Antipartum haemorrhage Flashcards
What is placenta praevia?
Placenta implanted within bottom 1/3 of uterus
How often does placenta praevia occur?
1/200 pregnancies
When does placenta praevia usually present?
> 20 weeks
What are the risk factors for placenta praevia?
Multiparity Previous c-section Uterine abnormalities (fibroids) Smoking Older maternal age Multiple pregnancy
What is major placenta praevia?
Placenta covers internal os
What is minor placenta praevia?
Placenta in lower segment but does not cover internal os
How do you deliver major placenta praevia?
C-section delivery
How do you manage minor placenta praevia?
Aim for vaginal delivery unless placenta encroaches within 2cm of the internal os
How might placenta praevia present?
Painless anti-partum haemorrhage
Abnormal foetal lie
What examinations should you do if placenta praevia is suspected
AVOID PV exam
Speculum exam
Is sex safe in placenta praevia?
No
What is placenta accreta?
Abnormal adherence of all or part of the placenta to the uterus
What is placenta increta?
Placenta infiltrates the myometrium
What is placenta percreta?
Placenta infiltrate right through the myometrium to the serosa
What do placenta accreta/increta/percreta predispose the mother to?
Post-partum haemorrhage
What is the main risk factor for placenta accreta/increta/percreta?
Previous C-sections
What are the risk factors for placental abruption
Previous pelvic surgery
Thrombophilia
Smoking
When does placental abruption occur?
> 20 weeks
How often does placental abruption occur>
1% of pregnancies
What is the foetal mortality in placental abruption?
20-40%
How might placental abruption present?
Usually single instance of large blood loss
Constant pain and contractions
May be internal bleeding only
What does the uterus feel like in placental abruption?
Hard, painful, tender, sometimes enlarged uterus
What does the uterus feel like in placenta praevia?
Usually soft non-tender
How are the foetal heart sounds in placental abruption?
May be distressed/abnormal
How are the foetal heart sounds in placenta praevia?
Usually normal
What complications are there of placental abruption?
Increased risk of PPH
What is the management of APH?
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
