Aph Flashcards
What is the difference in how the uterus feels for placenta Praevia and abruptio placenta
Abruptio: hard- woody
Praevia: soft
What type of pain does abruptio cause?
Sudden abdominal pain and cramps
What are the clinical features of placenta Praevia ?
- unstable lie
- fetal heart present
- soft uterus with abdominal presenting part (breech or very high head)
What are indications for delivery for placenta Praevia
- electively at 37 weeks
- bleeding
- labour or rupture of the membranes
- fetal compromise
- other conditions eg GPH or IUGR
What investigations are necessary for abruptio placenta?
- haemoglobin and haematocrit
- clotting time and platelet count
- full haemtological investigations of clotting time delayed
- blood urea, creatinine, irate
- serum electrolytes
- blood gases
- CTG
What necessary resuscitation is necessary for women suffering from abruptio placenta?
- adequate blood transfusion
- 1 unit of fresh frozen plasma for every 2 units of blood
- cryoprecipitate, if fibrogen less than 1 g according to DIC screen
Other supportive measures:
- morphine
- specific blood clotting components or drugs
What causes DIC in patients suffering from abruptio?
Release of thromboplastin, causes DIC, depletion of fibrinogen
Why is epidural analgesia contra indicated in abruptio?
Contra indicated due to potential coagulopathy and resultant danger of spinal cord compression by blood
What are the causes of antepartum haemorrhage?
- Placenta Praevia
- Abruptio placenta
- Show
- Local lesion of the genital tract
- Vasa Praevia
- Ruptured uterus
- Idiopathic
- Other source: haematuria, bleeding from a haemorrhoid
