Antepartum haemorrhage

Question 1

definition

Answer 1

genital tract bleeding from 24 weeks gestation

Question 2

causes APH

Answer 2

placental abruption, placenta praevia, vasa praevia, uterine rupture, cervical polyps, erosions, carcinoma, cervicitis, vaginitis

Question 3

signs placenta praevia

Answer 3

shock in proportion to visible loss, NO PAIN, uterus non tender, lie and presentation may be abnormal, fetal heart usually normal, coag probs rare, small bleeds before the large

Question 4

signs placenta rupture

Answer 4

shock out of keeping with visible loss, pain constant, tender tense uterus, normal lie and presentation, fetal heart absent or distressed, coag problems

Question 5

what should you be worried about in placental rupture

Answer 5

pre eclampsia, DIC, anuria

Question 6

what happens to risk of PPH in both praevia and rupture

Answer 6

increased risk. lower segment may not contract well after placenta praevia

Question 7

what is placenta praevia

Answer 7

placenta lies in lower uterine segment. 0.5%

Question 8

associations placenta praevia

Answer 8

c section, sharp curette TOP, multiparity, multipole pregnancy, mother >40, assisted conception, D&C, fibroids, endometriosis

Question 9

management of major and minor placenta praevia

Answer 9

major- C section. minor- normal delivery

Question 10

what is a minor placenta praevia

Answer 10

doesn’t cross the internal os

Question 11

presentation APH

Answer 11

APH or failure of head to engage

Question 12

management placenta praevia

Answer 12

no vaginal exam. assess blood loss and cross match. severe bleeding- urgent delivery if less severe and

Question 13

what could happen to the baby in episodes of heavy bleeding

Answer 13

hypoxia

Question 14

complications of placenta praevia

Answer 14

haemorrhage, placenta accreta or percreta

Question 15

when would an elective c section be planned in placenta praevia

Answer 15

38 weeks

Question 16

what is placental abruption

Answer 16

placenta becomes detached from uterus

Question 17

associations abruption

Answer 17

IUGR, smoking, infection, vertex presentation, pre eclampsia, multiple pregnancy, polyhydramnios, incr age, thrombophilia, trauma, assisted reproduction

Question 18

complications abruption

Answer 18

placental insufficiency, uterine compression leading to tender uterus, DIC, backache

Question 19

what may concealed abruption lead to

Answer 19

maternal shock

Question 20

investigations in abruption

Answer 20

FBC, USS, CTG

Question 21

management abruption- when to admit patient

Answer 21

pain and uterine tenderness. IV fluids and steroids if

Question 22

what should delivery be in abruption

Answer 22

urgent C section if fetal distress. induction of labour if >37 weeks and no distress

Question 23

management minor pre term abruption

Answer 23

no distress. give steroids, monitor serial USS

Question 24

what colour is the blood in praevia/abruption

Answer 24

praevia- fresh red, profuse. abruption- dark red, can be concealed and not bleed

Question 25

what is placenta accreta

Answer 25

all or part of placenta abnormally attached to the myometrium

Question 26

treatment placenta accreta

Answer 26

C Section hysterectomy. DIC common

Question 27

what is released to cause DIC

Answer 27

thromboplastin

Question 28

what is vasa praevia

Answer 28

fetal vessels lying within placental membranes which cross the internal os.

Question 29

when is the vasa praevia at risk of tearing

Answer 29

when the membrane ruptures

Question 30

when is vasa praevia more common

Answer 30

following IVF