Antepartum Hemorrhage

Question 1

What is the first line killer in obeststricS?

Answer 1

hemorrhage (wither antepartum post partum or intrapartum) but mostly postpartum

Question 2

What are the other causes of maternal death?

Answer 2

Hemorrhage, embolism, hypertensive disease, infection

Question 3

What is antepartum hemorrhage

Answer 3

Bleeding in late second trimester or third trimester

Question 4

What does painful bleeding at third trimester indicate

Answer 4

Abruptio placenta

Question 5

What are the causes of painless bleeding in the 3rd trimester

Answer 5

Placenta previa

Question 6

What are the most common causes of antepartum hemorrhage?

Answer 6

1- placenta previa

2- abriptio placenta

Question 7

What are the other causes of APH?

Answer 7

• local causes
• uterine rupture
• vasa previa
• bleeding disorder
• uknown

Question 8

Can uterine rupture present as bleeding

Answer 8

Yes but not the most common presentation

Question 9

The most common causes of bleeding is

Maternal or fetal

Answer 9

Mostly materna, if it was vasa previa then it is fetal

Question 10

When is it okay to preform digital examination of cervix for patient presenting with antepartum hemorrhage

Answer 10

Only after ruling out placenta previa on ultrasound

Question 11

Why avoid digital examination of cervix in patient with placenta previa?

Answer 11

Because she might cause moblization & further damage

Question 12

Is sterile speculum examination recommended for patients with antepartum bleeding

Answer 12

Yes to rule out local causes of bleeding (tears, leisons, assess bleeding severity, cervix open or not)

Question 13

What are the investigations you’d like to order in antepartum bleeding

Answer 13

CBC, coagulation profile, types\crosshatched 4 units of blood, US, NST

Question 14

Why do coagulation profile (PT,PTT) in patients with antepartum bleeding?

Answer 14

Because it might cause DIC and provide these patients with fresh frozen plasma or cryoprecipitate

Question 15

What is the role of gestational age in antepartum hemorrhage

Answer 15

Should i do C\S, delivery or management

(If severe&raquo_space; always C\S
If mild & stable&raquo_space; GA 36\37= deliver - 28\29= manage

Question 16

What is the most comon type of abnormal placentation & anteparrtum hemorrhage?

Answer 16

Placent previa

Question 17

What are the predisposing factors for placenta previa

Answer 17

1- multiparity & multiple gestation
2- increased maternal age
3- prev placenta previa
4- C\S

Question 18

What are the classifications of placenta previa?

Answer 18

Complete, partial, marginal, low lying

Question 19

How to deliver paitents with complete, partial, marignal, low lying placenta

Answer 19

• Complete & partial: always C\s
• Marginal: depend on case
• Low lying: no bleeding, high enough to not touch cervix then do NVD

Question 20

What is previa

Answer 20

Covering the os with placnta 
Completey: complete 
Partially: partial 
Marginal: the edge is on the edge 
Low lying: the edge is <2cm from the edge

Question 21

At which trimester it’s okay to confirm placenta previa

Answer 21

After 28 weeks, because it might grow

But if it’s complete, then it’s less likely to grow

Question 22

What to do if the placenta is low but it’s >2cm away from the OS

Answer 22

No need to document or follow up

Question 23

How to diagnose placenta previa?

Answer 23

1- clinically: painless bleeding

2- US

Question 24

Which type of US is more accurate in detecting placenta previa

Answer 24

Transvaginal US (diff if it’s post or lateral)

Question 25

What are the precaution tips to give patients with placenta previa?

Answer 25

1- no intercourse
2- no digital exam
3- come to ER with any bleeding