APH PPH

Question 1

What is APH?

Answer 1

Bleeding from genital tract after 24 weeks gestation

Question 2

Risk factors for placenta praevia

Answer 2

• previous CS
• multiparrous
• multiple pregnancy

Question 3

When you are assessing grade of praevia, what investigation could help?

Answer 3

TV ultrasound - to assess distance from Cx

Question 4

What is Couveliare uterus?

Answer 4

When retroplacental blood penetrates through the uterine wall and into the peritoneum

Question 5

First observation to change in shock

Answer 5

Pulse will increase

-she may not feel any symptoms apart from being light headed

Question 6

Medication you can give to improve fetal surfactant production?

Answer 6

Bethametasone - give up to 36 weeks (only significant benefit up to 34 weeks)

Question 7

Definition of PPH

Answer 7

> 500ml blood loss
Primary = within 24 hr
Secondary = after 24 hr - 6 weeks

Question 8

Antenatal risk factors for PPH

Answer 8

• multiple pregnancy
• previous CS
• anaemia
• placenta previa
• placenta accreta
• previous PPH/retained placenta
• multiple pregnancy

Question 9

Intrapartum risk factors for PPH

Answer 9

prolonged labour
operative vaginal delivery / caesarean section
retained placenta

Question 10

How might a ruptured uterus present?

Answer 10

Vaginal bleeding
Severe abdominal pain
Shoulder tip pain

Question 11

How might an inverted uterus present?

Answer 11

Mild/severe abdominal pain

Symptoms of shock often without vaginal bleeding

Question 12

PPH initial management

Answer 12

-Uterine massage
-5 units iv Syntocinon stat
-40 units Syntocinon in 500ml
Hartmanns - 125 ml/h

If persistent: insert urinary catheter, give 500mcg of ergometrine IV