Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Reproduction & Sexual Health > Antepartum bleeding > Flashcards

Antepartum bleeding Flashcards

1
Q

antepartum haemorrhage (APH) definition

A

bleeding from the genital tract after 24 weeks gestation and before the end of the second stage of labour
i.e. >24/40 and before the baby is delivered

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

what are the commonest causes of antepartum haemorrhage?

A

placental abruption and placenta praevia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

minor APH

A

<50ml
settled

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

major APH

A

50-1000ml
no shock

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

massive APH

A

> 1000ml
and/or shock

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

what is placental abruption?

A

separation of a normally implanted placenta - partially or completely before birth of the fetus

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

what percentage of APHs does placental abruption make up?

A

40% of APH

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

what tests should we do if we think there is placental abruption?

A

NO TIME FOR TESTS !
Clinical diagnosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

when is placental abruption most likely to occur?

A

the last trimester, particularly during the last few weeks prior to birth

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

what percentage of cases of placental abruption occur in low-risk pregnancies?

A

70%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

placental abruption risk factors

A
  • unknown (low risk pregnancies!)
  • pre-eclampsia/hypertension
  • trauma
    -smoking/cocaine/ amphetamine
    -thrombophilias/renal diseases/diabetes/hypothyroidism
    -polyhydramnios
  • multiple pregnancy
  • preterm-PROM
    -Placenta insufficiency
    -previous abruption
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

placental abruption symptoms

A
  • CONTINUOUS severe abdominal pain
  • backache with posterior placenta
  • bleeding (may be concealed)
  • preterm labour
  • may present with maternal collapse
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

placental abruption overall signs

A
  • unwell distressed patient
  • signs may be inconsistent with revealed blood
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

placental abruption signs on abdominal examination

A
  • uterus large for date or normal
  • uterine tenderness
  • woody hard uterus
  • fetal parts difficult to identify
  • may be in preterm labour
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

“woody hard uterus”

A

placental abruption

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

placental abruption fetal condition

A
  • bradycardia
  • absent HR (intrauterine death)
  • CTG shows irritable uterus
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

placental abruption management

A
  • ABCDE approach
  • RESUSCITATE MOTHER
  • Assess and deliver baby
  • Manage complications
  • Debrief the parents
18
Q

how do we assess fetal heart in placental abruption management?

A

CTG
USS if no fetal heart

19
Q

fetal complications of placental abruption

A
  • intrauterine death (14%)
  • hypoxia
  • prematurity
  • small for gestation age and fetal growth restriction
20
Q

what is placenta praevia

A

when the placenta lies directly over the internal os

21
Q

when should the term “low-lying placenta” be used?

A

after 16/40 when the placental edge is less than 20mm from the internal os on TA or TV scanning

22
Q

Risk factors for placenta praevia

A
  • previous c section
  • previous termination of pregnancy
  • maternal age >40
  • multiparity
  • assisted conception
  • multiple pregnancy
  • smoking
  • deficient endometrium due to presence or history of: uterine scar, endometritis, manual removal of placenta, D+C, submucous fibroid
23
Q

placenta praevia symptoms

A
  • painless bleeding >24 weeks
  • usually unprovoked but coitus can trigger bleeding
  • bleeding can be minor e.g. spotting, or severe
  • fetal movements usually present
24
Q

do not perform vaginal examination until you exclude ______ ________

A

placenta praevia

25
Q

what scan confirms placenta praevia

A

transvaginal US

26
Q

what scan excludes placenta accreta

A

MRI

27
Q

when could a mother have a vaginal delivery with placenta praevia?

A

if placenta >2cm from os and no malpresentation

28
Q

when should delivery be considered in placenta praevia?

A

34-36 weeks if history of PVB or other risk factors for preterm delivery

36-37 weeks for uncomplicated placenta praevia

29
Q

what is placenta accreta?

A

a placenta abnormally adherent to the uterine wall

30
Q

what puts a woman at increased risk of placenta accreta?

A

previous c section - increasing risk with multiple c sections

placenta praevia

31
Q

placenta accreta management

A
  • prophylactic internal iliac artery balloon
  • caesarean hysterectomy
  • blood loss >3L expected
  • conservative management - incision upper segment
32
Q

uterine rupture definition

A

full thickness opening of the uterus
including serosa

33
Q

uterine rupture risk factors

A
  • previous c section
  • previous uterine surgery e.g. myomectomy
  • multiparity and use of prostaglandins/syntocinon
  • obstructed labour
34
Q

uterine rupture symptoms

A

severe abdominal pain
shoulder tip pain
maternal collapse
PV bleeding

35
Q

uterine rupture signs

A
  • intra-partum - loss of contractions
  • acute abdomen
  • presenting part rises
  • peritonism
  • fetal distress/intrauterine death
36
Q

what is vasa praevia?

A

blood vessels travelling from baby to placenta, unprotected by placental tissue or the umbilical cord, pass near to the cervix. If these blood vessels tear, this can be very dangerous for your baby.

37
Q

vasa praevia foetal mortality

A

around 60%

38
Q

vasa praevia type 1

A

the vessel is connected to a velamentous umbilical cord

39
Q

vasa praevia type II

A

the vessel connects the placenta with a succenturiate or accessory lobe

40
Q

vasa praevia management

A

antenatal diagnosis

  • steroids from 32 weeks
  • consider inpatient management if risks of preterm birth (32-34 weeks)
  • deliver by elective c section before labour (34-36 weeks)

APH from vasa praevia: emergency C section

placenta for histology

Reproduction & Sexual Health (36 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions