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O&G > 3rd Trimester bleeding > Flashcards

3rd Trimester bleeding Flashcards

1
Q

ABDO pain in pregnancy: Overview

A
  • Many possible causes.
  • Consider all differential diagnosis.
  • Any cause for acute abdomen can occur during pregnancy with some increasing in frequency of occurrence.
  • Approach similar to non pregnancy.
  • Consider physiologic/anatomic alterations related to pregnancy.
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2
Q

CAUSES of ABDO pain: OBSTETRIC causes

  • General (5)
  • <24wks (5)
  • > 24 wks (5)
A 
• Preterm Labour 
• Placental abruption 
• Choriamnionitis 
• Acute fatty liver of pregnancy 
• Torsion of the pregnant uterus 
(<24 wks)
• Miscarriage
• Constipation
• Round ligament pain 
• Ectopic pregnancy
• UTI
(>24 wks)
• Labour
• Braxton Hicks contractions
• Symphysis pubis dysfunction 
• Reflux oesophagitis 
• Uterine rupture
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3
Q

CAUSES of ABDO pain: GI causes

A
  • Acute appendicitis
  • Acute pancreatitis
  • Peptic Ulcer
  • Gastritis
  • Hepatitis
  • Bowel obstruction
  • Bowel perforation
  • Hernias
  • Constipation & irritable bowel
  • Acute cholecystitis
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4
Q

CAUSES of ABDO pain: GU causes

A
  • Acute pyelonephritis
  • Acute cystitis
  • Ovarian cyst rupture
  • Adnexal torsion
  • Renal Stones
  • Ureteral obstruction
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5
Q

CAUSES of ABDO pain: OTHER causes

A
  • Intraperitoneal haemorrhage
  • Red degeneration of Fibroid
  • Trauma to abdomen
  • Diabetic Ketoacidosis
  • Splenic rupture
  • Sickle cell crisis
  • Respiratory disease such as pneumonia or PE
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6
Q

CAUSES of ABDO pain: LATER in pregnancy

A
  • Torsion of pedunculated fibroid
  • Placental abruption
  • HELLP (hemolysis, elevated liver function, and low platelets) syndrome
  • Spontaneous rupture of the liver
  • Uterine rupture
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7
Q

Chorioamnionitis: Definition

A

Chorioamnionitis also known as intra-amniotic infection (IAI) is an inflammation of the fetal membranes (amnion and chorion) due to a bacterial infection.

It typically results from bacteria ascending from the vagina into the uterus and is most often associated with prolonged labor.

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8
Q

Preterm labour: Definition

A

Occurs when regular contractions result in the opening of your cervix after week 20 and before week 37 of pregnancy.

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9
Q

Preterm labour: PREDISPOSING factors

A
  • Maternal age
  • Low BMI
  • Cervical surgery
  • Cigarette smoking
  • Socio-economic factors
  • Past reproductive history - previous PTL increase risk
  • Present history- uterine over distension such as polyhydramnios, multiple pregnancy
  • Infection: Bacterial Vaginosis
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10
Q

Preterm labour: INVESTIGATIONS

A 
FOETAL FIBRONECTIN (fFN):
Extracellular matrix glycoprotein produced by amniocytes which can be determined by cervical vaginal secretions.
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11
Q

Preterm labour: MANAGMENT

A
  • Corticosteroids to induce fetal lung maturity – Betamethasone 12mg – 2 doses- 24 hours apart
  • Tocolytics: – Nifedipine, Atosiban, Indomethacin – to try to reduce contractions
  • Magnesium sulphate for fetal neuroprotection
  • Inform neonatal services in case of delivery
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12
Q

Placental abruption: Definition

A

Premature separation of placenta from the uterine wall.

Massive placental abruption = OBSTETRIC emergency.

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13
Q

Placental abruption: RISK factors

A
  • Maternal thrombophilia
  • Abdominal trauma
  • PET
  • Smoking
  • Cocaine use
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14
Q

Placental abruption: SIGNS + SYMPTOMS

A
  • Bleeding
  • Abdo pain
  • Revealed may be minimal compared to the abruption- concealed
  • Uterine tenderness (woody hardness)
  • Vaginal bleeding fetal compromise
  • Maternal shock
  • Coagulopathy
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15
Q

Placental abruption: MANAGEMENT

A
  • Depends on severity and complications
  • Minor: expectant management - particularly if <37 weeks
  • With monitoring and steroids for fetal lung maturity if <36 weeks
  • If maternal or fetal compromise immediate delivery
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16
Q

Uterine rupture: Definition

A

Uterine rupture is spontaneous tearing of the uterus that may result in the fetus being expelled into the peritoneal cavity.

Uterine rupture is rare. It can occur during late pregnancy or active labor. Uterine rupture occurs most often along healed scar lines in women who have had prior cesarean deliveries.

17
Q

Uterine rupture: SIGNS + SYMPTOMS

A
  • Abdominal pain
  • Hypovolaemia shock i.e. tachycardia, pallor and a drop in blood pressure
  • CTG abnormalities
  • Uterine contractions may stop
  • Palpation of fetus outside the uterus
18
Q

MEOWS

A

Modified Early warning scores (MOEWS) are non-specific; they alert clinical staff to an underlying problem, but do not determine what the problem is. MOEWS will help to identify women with potential for further deterioration. A Multidisciplinary approach is mobilised to provide optimal care for severely ill women.

19
Q

Intrapartum surveillance: Methods (2)

A
  • Intermittent auscultation (IA)

- Continuous CTG

20
Q

Cerebral palsy: Definition

A

A disorder of movement and/or posture as a result of non-progressive but permanent damage to the developing brain.

21
Q

Antenatal RISK factors that should prompt recommendation of EFM in labour: MATERNAL

A
  • Previous CS
  • Cardiac problems
  • Pre-eclampsia
  • Prolonged labour (>42 wks)
  • Prelabour rupture of membranes (>24hr)
  • Induction of labour
  • Diabetes
  • Antepartum haemorrhage
  • Other significant maternal medical conditions
22
Q

Antenatal RISK factors that should prompt recommendation of EFM in labour: FOETAL

A
  • IUGR
  • Prematurity
  • Oligohydraminos
  • Abnormal doppler velocimetry
  • Multiple pregnancy
  • Meconium-stained liquor
  • Breech presentation
23
Q

INTRAPARTUM risks requiring EFM

A
  • Oxytocin augmentation
  • Epidural anaesthesia
  • Intrapartum PV bleed
  • Pyrexia >37.5
  • Fresh meconium staining of liquor
  • Abnormal FHR on intermittent auscultation
  • Prolonged labour
24
Q

Meconium stained liquor

A
  • Meconium: dark green liquid normally passed by the newborn baby (it contains mucus, bile and epithelial cells).
  • Sometimes the meconium is passed when the baby is still in the womb.
  • This causes serious complications if they are inhaled by the foetus at any stage of labour.
  • Can result in Meconium Aspiration Syndrome.
25
Q

Feotal surveillance: CTG

A

Cardiotocography (CTG):
Used during pregnancy to monitor the foetal heart and contractions of the uterus. Its purpose is to monitor foetal wellbeing and allow early detection of foetal distress.

26
Q

How the CTG works

A
  • Device used in CTG is called a cardiotocograph.
  • It involves the placement of 2 transducers onto the abdomen of the pregnancy woman.
  • One transducer measures the foetal heart rate, using ultrasound.
  • The other transducer monitors the contractions of the uterus.
  • It does this by measuring the tension of the maternal abdominal wall.
  • This provides an indirect indication of intrauterine pressure.
27
Q

How to read a CTG

A

DR C BRaVADO

  • Define Risk
  • Contractions
  • Baseline rate
  • Variability
  • Accelerations
  • Decelerations
  • Overall impression
28
Q

NORMAL foetal HR

A

The normal fetal heart rate varies between 100-160 / min

29
Q

CTG: Baseline BRADYcardia

  • Description
  • Causes (2)
A

Description: Heart rate < 100 /min
Causes:
- Increased fetal vagal tone
- Maternal beta-blocker use

30
Q

CTG: Baseline TACHYcardia

  • Description
  • Causes (4)
A 
Description: Heart rate > 160 /min
Causes:
- Maternal pyrexia
- Chorioamnionitis
- Hypoxia
- Prematurity
31
Q

CTG: Loss of baseline variability

  • Description
  • Causes
A

Description: < 5 beats / min
Causes:
- Prematurity
- Hypoxia

32
Q

CTG: Early deceleration

  • Description
  • Causes
A

Description: Deceleration of the heart rate which commences with the onset of a contraction and returns to normal on completion of the contraction
Causes:
Usually an innocuous feature and indicates head compression

33
Q

CTG: Late deceleration

  • Description
  • Causes
A

Description: Deceleration of the heart rate which lags the onset of a contraction and does not returns to normal until after 30 seconds following the end of the contraction
Causes:
- Indicates fetal distress
- e.g. asphyxia or placental insufficiency

34
Q

CTG: Variable decelerations

  • Description
  • Causes
A

Description: Independent of contractions
Causes:
- May indicate cord compression

35
Q

Foetal surveillance: CTG classification (3)

A
  • Normal
  • Suspicious
  • Pathological

Classification is based on 4 parameters:

  • Baseline (beats/min)
  • Variability (beats/min)
  • Decelerations
  • Accelerations
36
Q

MATERNAL factors that contribute to an ABNORMAL CTG

A
  • Women’s position (advise to adopt left lateral)
  • Hypotension
  • Vaginal examination
  • Emptying bladder/bowels
  • Vomiting
  • Vasovagal episodes
  • Siting and toping up over regional anaesthesia.
37
Q

FOETAL blood sampling: Overview

A
  • This is used to improve the specificity of CTG in the detection of fetal hypoxia.
  • It should be obtained if the trace is pathological, unless obvious immediate delivery may be required (e.g. bradycardia of <80 beats/ min for >3min).
  • The woman should be in left lateral.
38
Q

FOETAL blood sampling: INTERPRETATION

A

Interpretation of the FBS results
• Normal (pH ≥7.25): repeat FBS within 1h if CTG remains pathological.
• Borderline (pH 7.21–7.24): repeat FBS within 30min if CTG remains pathological.
• Abnormal (pH d7.20): immediate delivery.

O&G (13 decks)

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