Bleeding in late pregnancy Flashcards
definition of antepartum haemorrhage?
“bleeding from the genital tract after 24 weeks”
bleeding in early pregnancy is considered before 24 weeks
.
when is the placenta functional by?
week 5
the placenta? entirely which tissue? sole source of nutrition from 6 weeks, produces? also acts as a protective filter
placental, hormones
most common cause of antepartum haemorrhage
placental abruption
risk factors for placental abruption?
pre eclampsia/hypertension, trauma, smoking, cocaine, amphetamines, polyhydramnios, multiple pregnancies, pre term (40% have no apparent cause)
sudden onset abdominal pain, uterine tenderness (wooden hard), uterus feels larger, difficulty feeling metal parts
y
why does the uterus go hard?
when placenta is expelled, remember the uterus contracts
sudden onset pain, vaginal bleeding and tenderness (wooden hard)
placental abruption
placenta praevia ?
partially totally implanted placenta in lower segment. painless recurrent 3rd trimester bleeding
what is the uterus like in placenta previa?
soft, non tender
how do you diagnose placenta previa?
us
what do you not do?
perform vaginal exam until you exclude it
what is placenta accreta?
placenta invades myoetrium. associated with severe bleeding
severe bleeding, painless. associated with placenta previa and previous cesarian section
y
uterine rupture
previous CS, obstructed labour, perotinism, metal head high
placenta praevia management?
admit, IV access, blood tests, scan, anti d, steroids, delivery
steroids promote fetal lung surfactant production
decrease in neonatal respiratory distress syndome
when would you administer this?
up to 36 weeks
what steroid would you use?
betamethasone
post partum haemorhage…normal blood loss?
up tp p500ml
abnormal 500-1500
significant above 1500ml
management of post part haemorrhage?
uterine massage, 5 units of syntocinon stat
most cases respond to massage and syntocinon
.
what is the management if it doesn’t respond?
500mcg ergometrine IV (ger)
if persistent bleeding, can use?
packs and balloons, tissue sealants, factor VIIa, arterial embolisation
placenta praevia - RECURRENT, PAINLESS 3rd trimester bleeding
y
sudden pain, bleed, uterus hard and large - placental abruption.
recurrent third trimester painless bleed - placenta praevia
severe painless bleed - accreta
.
why would you give anti d in placenta previa?
it is associated with placenta accreta
