antepartum haemorrhage

Question 1

what are the divisions or causes of antepartum haemorrhage ?

Answer 1

obstreitics causes
local gynaecological causes
general or systematic causes

Question 2

what is placenta praevia ?

Answer 2

a placenta that is encroaching on the lower uterine segment

Question 3

what are the risk factors for placenta praevia ?

Answer 3

previous placenta praevia 
previous Caesarian section
multiple pregnancies 
advanced maternal age 
smoking 
deficient endometrium

Question 4

what are the clinical signs related to PP ?

Answer 4

general condition of the patient is proportionate to the amount of bleeding
anemia
signs of hypovolemic shock

Question 5

what are the findings on abdominal examination in cases of PP ?

Answer 5

the abdomen and the uterus are lax and not tender

fundal level corresponds to the period of amenorrhea

Question 6

when can we perform a PV examination on a patient who is suspected to have PP ?

Answer 6

PV exam is contraindicated until PP is excluded , as this could cause placental seperation

Question 7

what investigations should be performed in women who are suspected of having PP ?

Answer 7

FCBC and blood typing
urea and electrolytes
liver function test
Ultrasound scan

Question 8

when should follow up for patients with PP be performed ?

Answer 8

32 weeks once

then confirm at 36 weeks

Question 9

what fetal investigations should be performed ?

Answer 9

FHR by CTG

Question 10

at what gestational age should planned delivery occur in cases of PP ?

Answer 10

late preterm ( between n34 and 36 weeks )

for women with uncomplicated placenta praevia delivery should be considered between 36 and 37 weeks of gestation

Question 11

what are the indications for CS in placenta praevia ?

Answer 11

total, partial or marginal posterior types of PP
severe bleeding or a shocked patient
bleeding and a closed cervix
fetal distress due to severe bleeding

Question 12

what is placenta accreta ?

Answer 12

a spectrum of disorders where the placenta grows too deeply into the uterine wall, of which there are types

Question 13

what are the different types of placenta accreta ?

Answer 13

placenta accreta , too deep into the uterus
placenta increta , too deep into myometrium
placenta percreta , extension to nearby organs

Question 14

what are the risk factors for placenta accreta ?

Answer 14

previous and multiple caesarian sections
previous placenta accreta
repeated endometrial curettage

Question 15

what is placental abruption ?

Answer 15

it is bleeding from the genital tract after 20 weeks of gestation due to premature seperation of a normally situated placenta

Question 16

what are the types of placental abruption ?

Answer 16

revealed
concealed
concealed and revealed

Question 17

what are the risk factors for placental abruption ?

Answer 17

two previous pregnancies complicated by abruption
pre-eclampsia
trauma
frist trimesteric bleeding
maternal thrombophilia, non-vertex presentation

Question 18

on nexamination what will be evident in a woman suffering from placental abruption ?

Answer 18

on abdominal palpation :
the tense or woody feel to the uterus on abdominal palpation indicated a significant abruption
may also reveal uterine contractions

Question 19

what investigations should be performed in women presenting with APH due to placental abruption ?

Answer 19

CBC
coagulation screening
cross matching to get appropriate blood bags
Ultrasound scan

Question 20

if fetal death is diagnosed what is the preferred method of delivery ?

Answer 20

vaginal birth

Question 21

what is vasa praevia ?

Answer 21

Vasa praevia is a condition in which fetal blood vessels cross or run near the internal opening of the uterus

Question 22

when should we suspect vasa praevia ?

Answer 22

when there is fetal distress, however the mother is in good condition and fetal RBCs are found on CBC

Question 23

how can we make an accurate diagnosis of vasa praevia ?

Answer 23

trans-abdominal ultrasound

trans-vaginal colour doppler imaging

Question 24

in asymptomatic women diagnosed with vasa praevia when should a planned delivery be performed ?

Answer 24

34-36 weeks

Question 25

when should administration of corticosteroids for fetal lung maturity happen ?

Answer 25

at 32 weeks

Question 26

should women presenting with APH who are RHD negative be given anti-D Ig ?

Answer 26

if rh negative then give anti d injection with every episode of bleeding but with an interval of 6 weeks apart

Question 27

what is the optimal mode of anesthesia for women who have experienced APH ?

Answer 27

regional anesthesia

Question 28

if a woman with APH presents with coagulopathy how should she be managed ?

Answer 28

suspicion of DIC here is high
clotting profile
platelet count 4 units of FFP and 10 units of cryoprecipitate should be given meanwhile