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Repro > Bleeding In Late Preganancy > Flashcards

Bleeding In Late Preganancy Flashcards

1
Q

Bleeding in early pregnancy is considered as being when?

A

Before 24 weeks

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2
Q

Bleeding in late pregnancy is considered as being when?

A

24 weeks and beyond

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3
Q

Causes of antepartum haemorrhage?

A 
Placenta praevia
Placental abruption 
Vasa praevia 
Uterine rupture
Placenta accreta
Unexplained 
Local causes- cervical ectropion, polyps, cervical cancer, infection
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4
Q

What is an antepartum haemorrhage?

A

Bleeding from genital tract between 24 weeks gestation and end of 2nd stage of labour

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5
Q

Minor haemorrhage?

A

<50ml

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6
Q

Major antepartum haemorrhage?

A

50-1000ml with no signs of clinical shock

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7
Q

Massive antepartum haemorrhage?

A

> 1000ml and / or signs of clinical shock

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8
Q

What is placental abruption?

A

Partial or total Separation of normally implanted placenta from uterus

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9
Q

Condition describing partial or total separation of normally implanted placenta from uterus?

A

Placental abruption

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10
Q

Pathology of placental abruption leading to fetal hypoxia?

A

Vasospasm followed by arteriole rupture into decidua
Blood escapes into amniotic sac or under placenta and into myometrium.
Causes tonic contractions and interrupts placental circulation.
Hypoxia

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11
Q

Risk factors for placental abruption?

A 
PET, hypertension
Trauma
Smoking, cocaine, amphetamine
Thrombophilias, renal disease, diabetes
Polyhydramnios, multiple, preterm
Abnormal placenta
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12
Q

Symptoms of placental abruption?

A

Severe abdo pain
Bleeding
Preterm labour

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13
Q

Signs of placental abruption?

A 
Unwell distressed patient
Uterus tender and woody hard
Preterm
Fetal heart- Bradycardia/ absent (IUD)
CTG irritable uterus
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14
Q

Management of placental abruption?

A

Resuscitate mother
Assess and deliver baby
Manage complications

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15
Q

What is placenta praevia?

A

Placenta partially/ totally implanted in lower uterine segment

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16
Q

Condition defining Placenta partially/ totally implanted in lower uterine segment?

A

Placenta praevia

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17
Q

Major placenta praevia?

A

Lies over internal cervical os

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18
Q

Minor placenta praevia?

A

Leading edge of placenta in lower uterine segment but not covering cervical os

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19
Q

Risk factors for placenta praevia?

A 
Previous c section
Previous placenta praevia
Asian
Smoking
Previous TOP
Multiparity
>40 years old
Multiple
20
Q

Symptoms of placenta praevia?

A

Painless bleeding

21
Q

Signs of placental praevia?

A

Condition directly proportional to amount of bleeding
Uterus soft and non tender
CTG usually normal

22
Q

Diagnosis of placenta praevia?

A

By vaginal US

23
Q

Management of placenta praevia?

A

Resuscitate mum
Assess baby
C section if placenta <2cm from cervical os
Vaginal delivery if placenta >2cm from cervical os

24
Q

What is placenta accreta?

A

Morbidly adherent placenta to uterine wall

25
Q

Condition describing Morbidly adherent placenta to uterine wall?

A

Placenta accreta

26
Q

What is increta?

A

Invading into myometrium

27
Q

What is percreta?

A

Penetrating uterus to bladder

28
Q

Risk factors for placenta accreta?

A

Placenta praevia

Previous c section

29
Q

Management of placenta accreta?

A

Caesarean hysterectomy
Conservative
Prophylactic internal iliac artery balloon

30
Q

What is vasa praevia?

A

Unprotected fetal vessels transverse the fetal membranes over internal cervical os

31
Q

What conditions describes Unprotected fetal vessels transverse the fetal membranes over internal cervical os ?

A

Vasa praevia

32
Q

Presentation of vasa praevia?

A

Bleeding

Fetal bradycardia / death

33
Q

Management of vasa praevia?

A

Urgent c section

34
Q

What condition describes full thickness opening of the uterus?

A

Uterine rupture

35
Q

Rick factors for uterine rupture?

A 
Previous c section
Previous Uterine surgery
Multiparity
Use of prostaglandins or syntocinon
Obstructed labour
36
Q

Symptoms of uterine rupture?

A

Severe abdo pain
Shoulder tip pain
Maternal collapse
PV bleeding

37
Q

Signs of uterine rupture?

A

Loss of contractions
Acute abdo
Peritonism
Fetal distress /IUD

38
Q

Management of uterine rupture?

A

Urgent resuscitation

Urgent c section

39
Q

What is a post Partum haemorrhage ?

A

Blood loss >500ml after birth of baby

40
Q

Primary post Partum haemorrhage?

A

Within 24 hours of delivery

41
Q

Secondary post Partum haemorrhage?

A

> 24hours - 6weeks post delivery

42
Q

Minor post Partum haemorrhage?

A

500-1000ml

43
Q

Major post Partum haemorrhage?

A

> 1000ml

44
Q

Causes of post Partum haemorrhage?

A

4 Ts

  • tone
  • trauma
  • tissue
  • thrombin
45
Q

Management of post Partum haemorrhage?

A 
Vital signs
High flow O2
Blood samples 
IV Fluids
Catheterise
Deliver placenta and empty uterus
Give drugs to stimulate uterine contractions - syntometrine, oxytocin, ergometrine, misoprostol, carboprost
Repair vaginal and cervical tears
Rusch balloon -exerts pressure on placental bed
Suture
Internal iliac/ uterine artery ligation 
Subtotal or total hysterectomy

Repro (39 decks)

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