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)
