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Y3 Reproduction > Antepartum Haemorrhage > Flashcards

Antepartum Haemorrhage Flashcards

1
Q

what is bleeding in early pregnancy?

A

bleeding before 24 weeks

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2
Q

what is antepartum haemorrhage?

A

bleeding after 24 weeks and before the end of the second stage of labour

aka bleeding in late pregnancy

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3
Q

what is the sole source of foetal nutrition from week 6?

A

placenta

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4
Q

what are the two most common causes of APH?

A

placental abruption

placenta praevia

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5
Q

what is a minor APH?

A

<50ml

patient settled

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6
Q

what is a major APH?

A

50-1000ml

patient not in shock

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7
Q

what is a massive APH?

A

> 1000ml and/or patient in shock

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8
Q

what is placental abruption?

A

the separation of a normally implanted placenta before birth

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9
Q

how is placental abruption diagnosed?

A

a clinical diagnosis

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10
Q

how does placental abruption present?

A 
abdominal pain 
bleeding 
preterm labour 
severe = maternal collapse 
uterine tenderness
hard uterus on palpation
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11
Q

how is placental abruption managed?

A

IV fluids

assess and delivery of the baby

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12
Q

what is placenta praevia?

A

when the placenta lies directly over the internal os

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13
Q

what is low lying placenta?

A

when the placental edge is less than 20mm from the internal os after 16 weeks

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14
Q

what is the lower segment of the uterus?

A

the part of the uterus below the utero-vesical pouch superiorly and the internal os interiorly

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15
Q

what increases risk of placenta praevia in subsequent pregnancies?

A

c section

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16
Q

when is screening for placenta praevia done?

A

foetal anomaly scan

rescan at 32-36 weeks if there is persistent placenta praevia or low lying placenta

17
Q

how does placenta praevia present?

A

painless bleeding

18
Q

what should not be performed in patients with placenta praevia?

A

vaginal examination

19
Q

how is the mother managed in placenta praevia?

A

ABCDE approach

anti D if needed

20
Q

how is the baby managed in placenta praevia?

A

assess the babies condition

steroids if preterm and needing delivered

MgSO4 if <32 weeks and needing delivered

21
Q

when does a baby need MgSO4 and why?

A

if being delivered <32 weeks for neuroprotection

22
Q

when does a baby need to receive steroids?

A

if being delivered between 24 and 35+6 weeks

23
Q

when should delivery be considered in uncomplicated placenta praevia?

A

36-37 weeks

24
Q

when is CS done for placenta praevia?

A

if placenta covers os or is <2cm from os

25
Q

when can vaginal delivery be done in placenta praevia?

A

placenta >2cm from os and no malpresentation

26
Q

what are the three types of morbidly adherent placenta?

A

accreta
increta
percreta

27
Q

what increases the risk of morbidly adherent placenta?

A

multiple c sections

placenta praevia

28
Q

what is morbidly adherent placenta associated with?

A

severe bleeding and PPH

29
Q

what can severe cases of morbidly adherent placenta require to manage?

A

hysterectomy

30
Q

what increases the risk of uterine rupture?

A

previous CS, IOL or rupture

31
Q

what is the definition of uterine rupture?

A

full thickness opening of the uterus

serosa intact = called dehiscence

32
Q

how does uterine rupture present?

A

abdominal pain
shoulder tip pain
maternal collapse
PV bleeding

33
Q

what is vasa praevia?

A

when unprotected vessels traverse the membranes below the presenting part

rupture during labour

34
Q

how is vasa praevia managed?

A

ultrasound TA and TV with doppler

35
Q

what is type I vasa praevia?

A

when the vessel is connected to a velamentous umbilical cord

36
Q

what is type II vasa praevia?

A

when the vessel connects the placenta with an accessory lobe

37
Q

how is vasa praevia managed?

A

steroids from 32 weeks

deliver by CS at 34-36 weeks

Y3 Reproduction (49 decks)

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