Antepartum haemorrhage

Question 1

features of placenta praaevia ?

Answer 1

painless PV bleeding

abnormal lie

Question 2

when would you consider delivery in a patient with placenta praaevia ?

Answer 2

> 37 weeks gestation

if < 32 weeks, repeat scan at 37 weeks and reassess position

Question 3

features of placental abruption ?

Answer 3

painful PV bleeding
may not have bleeding (concealed)
contractions
shock is out of keeping with visible loss

uterus tense and tender
uterus large for gestation

Question 4

what is the difference between placenta accrete, percreta and increta?

Answer 4

accrete - placenta implants on the myometrium but doesn’t penetrate it

increta - villi invade myometrium but doesn’t penetrate through

percreta - placenta implants through the whole myometrium

Question 5

risk factors for placenta praaevia ?

Answer 5

previous c section
mulitiparous
previous placenta praaevia

Question 6

risk factors for placental abruption ?

Answer 6

hypertension, pre-eclampsia
polyhydramnios
multiple pregnancies
cocaine

Question 7

indications for delivery before 37 weeks in placenta praaevia ?

Answer 7

foetal distress
intrauterine death 
intrauterine growth restriction 
onset of labour 
severe bleed

Question 8

describe the management of a patient who presents with bleeding due to placenta praaevia ?

Answer 8

mild bleeding
- admit for observation and manage as outpatient after bleeding has settled

moderate

• admit and keep observe
• steroids for foetal lungs

severe
- admit for c-section

Question 9

what is vasa praaevia ?

Answer 9

vessels from umbilical cord attach to the membranes instead of the placenta
causes abnormal bleeding from foetal vessels into the membrane

Question 10

how does vasa praevia usually present ?

Answer 10

rupture of the membranes shortly followed by heavy PV bleeding
foetal bradycardia