bleedin

Question 1

3a perineal tear

Answer 1

injury to perineum involving < 50% of external anal sphincter

Question 2

how is Post partum haemorrhage defined?

Answer 2

loss of > 500 ml after vaginal delivery

or

loss of > 1000ml post c section

Question 3

4 Ts causing Post partum haemorrhage

Answer 3

• aTony
• Trauma
• Tissue retention
• Thrombin

Question 4

how is primary & secondary post partum haemorrhage distinguished?

Answer 4

primary - within 24 hours

secondary - between 24 hours and 12 weeks

Question 5

management of atony causes of PPH

Answer 5

• bimanual compression, fundal massage to stimulate uterine contraction
  medications: syntocinon, ergometrine, carboprost
  surgical: intrauterine baloon tamponade, hysterectomy, artery ligation

Question 6

risk factors for trauma causing post partum haemorrhage

Answer 6

instrumental delivery (forceps)

Question 7

management of tissue causing post partum haemorrhage

Answer 7

IV oxytocin, manual removal of placenta with local/general anaesthesia

Question 8

placenta obstructing cervical os?

Answer 8

placenta praevia

Question 9

risk factors for placenta praevia?

Answer 9

• previous c secion
• high parity
• endometriosis hx

Question 10

clinical presentation of placenta praevia

Answer 10

painless vaginal bleeding

non tender uterus

Question 11

woody, tense abdomen?

Answer 11

placental abruption

Question 12

patho of placental abruption

Answer 12

part or all of the placenta separates from the wall of the uterus

Question 13

vasa praevia triad?

Answer 13

• vaginal bleeding
• rupture of membranes
• fetal compromise

Question 14

what is PLacenta accreta?

Answer 14

rare complication of pregnancy where the placenta grows into the muscles of the uterus making delivery of the placenta difficult

Question 15

3 causes of antepartum haemorrhage

Answer 15

• placenta praevia
• placental abruption
• vasa praevia

Question 16

causes fo spotting & minor bleeding in pregnancy (3)

Answer 16

• cervical ectoprion
• infection
• vaginal abrasions from intercourse/procedures

Question 17

where placenta is attached to lower portion of uterus, lower than presenting part of the fetus

Answer 17

placenta praevia

Question 18

when are corticoteroids given to mature fetal lungs

Answer 18

between 34 weeks and 35+6 weeks

Question 19

why is early delivery planned for women with placenta praevia

Answer 19

reduce risk of spontaneous labour & bleeding

Question 20

condition where the placenta separates from the wall of the uterus during pregnancy

Answer 20

placental abruption

Question 21

typical presentation of placental abruption

Answer 21

• sudden onset abdo pain continuous
• vaginal bleeding
• shock
• fetal distress
• characteristic woody abdomen on palpation

Question 22

characteristic palpation of abdomen finding in placental abruption

Answer 22

hard, woody uterus

Question 23

what is a concealed abruption?

Answer 23

this is where the cervical os remains closed & any bleeding that occurs remains in the uterine cavity

Question 24

what does the Kleihauer test achieve?

Answer 24

used to quantify how much fetal blood is mixed with maternal blood, to determins the dose of anti-D required

Question 25

name gievn to condition whereby the placenta implants deeper, through and past the endometrium

Answer 25

placenta accreta

Question 26

what test can assess depth & width of the invasion of placenta accreta?

Answer 26

MRI scan

Question 27

condition where the fetal vessels are within the fetal membranes and travel across the inernal cervical os?

Answer 27

vasa praevia

Question 28

platelet count change during pregnancy

Answer 28

falls

Question 29

urea & creatinine change during pregnancy & why?

Answer 29

increased perfusion to the kidneys resulting in reduced urea & creatinine