Antepartum haemorrhage Flashcards

1
Q

What is APH?

A

Bleeding before 24 weeks

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2
Q

What are the causes

A

abruption
placenta praevia
vasa praevia

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3
Q

What are lower genital tract sources of bleeding during pregnancy?

A
−	Cervical polyps
−	Erosions
−	Carcinoma
−	Cervicitis
−	Vaginitis
−	Vulval varicosities
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4
Q

What is placental abruption?

A

where part of the placenta becomes detached from the uterus

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5
Q

what increases the risk of placental abruption

A
pre-eclampsia
smoking 
IUGR
PROM
Multiple pregnancy
polyhydramnios
increased maternal age 
thrombophilia
abdo trauma
infection
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6
Q

What is the nature of bleeding in placental abruption?

A

bleeding may be localised to one placental area and therefore may be concealed and shock not in keeping w visible loss

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7
Q

What are the signs of placental abruption?

A
fetal anoxia or death 
tenderness - compression of uterine muscles by blood
backache if posterior abruption
uterine hypercontractibility (>5/10min)
DIC If thrombosis[plastin released
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8
Q

What are some severe complications of placental abruption?

A

sheehans syndrome

renal failure

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9
Q

What are the clinical features of placental abruption

A
shock out of keeping with visible loss
pain constant
tender, tense uterus
normal lie and presentation
fetal heart: absent/distressed
coagulation problems
beware pre-eclampsia, DIC, anuria
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10
Q

How does abruption differ to placenta praevia

A
in praevia - shock is in proportion to visible loss
no pain
uterus not tender
fetal heart normal 
small bleeds before large
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11
Q

What is placenta praevia?

A

placenta lies in the lower segment of the uterus

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12
Q

What is the management of APH w mild bleeding?

A

Crossmatch
HR, BP, blood loss
Establish diagnosis: US, speculum
If diagnosis is placenta praevia: keep in hosp, CS at 37-28w

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13
Q

What is the management of severe bleeding w APH?

A
DELIVER - CS for placenta praevia 
IVI 
Take bloods
Raise legs
Give O2
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14
Q

What is the management of shock w APH?

A

Give fresh ABO Rh compatible or O Rh-ve blood until systolic BP >100mmHg

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15
Q

How should 3rd stage of labour be managed?

A

syntometrine

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16
Q

What should be done if APH occurs at term?

A

induce labour