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Reproduction Key Information > Antepartum Haemorrhage (APH) > Flashcards

Antepartum Haemorrhage (APH) Flashcards

1
Q

what is APH?

A

bleeding after 24 weeks and before 2nd stage of labour (delivery of the baby)

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2
Q

quantifying APH

A

spotting
minor= <50ml
major= 50-1,000ml, no shock
massive= >1,000ml and/or shock

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3
Q

causes

A 
placental abruption
placental praevia
placental accrete
uterine rupture
vasa praevia
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4
Q

what is placental abruption?

A

separation of a normally implanted placenta

blood escapes into amniotic sac and there is interruption of placental circulation

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5
Q

what does placental abruption cause?

A

couvelaire uterus (haematoma bruised uterus)

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6
Q

risk factors for placental abruption

A 
PET
trauma
drugs
abnormal placenta
polyhydramnios
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7
Q

presentation of placental abruption

A

severe continuous abdominal pain (backache if posterior placenta)
painful bleeding
preterm labour
maternal collapse

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8
Q

what is a potential cause of placental abruption

A

in association with trauma

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9
Q

diagnosis of placental abruption

A

large tense uterus
woody abdomen
unable to feel foetal parts
foetal demise

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10
Q

management of placental abruption

A

resuscitate mother

delivery of baby= urgent C/S or IOL by amniotomy

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11
Q

what is placental praevia?

A

placenta lies over the internal os

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12
Q

define a low-lying placenta

A

after 16 weeks the edge is <20mm from the internal os

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13
Q

what increases the risk of placental praevia?

A

C/S

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14
Q

presentation of placental praevia

A

painless bleeding >24 weeks (3rd trimester)
usually unprovoked but can be triggered by coitus
foetal movements present/ no foetal stress

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15
Q

diagnosis of placental praevia

A

screening at foetal anomaly scan (18-20 weeks)
re-scanned at 32 and 36 weeks
do NOT perform vaginal or PR exam
CTG normal

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16
Q

what do you not do in placental praevia?

A

perform a vaginal or PR exam

17
Q

management of placental praevia

A

C/S if placental covers os or <2cm

need consent for hysterectomy and risk of GA

18
Q

when can a vaginal delivery be done in placental praevia?

A

placenta >2cm from os and no malpresentation

19
Q

what is placenta accrete?

A

placenta is abnormally adherent to the uterine wall

20
Q

what increases the risk of placenta accrete?

A

multiple C/S

post-endometrial ablation

21
Q

what is an increta?

A

placenta has invaded the myometrium

22
Q

what is a percreta?

A

placenta has invaded the bladder

23
Q

which condition do you always give contraception in?

A

placenta accrete

24
Q

presentation of placenta accreta

A

severe bleeding

doughy abdomen

25
Q

management of placenta accreta

A

internal iliac artery balloon

C/S hysterectomy

26
Q

what is uterine rupture?

A

full thickness opening of the uterus (including serosa)

27
Q

risk factors for uterine rupture

A

previous C/S

uterine surgery

28
Q

presentation of uterine rupture

A 
severe abdominal pain
shoulder tip pain
PV bleeding
maternal collapse
foetal distress and loss of engagement
29
Q

risk factors for uterine rupture

A

previous C/S or surgery

30
Q

management of uterine rupture

A

resuscitation- tranexamic acid

31
Q

what is vasa praevia?

A

unprotect foetal vessels transverse the membranes below the presenting part over the internal os

32
Q

what will happen in vasa praevia?

A

vessels will rupture during labour or amniotomy

33
Q

what is vasa praevia associated with?

A

vessel connected to a velamentous umbilical cord or connect placenta with a succenturiate or accessory lobe

34
Q

presentation of vasa praevia

A

foetal blood + sudden foetal distress

dark red bleeding

35
Q

diagnosis of vasa praevia

A

USS TA and TV with doppler

36
Q

management of vasa praevia

A

elective C/S before labour (34-36 weeks)

if APH, emergency C/S

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