6.1 - Placental Complications - exam Flashcards
1
Q
Antepartum Haemorrhage
A
- defined as bleeding from the genital tract after 20 weeks gestation
- before onset of labour
- may occur intrapartum bleeding
2
Q
Placenta previa (first)
A
- Placenta implants in the lower uterus
covers the internal cervical os
3
Q
Cause of placental previa
A
- cause is unclear
- ? upper uterus endometrium is not well vascularized
- Damage from:
- Previous cesarean
- Abortion (induced or spontaneous)
- Uterine surgery
- Multioparity
4
Q
Risk Factors
A
- Having multiple placentas
- multiple fetus
- placenta larger than normal surface area
- caused by having twins or triplet
- Maternal risk factors
- Maternal age >35
- Intrauterine fibroids
- maternal smoking, cocaine
- scaring from the previous surgery - csection
5
Q
Types of placenta previa
A
- complete - completing covering the cervical OS
- Partial - covering part of the cervical OS
- Marginal within 2 cm of the cervical OS
6
Q
Antenatal bleeding
A
- Lower uterine segment increases in size
- disrupts placental vessels
- causes painless bright red bleeding (after 20 weeks gestation)
- Intermittent or continuous bleeding
7
Q
complications of placenta previa
A
- Maternal:
- related to blood loss
- dilation and contractions can cause bleeding
- If placenta doesn’t completely separated called Placenta Accreta
- increase hemmorrhage
- Hysterectomy
- Fetal:
- Hypoxia & preterm delivery
8
Q
Placenta acreta - first layer invades the myomtrium
A
- Placenta invades the myomtrium
- usually the Decidua
- uterus has 3 layers
- endometrium
- Myometrium
- Perimemum
- Endometrium changes for implantation of embryo
- decidualization
- than called the Decidua
- Trophblasts - implantation into the decidua
- Decidua basalis
9
Q
Placenta increta - well into the myometrium
A
bedding well in to the myometrium
10
Q
Placental Percreta - most dangerous ICU admission post delivery
A
- invades the:
- endometrium
- myometrium
- perimetumum
- an can attached to the bladder
11
Q
Why Placenta accreta occur
A
- Previous c-section
- Curettage
- myomectomy
- transfers a thin emdmetrium
- lower segment of the uterus. (thinner walls)
12
Q
Diagnosis
A
- Prenatal ultrasound 20 weeks ultrasound
- (sometimes) during labour
13
Q
Treatment & Management
A
- plan and manage preterm labour
- avoid if possible
- corticosteroids given to enhance fetal lungs development
- minor bleeding
- bed rest
- Major Bleeding
- Blood products
- Intravenous fluids
- c-section required
- Severe cases
- immediate c-section preformed
14
Q
Signs of placenta previa
A
- P - painless bright red bleeding
- R - relaxed soft uterus non-tender
- E - episodes of bleeding:
- (mild profuse) 3rd trimester
- body prepares for birth
- thinning of the cervix tears vessels placenta
- V - visible bleeding
- I - intercourse post bleeding (spontaneous or labour)
- A - abnormal fetal position:
- breech
- transverse lie
- fetal HR normal
15
Q
Midwifery interventions
A
- Pelvic rest
- no intercourse
- no vaginal exams
- No abdo manipulation
- No bleeding
- light bed rest
- no strenuous activities until baby is ready for devlier
- If bleeding
- Hospitalised
- Haemorrhage risk
- bloods transfusion may be required
- IVC
- Group & hold
- FBE
- Rh negative
- Kleihauer
- Rh negative
- abdominal trauma
- abnormal CTG
- external monitor baby - CTG or FHR
- monitor and weight blood loss
- Obs
- if active bleeding 15 mins obs
- Left side lying
- c-section if bleeding doesn’t sto
- Tocolytics
- to stop contractions (contraindication if woman is actively bleeding
- Magnesium sulfate
- contraindication if the woman is actively bleeding
- Indicated at <30 weeks for neuroprotection
- if delivery is imminent
- Regimen of Magnesium sulphate
- loading dose 4 grams iv bolus over 20 minutes
- maintenance dose 1 gram iv for 24 hours or until birth - whatever is first
- Amniocentesis
- lung maturity
- Steroids
- Teds
