Antepartum haemorrhage Flashcards
1
Q
Causes of antepartum haemorrhage
A
- 50% are unexplained causes
- Placenta previa
- Placental abruption
- Vasa previa
2
Q
Definition of placenta previa
A
The placenta is completely or partially attatched to the lower segment of the uterus
3
Q
risk factors of placenta previa
A
- increasing maternal age
- increasing parity
- multiple pregnancies
- Previous caesareans section
4
Q
Examination of placenta previa
A
- Abdominal & uterine exam - the uterus is soft and non tender
- Palpate for the fetus - if cephalic presentation, fetus is not engaged due to low lying placenta in the way.
- Speculum - to exclude lower genital tract causes of APH. Digital examination can provoke a massive bleed.
5
Q
Uterus in placenta previa
A
Soft and non tender
6
Q
Diagnosis of placenta previa
A
- Transvaginal ultrasound at 20 weeks - placental site is localised. if low lying placenta is noted at this time;
- Follow up scan in third trimester - placenta previa is diagnosed - majority of patients, the upper segment of the uterus grows and seems as though placenta is moved p and away from the internal os.
7
Q
investigations of placenta previa
A
- Blood typing - blood for transfusion if necessary
- Identify if anti D antibodies are necessary
- Renal function test - if urine output is poor
- Corticograph - for fetal wellbeing
8
Q
management of placenta previa
A
- C section if placenta is enroaching within 2 cm of the internal os
- Massive bleeding if labour ensues and dilation of the internal os which is overlied by the placenta
9
Q
complication of placenta previa
A
- PPH - lower uterine segment is less effective at retraction following deliveyr of the placenta
- Placenta accreta - part or all of the placenta remains attatched to the uterus walls because it grows too deep into the uterine wall
10
Q
How to manage a low lying placenta at 16 - 20 week scan
A
- rescan at 34 weeks
- Still present at 34 weeks grade1/2 -> rescan every 2 weeks
- C section performed if high presenting part or abnormal lie at 37 weeks
11
Q
Placental abruption
A
- detachment of the placenta from the uterus wall - blood dissects under the placenta into the uterine wall - blood can leave via the uterine walls via the cervix ‘revealed haemorrhage’ - blood may become trapped within the uterine cavity - ‘concealed haemorrhage’
12
Q
Causes of placental abruptions
A
- Pre eclampsia 2. Cigarette smoking and cocaine abuse
13
Q
Investigation of placental abruption
A
- Vaginal bleeding associated with abdominal pain
- Palpation of uterus - hard and tender - bleeding extends into uterine muscle - tonic contraction - uterus feels hard
- Transvaginal ultrasound if placental site has not been located 4. Urinalysis for proteinuria - strong link between preclampsia and abruption
- Renal function tests - if bleeding and urine output is low
- Blood typing - identify blood group and improve stocks of blood for transfusion
- Kleihauer test - check for fetal blood cells in the maternal circulation to confirm for fetomaternal haemorrhage which occurs in placental abruption
- Cardiotocograph - check for fetal wellbeing
14
Q
management of placental abruption
A
- Assess the severity of symptoms 2. If fetal and maternal wellbeing is retained - allow for symptoms to pass 3. If not - active resuscitation
15
Q
complications of placental abruption
A
- Postpartum haemorrhage - reduced blood flow and hypovolemic shock during/after child birth –> Sheehan’s syndrome –> postpartum pituitary gland necrosis due to ischameia
- Placental insufficiency caused fetal anoxia or death
