Antepartum Haemorrhage (APH)

Question 1

define antepartum haemorrhage

Answer 1

bleeding >24 weeks and before the 2nd stage of labour

Question 2

major APH

Answer 2

> 500ml

Question 3

massive APH

Answer 3

> 1,000ml with or without shock

Question 4

causes of APH

Answer 4

placental abruption
placental praevia
placenta accreta
uterine rupture
vasa praevia

Question 5

what is placental abruption?

Answer 5

separation of a normally implanted placenta so blood escapes into the amniotic sac interrupting placenta circulation

Question 6

RF for placental abruption

Answer 6

PET
trauma
drugs
abnormal placenta
polyhydramnios

Question 7

presentation of placental abruption

Answer 7

severe continuous abdo pain
painful bleeding
maternal collapse
tense uterus (woody abdomen)
unable to feel foetal parts with foetal demise

Question 8

management of placental abruption

Answer 8

resuscitation of mother

delivery of baby

Question 9

what is placenta praevia?

Answer 9

low-lying placenta <20mm from internal os

Question 10

what is placenta praevia associated with?

Answer 10

previous C/S

Question 11

grading of placenta praevia

Answer 11

1. lower half of uterus
2. near but doesn’t cover the cervical os
3. partially covers internal os
4. covers os

Question 12

presentation of placenta praevia

Answer 12

painless bleeding
can be triggered by coitus
foetal movements present with no distress

Question 13

diagnosis of placenta praevia

Answer 13

screened at anomaly scan
re-scanned 32 and 36 weeks TVUS
do not perform DRE or vaginal exam
CTG normal

Question 14

management of placenta praevia

Answer 14

C/S if <2cm

needs consent for hysterectomy and GA risks

Question 15

what is placenta accreta?

Answer 15

placenta is abnormally adherent to the uterine wall

Question 16

RF for placenta accreta

Answer 16

previous C/S and endometrial ablation

Question 17

define invasion of myometrium

Answer 17

placenta increta

Question 18

invasion of the bladder

Answer 18

placenta percreta

Question 19

presentation of placenta accreta

Answer 19

severe bleeding

doughy abdoemn

Question 20

management of placenta accreta

Answer 20

internal iliac artery balloon

C/S hysterectomy

Question 21

what is uterine rupture?

Answer 21

full thickness opening of the uterus including the serosa

Question 22

risk factors for uterine rupture

Answer 22

previous C/S or uterine surgery

Question 23

presentation of uterine rupture

Answer 23

severe abdo pain + shoulder tip pain
PV bleeding
maternal collapse
foetal distress and loss of engagement

Question 24

management of uterine rupture

Answer 24

resuscitation
C/S +/- hysterectomy
uterine relaxation with terbutaline, nitroglycerin (beta-mimetics)

Question 25

what is vasa praevia?

Answer 25

unprotected foetal vessels transverse the membranes below the presenting part over the internal cervical os

Question 26

two types of vasa praevia

Answer 26

1. vessel connected to velamentous umbilical cord

2. connect placenta with succenturiate or accessory lobe

Question 27

presentation of vasa praevia

Answer 27

foetal blood + sudden foetal distress

Question 28

diagnosis of vasa praevia

Answer 28

USS TA or TV with doppler

Question 29

management of vasa praevia

Answer 29

elective C/S before labour (34-36 weeks)
give steroids
APH do emergency C/S