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Ante-Partum Haemorrhage Flashcards

1
Q

What is Antepartum haemorrhage?

A

Bleeding of the genital tract from 24 weeks of gestation until birth

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2
Q

What causes APH? (5)

A
  1. Placental abruption
  2. Placenta Privea
  3. Uterine rupture
  4. Vasa Privea
  5. Other Gynacological reasons- cervical lesions, infection etc.
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3
Q

What is placenta Privea?

A

When the placenta is partially of fully implanted into the lower uterine segment

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4
Q

When is it normal to have the placenta in the lower uterine segment?

A

<20 weeks of gestation

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5
Q

What causes placenta privea?

A
  1. Twins
  2. Multiparity
  3. Increased maternal age
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6
Q

How do we classify Placenta Privea?

A
  1. Marginal (types 1+2) is when the placenta is in the lower segment however not over the OS
  2. Major (types 3+4) is when the placenta is completely or partially covering the OS
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7
Q

What are the complications of placenta privea? (4)

A
  1. CS due to obstructed head engagement
  2. Haemorrhage
  3. Placenta accreta
  4. Placenta precreta
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8
Q

What is Placenta accrete?

A

Implantation into previous CS and myometrium

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9
Q

What is Placenta Percreta?

A

Penetration of the placenta through the uterine wall into surrounding structures

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10
Q

What are the clinical features of placenta privea?

A
  1. Intermittent painless bleeding

2. Breech/transverse lie

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11
Q

Should a VE be done in suspected placenta privea?

A

NO - can provoke massive bleed

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12
Q

How do we investigate placenta privea?

A
  1. US to locate the placenta.

IF the placenta is <2CM from the internal OS at term it is positive

  1. FBS, 6 units crossmatch, clotting
  2. CTG
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13
Q

What would you do if an US shows placenta privea at 20 weeks?

A

Re-scan at 32 weeks

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14
Q

How is Placenta accreta diagnosed?

A
  1. On US - if placenta is anterior with pre LSCS order an MRI
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15
Q

How is placenta privea managed?

A
  1. Admission
  2. IV access
  3. Steroids if <34 weeks
  4. Blood ready to be transfused
  5. Anti-D if RH -ve
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16
Q

How are babies with placenta privea delivered?

A
  1. Elective C-Section by senior consultant
  2. Intra-operative and post operative PPH lookout
  3. Lower segment does not contract well due to placental insertion
17
Q

How are babies with placenta accreta managed?

A
  1. Consultant care -OBGYN + ANAESTHATIST
  2. blood available
  3. MDT
  4. Pre-delivery discussion about possible intervention (hysterectomy, cell salvage, leaving the placenta in and interventional radiology)
18
Q

What is placental abruption?

A

When the placenta separates before the delivery of the baby

19
Q

What foetal complications does placental abruption cause?

A
  1. Foetal distress

2. Foetal death

20
Q

What are the symptoms associated with placental abruption? (6)

A
  1. Vaginal bleeding
  2. Abdominal pain
  3. Uterine tenderness/contractions
  4. Foetal distress
  5. Intrauterine death
  6. DIC
21
Q

What causes placental abruption? (10)

A
  1. IUGR
  2. Pre-eclampsia
  3. Autoimmune disease
  4. Smoking
  5. Cocaine
  6. Previous abruption
  7. Multiple pregnancy
  8. Multiparity
  9. Trauma
  10. Pre-existing HTN
22
Q

What are the clinical features of placental abruption?

A
  1. Painful bleeding (due to blood behind the placenta)

can be concealed or revealed

23
Q

What do you see on examination of placental abruption? (5)

A
  1. Tachy
  2. Hypotension
  3. Tender uterus
  4. Foetal heart sound abnormal/absent
  5. Hard woody uterus
24
Q

How is placental abruption investigated?

A
  1. Clinical diagnosis
  2. CTG
  3. FBC, clotting, crossmatch, U+E
  4. Catheter hourly UO
25
Q

How is placental abruption managed?

A
  1. Admission
  2. IV fluids/blood
  3. Steroids if gestation <34
  4. Analgesia
  5. Anti D if indicated
  6. Early delivery
26
Q

When do you deliver in a mum with placental abruption?

A
  1. When the mother is stable

2. Depends on foetal state and gestation

27
Q

When would you perform C-section in placental abruption?

A

Foetal distress

28
Q

How do you induce labour in placental abruption with no foetal distress?

29
Q

How is placental abruption conservatively managed?

A
  1. Steroids
  2. Close monitoring
  3. PPH lookout
30
Q

Difference between Placenta privea and placental abruption in terns of:

Shock

Pain

Bleeding

Tenderness

Foetus

US

A

Abruption:

Shock: Inconsistent with external loss
Pain: Common severe
Bleeding: can be concealed
Tenderness: severe tenderness with woody uterus
Foetus: can be dead/distressed
US: Normal

Placenta Privea:

Shock: Consistent with external loss
Pain: No pain
Bleeding: Red and profuse 
Tenderness: Rare
Foetus: Abnormal lie/head height
US: Low placenta
31
Q

What is the most common cause of bleeding of undetermined origin and how is it managed?

A

Minor abruption

Managed conservatively

32
Q

What is vasa privea

A

When the foetal blood vessels run in the membrane infant of the presenting part causing a massive bleed when membranes rupture

OBSTETRICS (11 decks)

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