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Obs and Gyne > Antipartum haemorrhage > Flashcards

Antipartum haemorrhage Flashcards

1
Q

What is placenta praevia?

A

Placenta implanted within bottom 1/3 of uterus

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2
Q

How often does placenta praevia occur?

A

1/200 pregnancies

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3
Q

When does placenta praevia usually present?

A

> 20 weeks

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4
Q

What are the risk factors for placenta praevia?

A 
Multiparity
Previous c-section
Uterine abnormalities (fibroids)
Smoking
Older maternal age
Multiple pregnancy
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5
Q

What is major placenta praevia?

A

Placenta covers internal os

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6
Q

What is minor placenta praevia?

A

Placenta in lower segment but does not cover internal os

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7
Q

How do you deliver major placenta praevia?

A

C-section delivery

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8
Q

How do you manage minor placenta praevia?

A

Aim for vaginal delivery unless placenta encroaches within 2cm of the internal os

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9
Q

How might placenta praevia present?

A

Painless anti-partum haemorrhage

Abnormal foetal lie

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10
Q

What examinations should you do if placenta praevia is suspected

A

AVOID PV exam

Speculum exam

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11
Q

Is sex safe in placenta praevia?

A

No

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12
Q

What is placenta accreta?

A

Abnormal adherence of all or part of the placenta to the uterus

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13
Q

What is placenta increta?

A

Placenta infiltrates the myometrium

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14
Q

What is placenta percreta?

A

Placenta infiltrate right through the myometrium to the serosa

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15
Q

What do placenta accreta/increta/percreta predispose the mother to?

A

Post-partum haemorrhage

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16
Q

What is the main risk factor for placenta accreta/increta/percreta?

A

Previous C-sections

17
Q

What are the risk factors for placental abruption

A

Previous pelvic surgery
Thrombophilia
Smoking

18
Q

When does placental abruption occur?

A

> 20 weeks

19
Q

How often does placental abruption occur>

A

1% of pregnancies

20
Q

What is the foetal mortality in placental abruption?

A

20-40%

21
Q

How might placental abruption present?

A

Usually single instance of large blood loss
Constant pain and contractions
May be internal bleeding only

22
Q

What does the uterus feel like in placental abruption?

A

Hard, painful, tender, sometimes enlarged uterus

23
Q

What does the uterus feel like in placenta praevia?

A

Usually soft non-tender

24
Q

How are the foetal heart sounds in placental abruption?

A

May be distressed/abnormal

25
Q

How are the foetal heart sounds in placenta praevia?

A

Usually normal

26
Q

What complications are there of placental abruption?

A

Increased risk of PPH

27
Q

What is the management of APH?

A 
Admit
O2 - 15L
IV access - fluids
Order bloods/cross match
Get systolic BP >100
Clotting screen
Catheterise (UO >30ml/hr)
Help
US - TV/abdo
Exclude placenta praevia before doing PV exam

Obs and Gyne (9 decks)

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