APH, PP, PA, VP Flashcards
What is APH
it is bleeding from 28 weeks of pregnancy and prior to birth of the baby
what are the causes of APH
placenta previa
placenta abruptio
infections
rupture of the uterus
vasa praevia
local lesions (CA, Polyps)
Idiopathic
which two cases of bleeding does one always need to distinguish
placenta previa and placenta abruptio
what is placenta praevia
implantation of the placenta in the lower segment of the uterus
the placenta is less than 3 cm from the margin of the internal OS
the placenta lies in front of the presenting part
who is at risk for placenta praaevia
Asian Women
fetal malpresentation
multiple pregnancy
advanced maternal age
previous C/S
previous termination of pregnancy
previous placental praaevia
multiparity
uterine abnormalities
tobacco/coccaine/ amphetamine use
what are the complications of placental praaevia
PPH
IUGR
PROM
infection
anaemia
fetal death
preterm birth
maternal shock
placenta Accreta/Increta/precreta
placental accreta lie
in the lower segment of the uterus
placental precreta lie
fundus
placenta increta lie
in the higher segment of the uterus
what are the symptoms of placental previa
- Painless bleeding
- bright red blood
- low Hb
- Presence of fetal movement and FHR
- uterus may be soft and non tender on palpation
- uterus is not bigger than it should be for dates
- presence of abnormal presentation
- patient may be in shock
- head is easily balottable above the pelvis
what are the different types of placental previa
major - complete and partial
minor - marginal and low lying
what determines the management of placental previa
- Amount of blood loss
- condition of the mother and fetus
- gestational age
- type of placental previa (lie)
what is the contraindicated in the management of a placental previa
Vaginal Exam
what is the management plan for minimal bleeding placenta previa
- continue pregnancy until the feus is mature
- monitor the foetus
- maternal condition monitoring
when is vaginal delivery allowed in placental previa
- minor placental previa
- slight bleeding
- vertex presentation
- adequate pelvis with no soft tissue obstruction
- partially dilated cervix to allow amniotomy (artificial rupture of membranes)
What are the things that need to be done in placental previa bleeding
- IVI Resuscitate and stabilize
- U/S to localize placenta
- Plasma Ringers lactate
- Vital signs
- FHR-CTG
- HB
- Refer to level 2-3 hospital (flying squad)
- C/S
- Anti D/Rhogam?
- Cross match bloods/ GPH bloods?
what is placental abruptio
premature separation of a normally situated placenta
what are the two types of bleeding that occur with placental abruptio
- revealed bleeding
- concealed bleeding
what occurs in revealed bleeding
occurs in the lower part of the placenta where blood escapes from the vagina
what occurs in canceled bleeding
blood seeps between placenta and uterine wall. mixed bleeding.
what are the risk factors of placental abruptio
- Pre-eclampsia
- Hypertension
- Chorioamnionitis may initiate uteroplacental bleeding
- ECV
- Blunt abdominal trauma
- Cigarette smoking and use of cocaine and tik (2x increase risk)
- Previous history of abruptio
- Multiple pregnancy
- Polyhydramnios
- > age 35-40
- Abruptio frequently causes contractions, leading to further separation
what are the signs and symptoms present in placental abruptio
- Sudden onset of Severe, constant abdominal pain
- Continuous bleeding
- Dark blood
- Tense and tender uterus (woody)
- Reduced or no fetal movement
- No fetal parts felt
- Maternal shock
- Unlikely to hear FHR with concealed hemorrhage
- Uterus larger for dates due to extravasation of blood between muscle fibre of the uterus
what is vasa previa
it occurs when the fetal blood vessel run freely and unsupported through the membranes, over the cervix beneath the presenting part
what is the aetiology of vasa previa
unknown
what are the risk factors of vasa previa
- placental previa
- IVF
What will you pick up on history for vasa previa
there is PV bleed at time of ROM usually associated with fetal heart rate abnormalities
what forms part of management of vasa previa
1, Exclude risk factors at first booking and refer
2. Advise: stop smoking/illicit drug use
3. IOL in case of history
4. Treat woman accordingly: check degree of shock, resuscitate, stabilize (how much blood loss?)
5. Vital signs
6. U/S and CTG (for fetal condition and Gestational age)
7. HB
8. Urine output
9. Analgesia
10. FBC, Cross match, clotting studies, Anti-D in Rh-negative women
11. C/S if fetus alive and viable, if non-viable-IOL, ROM, IV Syntocinon
what 10 categories/points are used to differentiate placenta abrptio and placenta previa
- maternal condition
- fetal condition (good or poor)
- uterus on palpation (soft or woody)
- presenting part (fetal presenting part)
- maternal Hb (may be low or low)
- Coagulopathy (present or not)
- delivery (urgency) (No hurry unless maternal condition poor or emergency delivery)
- diagnosis (clinically and ultrasound/CTG)
- predisposing factors (Previous uterine surgery or hypertension and trauma)
- pain (none or sudden severe pain)
- blood colour (bright red or dark)
which one is the commonest cause of fetal distress
placental abruptio
brief summary on Placental abruptio
- Premature separation of a normally situated placenta. with a Incidence of : 1:100
- Domestic violence may result in Abruptio.
- It Is the common cause of fetal distress and result in Stillborn fetuses = 30%.
- High maternal morbidity and mortality
- Can cause hypovalaemic shock/PPH/acute renal failure and DIC (due to uncontrolled activation of the coagulation system, concealed and retroplacental)
- Can cause Couvelaire Uterus resulting in uterine rupture due to increase of pressure during contractions.
