Bleeding in late pregnancy

Question 1

definition of antepartum haemorrhage?

Answer 1

“bleeding from the genital tract after 24 weeks”

Question 2

bleeding in early pregnancy is considered before 24 weeks

Answer 2

.

Question 3

when is the placenta functional by?

Answer 3

week 5

Question 4

the placenta? entirely which tissue? sole source of nutrition from 6 weeks, produces? also acts as a protective filter

Answer 4

placental, hormones

Question 5

most common cause of antepartum haemorrhage

Answer 5

placental abruption

Question 6

risk factors for placental abruption?

Answer 6

pre eclampsia/hypertension, trauma, smoking, cocaine, amphetamines, polyhydramnios, multiple pregnancies, pre term (40% have no apparent cause)

Question 7

sudden onset abdominal pain, uterine tenderness (wooden hard), uterus feels larger, difficulty feeling metal parts

Answer 7

y

Question 8

why does the uterus go hard?

Answer 8

when placenta is expelled, remember the uterus contracts

Question 9

sudden onset pain, vaginal bleeding and tenderness (wooden hard)

Answer 9

placental abruption

Question 10

placenta praevia ?

Answer 10

partially totally implanted placenta in lower segment. painless recurrent 3rd trimester bleeding

Question 11

what is the uterus like in placenta previa?

Answer 11

soft, non tender

Question 12

how do you diagnose placenta previa?

Answer 12

us

Question 13

what do you not do?

Answer 13

perform vaginal exam until you exclude it

Question 14

what is placenta accreta?

Answer 14

placenta invades myoetrium. associated with severe bleeding

Question 15

severe bleeding, painless. associated with placenta previa and previous cesarian section

Answer 15

y

Question 16

uterine rupture

Answer 16

previous CS, obstructed labour, perotinism, metal head high

Question 17

placenta praevia management?

Answer 17

admit, IV access, blood tests, scan, anti d, steroids, delivery

Question 18

steroids promote fetal lung surfactant production

Answer 18

decrease in neonatal respiratory distress syndome

Question 19

when would you administer this?

Answer 19

up to 36 weeks

Question 20

what steroid would you use?

Answer 20

betamethasone

Question 21

post partum haemorhage…normal blood loss?

Answer 21

up tp p500ml

Question 22

abnormal 500-1500

Answer 22

significant above 1500ml

Question 23

management of post part haemorrhage?

Answer 23

uterine massage, 5 units of syntocinon stat

Question 24

most cases respond to massage and syntocinon

Answer 24

.

Question 25

what is the management if it doesn’t respond?

Answer 25

500mcg ergometrine IV (ger)

Question 26

if persistent bleeding, can use?

Answer 26

packs and balloons, tissue sealants, factor VIIa, arterial embolisation

Question 27

placenta praevia - RECURRENT, PAINLESS 3rd trimester bleeding

Answer 27

y

Question 28

sudden pain, bleed, uterus hard and large - placental abruption.
recurrent third trimester painless bleed - placenta praevia
severe painless bleed - accreta

Answer 28

.

Question 29

why would you give anti d in placenta previa?

Answer 29

it is associated with placenta accreta