Bleeding In Late Preganancy Flashcards
Bleeding in early pregnancy is considered as being when?
Before 24 weeks
Bleeding in late pregnancy is considered as being when?
24 weeks and beyond
Causes of antepartum haemorrhage?
Placenta praevia Placental abruption Vasa praevia Uterine rupture Placenta accreta Unexplained Local causes- cervical ectropion, polyps, cervical cancer, infection
What is an antepartum haemorrhage?
Bleeding from genital tract between 24 weeks gestation and end of 2nd stage of labour
Minor haemorrhage?
<50ml
Major antepartum haemorrhage?
50-1000ml with no signs of clinical shock
Massive antepartum haemorrhage?
> 1000ml and / or signs of clinical shock
What is placental abruption?
Partial or total Separation of normally implanted placenta from uterus
Condition describing partial or total separation of normally implanted placenta from uterus?
Placental abruption
Pathology of placental abruption leading to fetal hypoxia?
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
Risk factors for placental abruption?
PET, hypertension Trauma Smoking, cocaine, amphetamine Thrombophilias, renal disease, diabetes Polyhydramnios, multiple, preterm Abnormal placenta
Symptoms of placental abruption?
Severe abdo pain
Bleeding
Preterm labour
Signs of placental abruption?
Unwell distressed patient Uterus tender and woody hard Preterm Fetal heart- Bradycardia/ absent (IUD) CTG irritable uterus
Management of placental abruption?
Resuscitate mother
Assess and deliver baby
Manage complications
What is placenta praevia?
Placenta partially/ totally implanted in lower uterine segment
Condition defining Placenta partially/ totally implanted in lower uterine segment?
Placenta praevia
Major placenta praevia?
Lies over internal cervical os
Minor placenta praevia?
Leading edge of placenta in lower uterine segment but not covering cervical os
Risk factors for placenta praevia?
Previous c section Previous placenta praevia Asian Smoking Previous TOP Multiparity >40 years old Multiple
Symptoms of placenta praevia?
Painless bleeding
Signs of placental praevia?
Condition directly proportional to amount of bleeding
Uterus soft and non tender
CTG usually normal
Diagnosis of placenta praevia?
By vaginal US
Management of placenta praevia?
Resuscitate mum
Assess baby
C section if placenta <2cm from cervical os
Vaginal delivery if placenta >2cm from cervical os
What is placenta accreta?
Morbidly adherent placenta to uterine wall
Condition describing Morbidly adherent placenta to uterine wall?
Placenta accreta
What is increta?
Invading into myometrium
What is percreta?
Penetrating uterus to bladder
Risk factors for placenta accreta?
Placenta praevia
Previous c section
Management of placenta accreta?
Caesarean hysterectomy
Conservative
Prophylactic internal iliac artery balloon
What is vasa praevia?
Unprotected fetal vessels transverse the fetal membranes over internal cervical os
What conditions describes Unprotected fetal vessels transverse the fetal membranes over internal cervical os ?
Vasa praevia
Presentation of vasa praevia?
Bleeding
Fetal bradycardia / death
Management of vasa praevia?
Urgent c section
What condition describes full thickness opening of the uterus?
Uterine rupture
Rick factors for uterine rupture?
Previous c section Previous Uterine surgery Multiparity Use of prostaglandins or syntocinon Obstructed labour
Symptoms of uterine rupture?
Severe abdo pain
Shoulder tip pain
Maternal collapse
PV bleeding
Signs of uterine rupture?
Loss of contractions
Acute abdo
Peritonism
Fetal distress /IUD
Management of uterine rupture?
Urgent resuscitation
Urgent c section
What is a post Partum haemorrhage ?
Blood loss >500ml after birth of baby
Primary post Partum haemorrhage?
Within 24 hours of delivery
Secondary post Partum haemorrhage?
> 24hours - 6weeks post delivery
Minor post Partum haemorrhage?
500-1000ml
Major post Partum haemorrhage?
> 1000ml
Causes of post Partum haemorrhage?
4 Ts
- tone
- trauma
- tissue
- thrombin
Management of post Partum haemorrhage?
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
