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Jason's MD3 Women's > Antepartum Haemorrhage, Alloimunisation > Flashcards

Antepartum Haemorrhage, Alloimunisation Flashcards

1
Q

Antepartum haemorrhage is?

A

Any bleeding from genital tract after 20th week before onset of labour of >50ml

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2
Q

2 groups of Antepartum haemorrhage

A

Major

APH

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3
Q

Major Antepartum haemorrhage Mx?

A

DR ABCDEFG

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4
Q

DDx for major Antepartum haemorrhage?

A

praevia
Abrupt ion
Vasa Previa
Cervical and lower genital tract bleeding

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5
Q

30% of Antepartum haemorrhage have what?

A

Placenta praevia

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6
Q

Major vs. minor placenta praevia?

A

Major: covering cervical so
Minor: encroaching on lower uterine segment

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7
Q

What increases risk of placenta praevia?

A

C-section

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8
Q

What U/S for placenta praevia?

A

Transvaginal

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9
Q

Does placental praevia ‘move’?

A

No the lower segment disintegrates in 3rd trimester

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10
Q

Placenta praevia presentation?

A

Painless heavy bleeding

Malpresentation

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11
Q

Triggers of placenta praevia?

A

Digital examination

Intercourse

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12
Q

When placenta praevia happens?

A

3rd trimester

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13
Q

Short term prob of placenta praevia?

A

Haemodynamic instability

Fetal-abnormal cardiotocograph

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14
Q

Long term probs with placenta praevia?

A

IUGR
Preterm, prelabour rupture of membranes
Vasa praevia(the central part disintegrates, have bilobed placenta with vessels right in the middle)

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15
Q

placenta praevia Mx?

A

Major or minor: symptomatic = in-patient care

Major ASYMPTOMATIC = 34 weeks inpatient

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16
Q

How to birth placenta praevia?

A

C-section

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17
Q

Vaginal placenta praevia minor threshold?

A

2cm from cervical OS

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18
Q

placenta praevia delivery timeline?

A

Around 37 weeks

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19
Q

placenta praevia bleeding in c-section

A

More bleeding, can lose a lot fast

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20
Q

placenta praevia, with previous c-sections, what risk?

A

Placenta accreta, increta, percreta

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21
Q

Placenta accreta, increta, percreta Risk goes up if?

A

Previous C-section and have placenta praevia

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22
Q

Placenta Abruption Bleeding?

A

Can be concealed

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23
Q

25% of APH is?

A

Placenta Abruption

24
Q

Placenta Abruption risk factors

A 
HTN
Preeclampsia
Thrombophilia, prev abruption, 
smoking, cocaine use
Chorioamnionitis
Trauma - MVA
Sudden reduction in size of over-distended uterus
25
Q

Placenta Abruption presentation?

A

Abdo or back pain with bleeding
Fetal demise
Woman will be in DIC

26
Q

Placenta Abruption Mx?

A 
Hx
Wide bore I access
FBC, coags
Kleihauer-Betke to assess feto maternal transfusion
Get along monitoring
Vitals
Anti-D
Fluids/bloods
27
Q

Placenta Abruption deliver straight away? What give?

A

If partial: corticosteroids if before 34 weeks

Magnesium sulphate - neuro protection if less than 30 weeks

28
Q

What NOT to give in Placenta Abruption?

A

NO Tocolytics

29
Q

If Placenta Abruption near term?

30
Q

If Placenta Abruption premature 32-37?

A

Depends: distressed, rock hard uterus, shock: then deliver

31
Q

If less than 32 weeks Placenta Abruption?

A

Try to push for conservative, but if woman is in danger, deliver

32
Q

Placenta Abruption delivery

A

Push for normal

C-section if mom or fetus is unstable

33
Q

Placenta Abruption induction?

A

Yes if fetal demise

34
Q

Vasa praevia def’n?

A

Umbilical vessels, unsupported by either the umbilical cord or placental tissue, traverse the fetal membranes of the lower segment above the cervix

35
Q

Vasa praevia Dangers

A

Baby will die in one minute

36
Q

Vasa praevia Mx?

A

In hospital, any bleeding, code pink with code green c-section

37
Q

Vasa praevia associated with

A

Vela entrust cord insertion
Bipartite placenta
Succenturiate lobe

38
Q

Vasa praevia Dx?

A

Trans vaginal U/S

39
Q

Vasa praevia feel it?

A

On VE, yes, if feel pulsating, take out finger and call for help.

40
Q

45% of APH?

A

Vaginal and lower genital tract bleeding

41
Q

Vaginal and lower genital tract bleeding DDx?

A 
Heavy show/onset of labour
Cervical Ectropion/dysplasia
Polyps
Varices
Trauma: NAI
42
Q

Common antibodies alloimmunisation?

A

Rhesus, D, C, E, c, e

Kell (The WORST)

43
Q

Less common antibodies alloimmunisation?

A

Kidd
Duffy
KPA or b
S

44
Q

Events that can isoimmunisation a mom?

A 
Delivery
Abrupt ion
Trauma
CVS
ECV
Infection
45
Q

How to prevent isoimmunization?

A

Anti-D, need to give enough if lots of bleeding

46
Q

When give anti-D?

A

28-34 weeks

47
Q

When not give anti-D?

A

If already have own active antibodies to anti-D

48
Q

When give anti-D?

A

Within 72 hours of sensitizing event

300ug, usually in units

49
Q

How much anti-D give?

A

625IU at 28 and 34 weeks

600 post-partum

50
Q

Critical titre for anti D in mother?

51
Q

If dad is heterozygous, then how change management?

A

Take maternal serum, cell-free DNA testing to see if fetus is +ve or neg and changes management

52
Q

If they have Kell, what is titre?

A

ANY Kell is bad.

53
Q

How to monitor fetal Anaemia?

A

Look at MCA peak systolic velocity (PSV)

If more than 1.5MoM

54
Q

If MCA PSV if >1.5MoM

A

Intrauterine blood transfusion

55
Q

How to treat fetal Anaemia?

A

Intrauterine transfusion, sometimes multiple if needed

Jason's MD3 Women's (58 decks)

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