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repro and sexual health > Antepartum haemorrhage > Flashcards

Antepartum haemorrhage Flashcards

1
Q

functions of the placenta

A

gas transfer
metabolism/waste disposal
hormone production
protective filter

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2
Q

definition of APH

A

bleeding from the genital tract after 24 weeks gestation and before the end of the second stage of labour

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3
Q

commonest causes of APH

A

placental abruption
placenta praevia

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4
Q

what is placental abruption

A

separation of normally implanted placenta- partially or totally before birth
clinical diagnosis

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5
Q

pathology of placental abruption

A

vasospasm followed by arteriole rupture into the decidua > blood escapes into amniotic sac and into myometrium
causes tonic contractions and interrupts placental circulation causing hypoxia

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6
Q

couvelaire uterus

A

haemorrhage from placental blood vessels goes into decidua basalis causing placental separation, followed by infiltration in the lateral portions of the uterus

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7
Q

risk factors for abruption

A

most are unknown
- pre-eclampsia
- trauma
- smoking/cocaine/amphetamine
- medical thrombophilias
- polyhydramnios
- multiple pregnancy
preterm- PROM

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8
Q

presentation of placental abruption

A

severe abdominal pain- continuous
backache- with posterior placenta
bleeding
preterm labour
maternal collapse

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9
Q

signs of placental abruption

A

unwell distressed patient
uterus LFD or normal
uterine tenderness
woody hard uterus
fetal parts difficult to identify
preterm labour
fetal heart rate: bradycardia/absent

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10
Q

management of placental abruption

A

ABCDE
- 2 large bore IV access
- bloods: FBC, clotting, LFT U&E, X match 4-6 units RBC
- IV fluids
- catherterise
resus mother
assess and deliver the baby
assess fetal heart

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11
Q

definition of placenta praevia

A

placenta lies directly over the internal os

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12
Q

when should term low-lying placenta be used

A

after 16 weeks when placental edge is less than 20 mm from the internal os on transabdominal or TVUS scanning

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13
Q

risk factors for placenta praevia

A

previous caesarean sections
pervious TOP
advanced maternal age
multiparity
smoking
assisted conception
multiple pregnancy

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14
Q

placenta praevia screening

A

midtrimester fetal anomaly scan should include placental localisation
rescan at 32 and 36 weeks if PP or LLP
TVUS is better than transabdominal

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15
Q

symptoms of placenta praevia

A

painless bleeding > 24 weeks
usually unprovoked but coitus can trigger bleeding
bleeding can be minor
fetal movements usually present

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16
Q

signs of placental praevia

A

patients condition directly proportional to amount of observed bleeding
uterus soft non tender
presenting part high
malpresentations- breech/transverse/oblique
fetal heart: CTG usually normal

17
Q

diagnosis of placenta praevia

A

check anomaly scan
confirm by TVUS
MRI for excluding placenta accreta
do not do vaginal exam

18
Q

management of placenta praevia

A

resus mother
- large bore IV access and G+S
assess baby
- steroids- 24-35+6 weeks
- MgSO4 if < 32 weeks

19
Q

definition of placenta accreta

A

a morbidly adherent placenta
abnormally adherent to the uterine wall

20
Q

placenta invading myometrium

A

increta

21
Q

placenta penetrating uterus to bladder

A

percreta

22
Q

management of placenta accreta

A

prophylactic internal iliac artery balloon
c hysterectomy
blood loss expected
conservative management + methotrexate

23
Q

presentation of uterine rupture

A

severe abdominal pain
shoulder tip pain
maternal collapse
PV bleeding

24
Q

signs of uterine rupture

A

intra-partum loss of contractions
acute abdomen
PP rises
loss of utrine contractions
peritonism
fetal distress/IUD

25
Q

management of uterine rupture

A

urgen resus and surgical management
2 large bore IV access
FBC, clotting, LFT, U&E, kleihauer
Xmatch 4-6 units

26
Q

what is vasa praevia

A

unprotected fetal vessels traverse the membranes below the presenting part over the internal cervical os

27
Q

diagnosis of vasa praevia

A

US TA and TV with doppler
clinical- ARM and sudden dark red bleeding with fetal bradycardia/death

28
Q

type I vasa praevia

A

when the vessel is connected to a velamentous umbilical cord

29
Q

type II vasa praevia

A

when the vessel connects the placenta with a succenturiate or accessory lobe

30
Q

risk factors for vasa praevia

A

placental anomalies: bilobed placenta or succenturiate lobes
history of low-lying placenta in second trimester
multiple pregnancy
in vitro fertilisation

31
Q

management of vasa praevia

A

antenatal diagnosis
steroids from 32 weeks
consider inpatient management if risks of preterm birth
deliver by elective c/section before labour 34-36 weeks
APH: emergency delivery

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