Antepartum Hemorrhage Flashcards
Describe 4 classes of APH
PV spotting
Minor <50ml
Major : 50-1000ml w/o shock
Massive >1000ml with shock
Risk factors of placenta previa x5
Previous placenta previa
Previous C section
Multiple gestation
Multiparity
Advanced maternal age
Factors likely to cause deficient endometrium x4
Uterine scar
Endometritis
Submucous fluid
Manual removal of placenta
State 4 classes of placenta previa
Low lying, marginal, partial, complete
True or false : Placenta previa bleeding is usually painful
False
True or false: P. previa is usually associated with breech presentation and non longitudinal lie
True
Factors influencing management of p.previa x3
GA
Severity of APH
Type of placental previa
Fetal complications of p.previa x3
Prematurity
Still birth
Fetal anoxia- complete loss of blood supply
Maternal complications of APH caused by p.previa x5
Shock, sepsis
Anemia
Death
Placental abruption
Postpartum endometritis
True or false: You can do a vaginal exam in a patient with p.previa
False
Risk factors of placenta abruption x5
Trauma
Previous abruption
Hypertensive disorders
Advanced maternal ages
Multiparity, multiple gestation
Describe effect of smoking on placental health x5
Smoking> vasoconstriction> ischemia> necrosis and hemorrhage> placental separation
Define placenta abruption
Premature separation of a previously implanted placenta from 28wk+ of gestation
3 types of p.abruption
With revealed hemorrhage
With concealed hemorrhage
Mixed p.abruption
Causes of APH x5
Placenta previa
Placenta abruption
Vasa previa
Varicosities
Uterine rupture
Complications of placenta previa x5
PPH
Placenta accreta
Fetal distress
Preterm labour
Amniotic fluid embolism
Goal of BP and urine output in resuscitation
SBP >100
Urine >30ml/hr
Management of APH in Rh neg mother > 20wks
300 microgram Rh IgG 6 weekly
Maternal complications of placenta abruption x5
PPH
DIC
Shock
Renal failure
Death
Fetal complications of placenta abruption x3
Growth restriction
IUFD
Prematurity
Define vasa praevia
Unprotected fetal vessels run between chorion and amnion passing through the cervical os
2 types of vasa previa
Velamentous cord insertion
Bilobed placentas
Painless pv bleeding after ROM
Vasa praevia
Pathophysiology of placenta abruption
Rupture of decidual spiral artery and hemorrhage into decidual basalis
Hematoma splits decidual leaving thin layer adherent
Hematoma grows to lift and compress adjacent placenta > detachment
