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Antepartum hemorrhage Flashcards

1
Q

Definition

A

Bleeding after 20 weeks, prior to labour

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2
Q

Definition

A

Bleeding after 20 weeks, prior to labour

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3
Q

Incidence

A

3-5%

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4
Q

Etiology

A

Uterine: placenta previa, placental abruption, vasa praevia, circumvallate placenta
Lower genital tract: cervical extropion, polyp, carcinoma, cervicitis, vaginitis
Unknown in 50%

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5
Q

Association of preterm infants and APH

A

20% preterm infants result of APH

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6
Q

History

A 
Amount of bleeding
Onset
Pain
Contractions
Mucoid discharge
Triggering event-> intercourse (ectropion etc)
Last pap smear
STD history
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7
Q

Most important distinguishing feature between placental abruption and placenta praevia

A

Constant abdominal pain

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8
Q

Examination

A 
Maternal well being:
Pulse, BP, T
Pallor
Abdominal tender, distension, ridigity
Speculum for cervical abnormalities
Digital examination- only when placenta praevia excluded, when contractions, to assess progress of cervix

Fetal well being:
Abdominal palpation for lie/presentation/engagement
CTG

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9
Q

Investigations

A 
FBC
Group hold/screen, cross match
Rhesus-->?Anti-D
Urine
UEC
LFT
Coagulation profile
Kleihauer tests
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10
Q

What is the Kleihauer test and what does it indicate

A

Blood film->shows fetal RBCs in maternal circulation indicating placental abruption

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11
Q

Definition of placenta praevia

A

Placenta encroaches on lower segment

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12
Q

Define the lower segment of uterus

A
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13
Q

Etiology of placenta praevia

A 
Multiparity
Multiples
Previous cesaerean
Smoking
\+Age
Fetal anomalies
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14
Q

Grading of PP

A

1: At lower segment, not reaching os
2: Reaches os, does not cover
3: Covers os only when not dilated
4: Covers os even when dilated

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15
Q

Presentation of PP

A 
Diagnosed on US
Painless bleeding
Pain->10% also have placental abruption
Postcoital bleeding
Spotting
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16
Q

Placenta previa and bleeding

A 
ABCs
2 large IV cannula, IDC
Infusion NS
Bloods group/screen/xmatch, anti-Dif Rh negative
Avoid all vaginal examination
USS, gentle speculum
If anemia, no longer bleeding, 10.5
Continue until can do C section
Consent and book for C section
Be sure to always have group and hold up to date- risk of PPH
If
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17
Q

Placenta previa and bleeding

A 
ABCs
2 large IV cannula
Infusion NS
Bloods group/screen/xmatch, anti-Dif Rh negative
Avoid all vaginal examination
USS, gentle speculum
If anemia, no longer bleeding, 10.5
Continue until can do C section
Be sure to always have group and hold up to date- risk of PPH
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18
Q

When might you consider an MRI

A

If suspect placenta accreta

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19
Q

Why is there +risk of post partum hemorrhage in PP

A

Lower segment does not contract as well and therefore less compression of the placental vessels

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20
Q

Recurrence rate of PP

A

4-8% in subsequent pregnancies

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21
Q

Incidence

22
Q

Etiology

A

Uterine: placenta previa, placental abruption, vasa praevia, circumvallate placenta
Lower genital tract: cervical extropion, polyp, carcinoma, cervicitis, vaginitis
Unknown in 50%

23
Q

Complications of placental rupture–>maternal and fetal

A 
Maternal:
Hypovolemia
AKI
ARD
PPH
DIC
Death
Sheehans

Fetal:
Mortality
Preterm
IUGR
Anemia
Congenital
24
Q

History

A 
Amount of bleeding
Onset
Pain
Contractions
Mucoid discharge
Triggering event-> intercourse (ectropion etc)
Last pap smear
STD history
25
Q

Most important distinguishing feature between placental abruption and placenta praevia

A

Constant abdominal pain

26
Q

Examination

A 
Maternal well being:
Pulse, BP, T
Pallor
Abdominal tender, distension, ridigity
Speculum for cervical abnormalities
Digital examination- only when placenta praevia excluded, when contractions, to assess progress of cervix

Fetal well being:
Abdominal palpation for lie/presentation/engagement
CTG

27
Q

Investigations

A 
FBC
Group hold/screen, cross match
Rhesus-->?Anti-D
Urine
UEC
LFT
Coagulation profile
Kleihauer tests
28
Q

What is the Kleihauer test and what does it indicate

A

Blood film->shows fetal RBCs in maternal circulation indicating placental abruption

29
Q

Risk of recurrence of placental abruption in next pregnancy

30
Q

Define the lower segment of uterus

31
Q

Etiology of placenta praevia

A 
Multiparity
Multiples
Previous cesaerean
Smoking
\+Age
Fetal anomalies
32
Q

Grading of PP

A

1: At lower segment, not reaching os
2: Reaches os, does not cover
3: Covers os only when not dilated
4: Covers os even when dilated

33
Q

Presentation of PP

A 
Diagnosed on US
Painless bleeding
Pain->10% also have placental abruption
Postcoital bleeding
Spotting
34
Q

Management of asymptomatic low lying placenta

A

Rescan at 34 weeks to determine location
If still grade 1/2 at 34 weeks, scan fortnightly
Unless bleeding, do not need to admit
If high presenting part/abnormal lie at 37 weeks, suggests placenta previa
Final scan at 36-37 weeks and acted upon
C-section done electively- major 37-38 weeks (usually when

35
Q

Placenta previa and bleeding

A 
ABCs
2 large IV cannula
Infusion NS
Bloods group/screen/xmatch, anti-Dif Rh negative
Avoid all vaginal examination
USS, gentle speculum
If anemia, no longer bleeding, 10.5
Continue until can do C section
Be sure to always have group and hold up to date- risk of PPH
36
Q

When might you consider an MRI

A

If suspect placenta accreta

37
Q

Why is there +risk of post partum hemorrhage in PP

A

Lower segment does not contract as well and therefore less compression of the placental vessels

38
Q

Recurrence rate of PP

A

4-8% in subsequent pregnancies

39
Q

Placental abruption definition and incidence

A

Premature separation of normally situated placenta, blood detaches
2% of pregnancies

40
Q

Etiology/associations placental abruption

A 
HTN
Trauma
Multiparity
\+Serum AFP
Polyhydramnios, multiples
Cocaine
Previous abruption
\+Age
Cigarrette
External cephalic version
41
Q

Difference between concealed and revealed placental rupture

A

Concealed–>30%, blood remains behind placenta X escape cervix
Revealed –>70% escapes through cervix

42
Q

Complications of placental rupture–>maternal and fetal

A 
Maternal:
Hypovolemia
AKI
ARD
PPH
DIC
Death

Fetal:
Mortality
Preterm
IUGR
Anemia
Congenital
43
Q

Presentation of placental rupture

A 
Pain
Vaginal bleeding
Labour
Abdominal tenderness
Fetal distress
Hypovolemia
Ask about PET symptoms
44
Q

How is the diagnosis of placental rupture made

A

Clinical diagnosis- do not need USS to confirm

45
Q

Examination of placental rupture

A

General maternal well-being->BP, pusle, T, 02 sats
Abdominal examination->tonic contractions->hard, tender uterus
Must exclude HTN and proteinuria due to association with pre-eclampsia
Check for liver tenderness, hyperreflexia and clonus

46
Q

Investigations in placental abruption

A

FBC, UEC, LFT, coags, Blood group and hold, Xmatch, Rh status (anti-RhD), urinalysis, Lkei
CTG, USS of limited valuue->if clinical diagnosis

47
Q

Management of placental abruption

A

As for placenta praevia->dependant on severity of bleeding

48
Q

Risk of recurrence of placental abruption in next pregnancy

49
Q

How is the blood loss in vasa previa different from the blood loss in PP and placental abruption

A

The blood lost from vasa previa is from the fetus->needs urgent delivery before the fetus exsanguinates

50
Q

Management if coagulopathy

A

give 4 units FFP,
have 6 units PLTs ready
Usually resolves 4-6 hours
after delivery

51
Q

Can an epidural be given in placental abruption

A

No, risk of coagulopathy

Obstetrics and Gynaecology (45 decks)

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