Antepartum Haemorrhage (APH)

Question 1

what is APH?

Answer 1

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

Question 2

quantifying APH

Answer 2

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

Question 3

causes

Answer 3

placental abruption
placental praevia
placental accrete
uterine rupture
vasa praevia

Question 4

what is placental abruption?

Answer 4

separation of a normally implanted placenta

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

Question 5

what does placental abruption cause?

Answer 5

couvelaire uterus (haematoma bruised uterus)

Question 6

risk factors for placental abruption

Answer 6

PET
trauma
drugs
abnormal placenta
polyhydramnios

Question 7

presentation of placental abruption

Answer 7

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

Question 8

what is a potential cause of placental abruption

Answer 8

in association with trauma

Question 9

diagnosis of placental abruption

Answer 9

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

Question 10

management of placental abruption

Answer 10

resuscitate mother

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

Question 11

what is placental praevia?

Answer 11

placenta lies over the internal os

Question 12

define a low-lying placenta

Answer 12

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

Question 13

what increases the risk of placental praevia?

Answer 13

C/S

Question 14

presentation of placental praevia

Answer 14

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

Question 15

diagnosis of placental praevia

Answer 15

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

Question 16

what do you not do in placental praevia?

Answer 16

perform a vaginal or PR exam

Question 17

management of placental praevia

Answer 17

C/S if placental covers os or <2cm

need consent for hysterectomy and risk of GA

Question 18

when can a vaginal delivery be done in placental praevia?

Answer 18

placenta >2cm from os and no malpresentation

Question 19

what is placenta accrete?

Answer 19

placenta is abnormally adherent to the uterine wall

Question 20

what increases the risk of placenta accrete?

Answer 20

multiple C/S

post-endometrial ablation

Question 21

what is an increta?

Answer 21

placenta has invaded the myometrium

Question 22

what is a percreta?

Answer 22

placenta has invaded the bladder

Question 23

which condition do you always give contraception in?

Answer 23

placenta accrete

Question 24

presentation of placenta accreta

Answer 24

severe bleeding

doughy abdomen

Question 25

management of placenta accreta

Answer 25

internal iliac artery balloon | C/S hysterectomy

Question 26

what is uterine rupture?

Answer 26

full thickness opening of the uterus (including serosa)

Question 27

risk factors for uterine rupture

Answer 27

previous C/S | uterine surgery

Question 28

presentation of uterine rupture

Answer 28

``` severe abdominal pain shoulder tip pain PV bleeding maternal collapse foetal distress and loss of engagement ```

Question 29

risk factors for uterine rupture

Answer 29

previous C/S or surgery

Question 30

management of uterine rupture

Answer 30

resuscitation- tranexamic acid

Question 31

what is vasa praevia?

Answer 31

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

Question 32

what will happen in vasa praevia?

Answer 32

vessels will rupture during labour or amniotomy

Question 33

what is vasa praevia associated with?

Answer 33

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

Question 34

presentation of vasa praevia

Answer 34

foetal blood + sudden foetal distress | dark red bleeding

Question 35

diagnosis of vasa praevia

Answer 35

USS TA and TV with doppler

Question 36

management of vasa praevia

Answer 36

elective C/S before labour (34-36 weeks) | if APH, emergency C/S