antepartum haemorrhage Flashcards
what are the divisions or causes of antepartum haemorrhage ?
obstreitics causes
local gynaecological causes
general or systematic causes
what is placenta praevia ?
a placenta that is encroaching on the lower uterine segment
what are the risk factors for placenta praevia ?
previous placenta praevia previous Caesarian section multiple pregnancies advanced maternal age smoking deficient endometrium
what are the clinical signs related to PP ?
general condition of the patient is proportionate to the amount of bleeding
anemia
signs of hypovolemic shock
what are the findings on abdominal examination in cases of PP ?
the abdomen and the uterus are lax and not tender
fundal level corresponds to the period of amenorrhea
when can we perform a PV examination on a patient who is suspected to have PP ?
PV exam is contraindicated until PP is excluded , as this could cause placental seperation
what investigations should be performed in women who are suspected of having PP ?
FCBC and blood typing
urea and electrolytes
liver function test
Ultrasound scan
when should follow up for patients with PP be performed ?
32 weeks once
then confirm at 36 weeks
what fetal investigations should be performed ?
FHR by CTG
at what gestational age should planned delivery occur in cases of PP ?
late preterm ( between n34 and 36 weeks )
for women with uncomplicated placenta praevia delivery should be considered between 36 and 37 weeks of gestation
what are the indications for CS in placenta praevia ?
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
what is placenta accreta ?
a spectrum of disorders where the placenta grows too deeply into the uterine wall, of which there are types
what are the different types of placenta accreta ?
placenta accreta , too deep into the uterus
placenta increta , too deep into myometrium
placenta percreta , extension to nearby organs
what are the risk factors for placenta accreta ?
previous and multiple caesarian sections
previous placenta accreta
repeated endometrial curettage
what is placental abruption ?
it is bleeding from the genital tract after 20 weeks of gestation due to premature seperation of a normally situated placenta
what are the types of placental abruption ?
revealed
concealed
concealed and revealed
what are the risk factors for placental abruption ?
two previous pregnancies complicated by abruption
pre-eclampsia
trauma
frist trimesteric bleeding
maternal thrombophilia, non-vertex presentation
on nexamination what will be evident in a woman suffering from placental abruption ?
on abdominal palpation :
the tense or woody feel to the uterus on abdominal palpation indicated a significant abruption
may also reveal uterine contractions
what investigations should be performed in women presenting with APH due to placental abruption ?
CBC
coagulation screening
cross matching to get appropriate blood bags
Ultrasound scan
if fetal death is diagnosed what is the preferred method of delivery ?
vaginal birth
what is vasa praevia ?
Vasa praevia is a condition in which fetal blood vessels cross or run near the internal opening of the uterus
when should we suspect vasa praevia ?
when there is fetal distress, however the mother is in good condition and fetal RBCs are found on CBC
how can we make an accurate diagnosis of vasa praevia ?
trans-abdominal ultrasound
trans-vaginal colour doppler imaging
in asymptomatic women diagnosed with vasa praevia when should a planned delivery be performed ?
34-36 weeks
when should administration of corticosteroids for fetal lung maturity happen ?
at 32 weeks
should women presenting with APH who are RHD negative be given anti-D Ig ?
if rh negative then give anti d injection with every episode of bleeding but with an interval of 6 weeks apart
what is the optimal mode of anesthesia for women who have experienced APH ?
regional anesthesia
if a woman with APH presents with coagulopathy how should she be managed ?
suspicion of DIC here is high
clotting profile
platelet count 4 units of FFP and 10 units of cryoprecipitate should be given meanwhile
