Antepartum Haemorrhage Flashcards
define antepartum haemorrhage
bleeding from the genital tract from 24 weeks gestation until the second stage of labour
what are the causes of antepartum haemorrhage
placenta praevia placenta accreta uterine rupture vasa praevia preterm labour local causes - ectropion, infection, cervical cancer
what is placenta praevia
low lying placenta either covering the internal cervical os or within 2cm of the cervical os
when can placenta praevia be detected
can be in early pregnancy around 18-20 weeks on ultrasound - review again at 32 weeks to see if it has naturally moved itself
how does placenta praevia present
painless vaginal bleeding
shock in proportion to the blood loss
high presenting part, malpresentation
describe the feeling of the uterus in placenta praevia
uterus not tender
what is absolutely contraindicated until placenta praevia is ruled out
vaginal examinations
how is placenta praevia managed
keep in hospital until delivery
aim for delivery at 37-38 weeks
what are the risk factors for placenta praevia
high parity
maternal age >40
previous placenta praevia
what is placental abruption
when part or all of the placenta separates from the wall of the uterus permanently
what are the risk factors for placental abruption
previous placental abruption pre-eclampsia transverse lie polyhydramnios abdo trauma thrombophilias multiple pregnancy
explain why placental abruption occurs
rupture of maternal vessels in basal layer of endometrium, detached portion is unable to function and leads to foetal compromise
explain the difference between revealed and concealed placental abruption
revealed - blood drains through the cervix
concealed - remains in the uterus and forms a clot
describe the presentation of placental abruption
painful vaginal bleeding
shock is not proportional to blood loss, especially if concealed
describe the examination findings of the uterus in placental abruption
uterus feels hard woody and tender - tonically contracted and circulation has been interrupted causing ischaemia
how is placental abruption managed
emergency delivery if maternal or foetal compromise
IOL for haemorrhage at term without compromise
what are the risk factors for uterine rupture
previous c-section previous uterine surgery IOL obstructed labour multiple pregnancy
how does uterine rupture present
severe abdo pain
shoulder tip pain
o/e regression of presenting part
significant haemorrhage or shock
a prolonged pregnancy is beyond how many week
42 weeks
what are the risk factors for prolonged pregnancy
nulliparity
maternal age >40
previous prolonged pregnancy
increased BMI
what is the main complication of prolonged pregnancy
stillbirth
what are the indicators for prolonged pregnancy
static growth oligohydramnios reduced foetal movements presence of meconium dry/flaky skin with reduced vernix
when is a membrane sweep typically offered
40 weeks if nulliparous
41 weeks if multiparous
what are the two options for induction of labour
vaginal prostaglandins to prepare cervix by ripening it
amniotomy where membranes are artificially ruptured with amnihook
what is vasa praevia
when foetal blood vessels cross or run near the internal cervical os - vessels are at risk of rupture once the membranes have ruptured
what are the risk factors for vasa praevia
placental structural abnormalities
Hx of low lying pregnancy
multiple pregnancy
IVF
what is the presentation of vasa praevia
small amount of dark vaginal blood following rupture of membranes
acute foetal bradycardia and decelerations on CTG
there is maternal compromise in vasa praevia true/false
false - only risk of foetal mortality
how is vasa praevia managed
steroids at 32 weeks
elective c-section before labour around 34-36 weeks
placenta sent to histology for diagnosis
