9 - Obs - APH - Placental Abruption Flashcards
Pathology:
When part of ? separates, considerable maternal ? may occur behind it
-> Further placental ? and acute fetal ?. ? can track down between membranes and ? -> APH. May also enter ?. May enter myometrium. ?
haemorrhage absent in 20%.
placenta bleeding separation distress blood myometrium liquor visible
Complx
Fetal ? common (30%). Haemorrhage often needs ?: this, ??? and ? failure may rarely cause ? death.
death transfusion DIC renal maternal
Aetiology
Many have no ??s, but ????, pre-eclampsia, ? disease, maternal ?, ? use, prev Hx of ?(risk 6%), ? preg and ? all predispose. Also ass w ? or sudden ? in uterine volume (eg rupture of membranes in ?).
RFs IUGR autoimmune SMx cocaine abruption multiple multiparity trauma reduction polyhydramnios
Hx points…
? bleeding. Pain due to blood behind ? and in ?, usually constant w exacerbations, blood often ?. Degree of PV bleed doesn’t reflect ? of abruption as some may not escape ?. Pain/bleeding may occur ?. If pain alone, abruption ?, if bleeding -> revealed.
painful placenta myometrium dark severity uterus alone concealed
Ex points…
? from profound blood loss – inc ? loss. ? is a late sign. Uterus ? and contracting – ?
usually ensues. If severe, uterus ? and ? and fetus difficult to feel. Fetal heart tones abnormal/?. If ? failure – widespread bleeding
tachycardia concealed hypotension tender labour hard woody absent coagulation
Features of major placental abruption - 5 things
maternal collapse fetal distress/demise hard woody uterus coagulopathy poor UO or renal failure
Ix
it is a ? diagnosis - Ix helps estimate ?, plan resuscitation and the ?
To establish fetal wellbeing: ???, may show fetal ? and freq ?. USS to estimate fetal ? at preterm gestation and excludes ??, abruption may not be seen.
clinical
severity
delivery
CTG distress contractions weight placenta praevia
Ix
To establish maternal wellbeing: ???, ? screen and ?
match. ? with hourly output, reg ???, coag and ???
estimations and ? ? ? (CVP) monitoring, req in severe cases.
FBC coagulation cross catheterisation FBC U+E central venous pressure
MGMT - Assessment and Resus
Admit, even w/o PV ? if pain and uterine ?. IV ?, ? if <34wks. ? considered. ?analgesia, anti-D to Rh?ve women.
bleeding tenderness fluids steroids transfusion opiate -ve
MGMT - delivery
Depends on ? state and ?. Mother stabilized first.
If fetal distress: Urgent ? ?
If no fetal distress but gestation ?wks or more: Induction w ? . Fetal ?
monitored. Maternal condition closely observed and C section done if fetal ?.
If fetus dead: ? likely. ?products given and labour ?.
NB - amniotomy = AROM
fetal gestation C/s 37 amniotomy heart distress coagulopathy blood induced
MGMT
Conservative Management
If no fetal ?, preg is preterm and degree of ? minor, ? given (<34wks) and pt closely monitored on ? ward. If all Sx settle, may ? but preg now ?
risk, ??? for growth done.
Postpartum Management
PPH is a major risk no matter mode of delivery.
distress abruption steroids antenatal discharge high USS
