Antepartum Haemorrhage Flashcards
What is this describing?
Bleeding from the genital tract after 24+0 weeks gestation.
Antepartum haemorrhage
What does antepartum haemorrhage increase your risk of?
Postpartum haemorrhage
What examination should be avoided in antepartum haemorrhage?
PV examination (speculum is okay)
What is the emergency management of severe antepartum haemorrhage?
- Admit
- IV access, bloods (including clotting), raise legs
- High flow oxygen
- ABO Rh compatible or O- blood if shocked
- Catheterise bladder
What are the risk factors for placenta praevia?
Twins, high parity, increasing maternal age, history of C-section.
What are the clinical features of placenta praevia?
- Intermittent, painless bleed.
2. Breech presentation and transverse lie are common.
What are the two classifications of placenta praevia?
- Marginal (types I-II) - placenta in lower segment, not over os.
- Major (types III-IV) - placenta in lower segment, covering os.
How is suspected placenta praevia investigated?
- TVUSS
- Consider MRI to diagnose placenta accreta
- If PV bleeding - CTG, FBC, clotting, cross-match
What is this describing?
Placenta implanted in lower segment of the uterus.
Placenta praevia
What is the management of placenta praevia if incidental low lying on 16-20 week scan?
- Rescan at 32 weeks, if still present scan every 2 weeks.
2. Plan C-section by 37/40 if major, if minor aim for normal delivery.
What is the management of placenta praevia if there is bleeding?
- Admit, resuscitate (transfusion)
- Anti-D to RhD -ve
- IV access
- Steroids if GA <34/40
- Deliver by 37/40
What are the risks associated with placenta praevia?
- Postpartum haemorrhage - hysterectomy may be required
- IUGR, prematurity, and recurrence
- Requiring blood transfusion
- Placenta accreta or placenta percreta
What is placenta accreta?
Placenta implants onto previous C-section scar, may prevent placental separation.
What is placenta percreta?
Placenta penetrates through uterine wall into surrounding structures.
What is this describing?
Part or all of placenta separates before delivery of the foetus.
Placental abruption
What are the risk factors for placental abruption?
Pre-eclampsia, smoking, IUGR, multiple pregnancy, autoimmune disease, cocaine, previous history of abruption, HTN.
What is this a presentation of?
Pregnant woman, painful dark PV bleeding, tachycardia, uterus is ‘woody’ hard.
Placental abruption
How is placental abruption diagnosed?
- Clinical diagnosis - USS can exclude praevia, abdominal exam, speculum
- CTG to assess foetal distress
- FBC, U&Es, clotting, cross-match
- Catheterisation
What is the initial management for placental abruption?
- Admit, resuscitate (blood transfusion)
- Anti-D to RhD -ve
- IV access
- Steroids if GA <34/40
- Opioid analgesia
What is the ultimate management for placental abruption if there is foetal distress?
Emergency delivery by C-section
What is the ultimate management for placental abruption if there is no foetal distress and the GA is >37/40?
Induction of labour with amniotomy
What is the ultimate management for placental abruption if there is no foetal distress and it is preterm?
Steroids if <34/40, if symptoms settle then discharge and monitor with serial USS.
What is this describing?
Foetal blood vessels run in the membranes, usually due to cord being attached to membranes rather than placenta.
Ruptured vasa praevia
What is this a presentation of?
Painless, moderate PV bleeding at the rupture of the membranes with major foetal distress (bradycardia).
Ruptured vasa praevia
