antepartum

Question 1

define antepartum haemorrhage

Answer 1

vaginal bleeding after 24weeks but before second stage of labour

Question 2

define a minor antepartum haemorrhage

Answer 2

blood loss , <500ml thats settled

Question 3

define major antepartum haemorrhage

Answer 3

blood loss 500ml - 1L with no signs of shock

Question 4

define massive antepartum haemorrhage

Answer 4

> 1L and or signs of shock

Question 5

to be defined as placenta praevia the placenta must be found either..?

Answer 5

covering cervical os or within 2cm of it

Question 6

symptoms of placenta praevia

Answer 6

bright red painless bleeding

Question 7

risk factors for placenta praevia

Answer 7

age, previous c section or prev placenta praevia

Question 8

how does placental abruption present

Answer 8

painful vaginal bleeding

Question 9

woody hard uterus

Answer 9

placental abruption

Question 10

what causes placental abruption

Answer 10

vasospasm causes arteriole rupture into the decidua, blood escapes into amnitotic sac or further under placenta into myometrium. this causes tonic contractions and interrupts placental circulation- hypoxia. this results in a couvelaire uterus- blood between muscle fibres so appears blue and doesnt contract well increasing chance of PPH

Question 11

Symptoms of placental abruption

Answer 11

severe and constant abdo pain. backache with posterior placenta, bleeding (may be concealed), preterm labour, maternal collapse

Question 12

signs of placental abruption (inc. CTG signs)

Answer 12

large/norm for dates uterus, tenderness(woody hard uterus), difficulty identifying foetal parts, decreased or absent foetal HR,

CTG- shows irritable uterus which appears zigzag pattern or few contractions, foetal tachy, loss of variability or decelerations

Question 13

management of placental abruption

Answer 13

urgent c-section, replace blood products (RBC, platelet, fifrinogen)

Question 14

membranes ruptured followed by small volume of dark red blood w/ foetal bradycardia and decelerations

Answer 14

vasa praevia

Question 15

in what group of individuals in uterine rupture more likely

Answer 15

those with previous uterine surgery

Question 16

use of what medications can pre-ceed uterine rupture and why ?

Answer 16

syntocinon or prostaglandins resulting in uterine overstimulation

Question 17

management if uterine rupture

Answer 17

urgent c-section

Question 18

causes of PPROM

Answer 18

infection
cervical incompetency
uterine over distension- multiple babies
vascular causes- placental abruption

Question 19

why should PPROM not be investigated with PV unless labour suspected ?

Answer 19

risk of infection - chorioamniotitis

Question 20

when is a baby described as extremely pre-term ?

Answer 20

before 28 weeks

Question 21

when is a baby classed as very preterm

Answer 21

28-32 weeks

Question 22

how would you manage PPROM ?

Answer 22

1. monitor for chorioamniotitis
2. give antibiotics to prevent infection - erythromycin 250mg 6hrs for 10 days
3. tocolytics- nifiepine 1st line for 26-34 weeks (suppress labour)
4. maternal steroid to encourage lung maturation
5. Iv magnesium Sulphate