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YR5 Obstetrics and Gynaecology > APH > Flashcards

APH Flashcards

1
Q

What is APH?

A

Bleeding from the genital tract, occurring from 24w of pregnancy + prior to birth

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2
Q

What are the 3 most important causes of APH?

A

Placenta praevia
Placental abruption
Vasa praevia

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3
Q

Give 6 non-pregnancy related causes of APH

A

Infection
Cervicitis
Cervical ectropion
Cervical carcinoma
Cervical polyp
Trauma

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4
Q

Give 3 risk factors for vasa praevia

A

Low lying placenta
IVF pregnancy
Multiple pregnancy

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5
Q

What is vasa praevia?

A

Fetal vessels run across internal cervical os, due to velamentous insertion of umbilical cord/ presence of accessory placental lobe

Proximity to os means when ROM occurs, these bleed profusely

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6
Q

How does vasa praevia present?

A

Heavy painless PV bleeding following ROM

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7
Q

Give 7 risk factors for placental abruption

A

PREVIOUS abruption
Pre-eclampsia
Age >35
Polyhydramnios
PROM
Multiparity
Chorioamnionitis

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8
Q

What 2 substances increase risk of abruption?

A

Cocaine
Smoking

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9
Q

Give 5 risk factors for placenta praevia

A

PREVIOUS praevia
Hx C-section
Hx TOP
Multiparity
Age >40

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10
Q

What is placental abruption ?

A

premature separation of the normal-sited placenta from the uterus
usually in 3rd trimester but can happen any time after 20w

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11
Q

What are the 2 presentations of placental abruption?

A

Revealed: PV bleeding

Concealed: No visible bleeding

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12
Q

Give 4 signs/ symptoms of abruption

A

Abdo pain (most common): posterior abruptions may present with back pain

PV bleeding

Uterine contractions

Dizziness +/or loss of consciousness

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13
Q

Describe the uterus on palpation in abruption

A

“Woody”, tense uterus
Tender

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14
Q

What bloods are performed in abruption?

A

FBC, U+Es, LFTs
Clotting profile
Group + save
Cross match
Kleihauer test

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15
Q

What investigations are performed in abruption?

A

Bloods
CTG: fetal hypoxia- bradycardia, decals
USS (doesn’t exclude abruption)

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16
Q

What is the immediate management for placental abruption?

A

A-E approach
Gain 2x IV access
Bloods
Continuous foetal monitoring
Kleihauer test + anti-D
Fluid, antifibrinolytics, blood

17
Q

What is the management of abruption if the mother is haemodynamically unstable or there are signs of foetal distress?

A

Emergency C-section (irrespective of gestation)

18
Q

What is the management of abruption if the mother is haemodynamically stable and there are NO signs of foetal distress?

A

If <35w: steroids + admit for monitoring

If >37w: IOL

19
Q

What is placenta praevia?

A

placenta lying directly over the internal os.

20
Q

What is low lying placenta?

A

placental edge is <20 mm from the internal os on transabdominal or transvaginal scanning (TVS)

21
Q

How does placenta praevia present?

A

PainLESS PV bleeding
Soft uterus

22
Q

How should suspected praevia be examined?

A

AVOID PV exam

23
Q

Which scan is superior for diagnosing praevia?

A

TVUSS

24
Q

How should incidental finding of placenta praevia/ low lying placenta be managed?

A

Advise to avoid sex
Rescan at 32w (only 10% still low lying)

If still low/ praevia: Rescan at 36w

If still low/ praevia: Elective C section at 36-37w

25
Q

How should symptomatic presentation (painless bleeding) placenta praevia/ low lying placenta be managed?

A

A-E
Gain IV access
Bloods
Continuous fetal monitoring
Anti-D
Decide on delivery

26
Q

What is indicated in haemodynamic unstable mothers/ evidence of fetal distress in placenta praevia/ low lying placenta?

A

Emergency C section

27
Q

What is the management if a mother is haemodynamically stable and there are no signs of fetal distress in placenta praevia/ low lying placenta??

A

Give steroids + admit until bleeding stops

Rescan at 36w

If still low, elective C section at 34-36w

28
Q

Are tocolytics used in APH?

A

generally CONTRAINDICATED
senior obstetrician should make any decision regarding the initiation of tocolysis in APH

YR5 Obstetrics and Gynaecology (73 decks)

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