antepartum haemmhorage

Question 1

what are the risk factors for placenta praevia?

Answer 1

smoking, caesarean, previous pp, increase maternal age, multiparity,

Question 2

what is the definition?

Answer 2

implantation of the placenta over the cervical os in advance of fetal presenting part

Question 3

signs?

Answer 3

bright red bleeding which is PAINLESS

Question 4

if a woman presents with antepartum haemmhorage what shouldnt be done?

Answer 4

pelvic exam, until pp is ruled out

Question 5

where is the bleeding coming from?

Answer 5

it is of maternal origin

Question 6

what other signs may there be?

Answer 6

fetal malpresentation; fetus not engaging? as it is prevented by the placenta praevia

Question 7

which ix are done?

Answer 7

ultrasound is usually accurate enough.

only 5% from the second trimester survive to term

Question 8

mx- antepartum

Answer 8

• if fetal distress or too much haemhorrage risking mothers life - deliver via caesarean.
  can usually manage pp well, its a balance of delivering but letting the fetus mature enough before delivery.

sometimes it resolves and a vaginal delivery can happen

Question 9

intrapartum mx:

Answer 9

do a double team set up,
they prefer elective caesarean at 36-38 if known pp.
if patient wants vaginal birth, or ultrasound is inconclusive do double team too.- do bimanual exam ; if pp; then do c-section.
vaginal bleeding only if iufdeath.

Question 10

what is expectant managing?

Answer 10

expectant management is usually defined as watchful waiting or close monitoring by a physician instead of immediate treatment.

Question 11

fetal complications:

Answer 11

pre term birth.

Question 12

what is abruption

Answer 12

premature seperation of placenta from uterine wall

Question 13

risk factors:

Answer 13

hypertension, smoking, trauma, prior abruption, cocaine,

mat age increased, polyhydramnios, multiple pregnancy, multiparity, fibroids,uterine anomalies

Question 14

dx: signs

Answer 14

vaginal bleeding; uterine contractions, abdominal tenderness, if uterus is tender, it could mean extravasation of the blood into the myometrium

amniotic fluid port wine colour
hard to tell if abruption on ultrasound scan

Question 15

what is a direct contraindication if there is abruption?

Answer 15

tocolysis : meds also called anti-contraction medications or labor suppressants) are medications used to suppress premature labor.

Question 16

mx:

Answer 16

need to deliver if fetal distress

if there isn’t can do expectant management. and see how things go.

Question 17

what is advanced maternal age associated with?

Answer 17

Advanced maternal age is associated with:
Miscarriages
Chromosomal abnormalities
Hypertension
Diabetes
Prolonged labour
Low birth weight
Pre-term delivery, and
Neonatal mortality.