Bleeding In Late Preganancy

Question 1

Bleeding in early pregnancy is considered as being when?

Answer 1

Before 24 weeks

Question 2

Bleeding in late pregnancy is considered as being when?

Answer 2

24 weeks and beyond

Question 3

Causes of antepartum haemorrhage?

Answer 3

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

Question 4

What is an antepartum haemorrhage?

Answer 4

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

Question 5

Minor haemorrhage?

Answer 5

<50ml

Question 6

Major antepartum haemorrhage?

Answer 6

50-1000ml with no signs of clinical shock

Question 7

Massive antepartum haemorrhage?

Answer 7

> 1000ml and / or signs of clinical shock

Question 8

What is placental abruption?

Answer 8

Partial or total Separation of normally implanted placenta from uterus

Question 9

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

Answer 9

Placental abruption

Question 10

Pathology of placental abruption leading to fetal hypoxia?

Answer 10

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

Question 11

Risk factors for placental abruption?

Answer 11

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

Question 12

Symptoms of placental abruption?

Answer 12

Severe abdo pain
Bleeding
Preterm labour

Question 13

Signs of placental abruption?

Answer 13

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

Question 14

Management of placental abruption?

Answer 14

Resuscitate mother
Assess and deliver baby
Manage complications

Question 15

What is placenta praevia?

Answer 15

Placenta partially/ totally implanted in lower uterine segment

Question 16

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

Answer 16

Placenta praevia

Question 17

Major placenta praevia?

Answer 17

Lies over internal cervical os

Question 18

Minor placenta praevia?

Answer 18

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

Question 19

Risk factors for placenta praevia?

Answer 19

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

Question 20

Symptoms of placenta praevia?

Answer 20

Painless bleeding

Question 21

Signs of placental praevia?

Answer 21

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

Question 22

Diagnosis of placenta praevia?

Answer 22

By vaginal US

Question 23

Management of placenta praevia?

Answer 23

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

Question 24

What is placenta accreta?

Answer 24

Morbidly adherent placenta to uterine wall

Question 25

Condition describing Morbidly adherent placenta to uterine wall?

Answer 25

Placenta accreta

Question 26

What is increta?

Answer 26

Invading into myometrium

Question 27

What is percreta?

Answer 27

Penetrating uterus to bladder

Question 28

Risk factors for placenta accreta?

Answer 28

Placenta praevia | Previous c section

Question 29

Management of placenta accreta?

Answer 29

Caesarean hysterectomy Conservative Prophylactic internal iliac artery balloon

Question 30

What is vasa praevia?

Answer 30

Unprotected fetal vessels transverse the fetal membranes over internal cervical os

Question 31

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

Answer 31

Vasa praevia

Question 32

Presentation of vasa praevia?

Answer 32

Bleeding | Fetal bradycardia / death

Question 33

Management of vasa praevia?

Answer 33

Urgent c section

Question 34

What condition describes full thickness opening of the uterus?

Answer 34

Uterine rupture

Question 35

Rick factors for uterine rupture?

Answer 35

``` Previous c section Previous Uterine surgery Multiparity Use of prostaglandins or syntocinon Obstructed labour ```

Question 36

Symptoms of uterine rupture?

Answer 36

Severe abdo pain Shoulder tip pain Maternal collapse PV bleeding

Question 37

Signs of uterine rupture?

Answer 37

Loss of contractions Acute abdo Peritonism Fetal distress /IUD

Question 38

Management of uterine rupture?

Answer 38

Urgent resuscitation | Urgent c section

Question 39

What is a post Partum haemorrhage ?

Answer 39

Blood loss >500ml after birth of baby

Question 40

Primary post Partum haemorrhage?

Answer 40

Within 24 hours of delivery

Question 41

Secondary post Partum haemorrhage?

Answer 41

>24hours - 6weeks post delivery

Question 42

Minor post Partum haemorrhage?

Answer 42

500-1000ml

Question 43

Major post Partum haemorrhage?

Answer 43

>1000ml

Question 44

Causes of post Partum haemorrhage?

Answer 44

4 Ts - tone - trauma - tissue - thrombin

Question 45

Management of post Partum haemorrhage?

Answer 45

``` 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 ```