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Obstetrics > Antepartum Haemorrhage > Flashcards

Antepartum Haemorrhage Flashcards

1
Q

What are uterus os

A

The uterus has two orifices, or ostia, called the internal os and the external os:
Internal os: The internal orifice of the uterus, which connects the uterine cavity to the cervical canal
External os: The external orifice of the uterus

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2
Q

What is a low lying placenta?

A

blastocyte implanted in lower segment of uterus resulting in the formation of a placenta near internal cervix orifice opening

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3
Q

what is placenta praevia?

A

blastocyte implanted in lower segment of uterus resulting in the formation of a placenta that obstruct or partially obstruct internal cervix orifice opening

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4
Q

What can cause placenta trauma?

A

sex
vaginal exam
labour’s cervical dilation

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5
Q

How does placenta praevia present>

A

painless antepartum Haemorrhage w/ SNT utereus
– if < 24 weeks- Risk of miscarriage
– if >24 weeks - Antepartum haemorrhage

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6
Q

What should be investigated during Ante-partum Haemorrhage?

A
  1. FBC
  2. Group (Rhesus / ABO) & Save (Cross-match if transfusion needed)
  3. TRANS- VAGINAL/ABDO US
  4. Kleihauer Test (Measures amount of fetal haemoglobin in maternal blood)
  5. Foetal CTG - Cardiotocography - measures fetal pulse
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7
Q

How is placenta praevia diagnosed

A

Usually during 20 weeks anatomy USS
or follow up scan 32 weeks
or follow up scan at 36 weeks

transvaginal US

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8
Q

What are the DDX for antepartum haemorrhage

A

placental abruption
onset of labour
cervical ectropian (
vasa praevia

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9
Q

what is cervical ectropian?

A

Cervical ectropion is a condition in which the cells from the ‘inside’ of the cervical canal, known as glandular cells, are present on the ‘outside’ of the vaginal portion of the cervix.

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10
Q

How to manage placenta praevia?

A

PP often self resolves
Corticosteroid injection @ 34-36 weeks
Aim to deliver via caesarean section @36/37 weeks

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11
Q

what is vasa praevia?

A

Vasa praevia is a rare but serious obstetric condition in which fetal blood vessels cross or run near the internal opening of the cervix, and these vessels are unprotected by the umbilical cord or placenta.

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12
Q

Pathophysiology of vasa praevia?

A

exposed fetal vessels are liable to rupture and ahemorrhage in labour due to cervical dilation or .movement.
In particular if vessels overly os.

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13
Q

How would vasa praevia present?

A

antepartum haemorrhage
SROM Spontaneous rupture of membranes - labour

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14
Q

How is Vasa Praevia diagnosed antenatally?

A

Antenatal - Transvaginal US

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15
Q

How is Vasa Praevia diagnosed durign labour?

A

vaginal examination - palpable foetal vessel overlying os

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16
Q

How is vasa praevia managed?

A

if diagnosed - corticosteroid + C section

if detected at labour - C- Section

17
Q

What is Placenta Accreta Syndrome PAS and what are the different types?

A

PAS describes the different PATHOLOGICAL adherence of the placenta:

  • Placenta Accreta
  • Placenta Increta
  • Placenta Percreta
18
Q

Describe the placenta positioning in Placenta Accreta?

A

Placenta adheres to Myometrium (muscular middle layer of the uterus )

19
Q

Describe the placenta positioning in Placenta Increta?

A

Placenta adheres to outer serosa ( single outer cell layer of tissue made of epithelial cells that envelop the uterus.)

20
Q

Describe the placenta positioning in Placenta Percreta?

A

Placenta invades beyond uterine wall and may attach to surrounding organs

21
Q

Managing placenta accreta spectrum

A

C-Section =/- hysterectomy

21
Q

Presentation of placenta accreta spectrum

A

MASSIVE OBSTETRIC HAEMORRHAGE IN LABOUR

22
Q

What is placental abruption

A

premature separation of the palcenta from decidua (The decidua is a glandular layer of the endometrium that responds to hormones & forms part of the placenta)

23
Q

Pathophysiology of placental abruption

A

Combination of Chronic processes + Acute Trigger

Chronic Processes:
- Placental thrombosis / Infection
=> Hypoperfusion
=> Placental infarction = Shallow Trophoblast invasion
=> Poor placenta adherence
+
Acute trigger:
- Mechanical Trauma

= Seperation

24
Q

What does placenta seperation cause>

A

Rupture of maternal decidual vessels causing blood to accumulate between placenta and decidua

25
Q

Types of placental abruption

A

Concealed - Blood remians behind placenta preventing PV bleed
Revealed - Blood escapes from behind placenta - PV bleed
Mixed- clot forms behind placenta + PV bleed

26
Q

How would placental abruption present

A

Antepartum haemorrhage
abdo pain
woody hard contractile utereeus

27
Q

How to investiagte for placental abruption

A
  1. FBC
  2. Group (Rhesus / ABO) & Save (Cross-match if transfusion needed)
  3. TRANS- VAGINAL/ABDO US
  4. Kleihauer Test (Measures amount of fetal haemoglobin in maternal blood)
  5. Foetal CTG - Cardiotocography - measures fetal pulse
28
Q

Placental abruption tx

A

C section

Obstetrics (12 decks)

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