
What is placental accreta?
Condition that ocurs when the placenta grows into the myometrium
What are the risk factors of placental accreta?
Ceasarian Low lying placenta Congenital or acquired uterine defects Anterior placenta Ectopic implantation of placenta
What is a uterine rupture?
Muscular rupture of the uterus
What are the risk factors of a uterine rupture?
breech extraction High forceps delivery oxytocin use Obstructed labour in multiparous woman C-section scar rupture Previous uterine surgery
What are the signs of uterine rupture?
Pain and vaginal bleeding
Maternal shock
Cessation of contractions
Fetal distress
How do you treat a uterine rupture?
Laparotomy and delivery of baby by C section
Uterine repair of hysterectomy
What is vasa praevia?
Fetal vessels traverse membanes and lie over the OS
How do you treat vasa pravia?
Emergency C-section to avoid fetal death
