Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Repro > Bleeding In Late Pregnancy > Flashcards

Bleeding In Late Pregnancy Flashcards

1
Q

What is bleeding in late pregnancy called?

A

Antepartum haemorrhage

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What is the definition of bleeding in early pregnancy?

A

before 24 weeks

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What is the placenta?

A 
Entirely fetal tissue
Sole source of nutrition from 6 weeks
Gas transfer
Metabolism / waste disposal
Hormone production (HPL & hGh-V)
Protective filter
Very vascular
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What is the aetiology of an APH?

A 
Placenta previa
Placental abruption
Local causes - Polyps, cancer, infection
Uterine rupture
Show
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What are risk factors for placental abruption?

A

Pre-eclampsia/Hypertension
Trauma
Smoking/Cocaine/Amphetamine
Medical - Thrombophilias, Renal disease, diabetes
Poly-hydramnios, Multiple pregnancy, preterm-PROM
Abnormal placenta

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What is Couvelaire uterus?

A

AKA uteroplacental apoplexy

Loosening of the placenta

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What are clinical features of a placental abruption?

A 
Small/Large blood loss
Painful
Uterine tenderness/Wooden hard
Uterus feels bigger
Difficulty to feel fetal parts
CTG
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What is Placenta Previa?

A

Placenta is partially or totally implanted in the lower uterine segment

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What is the incidence of placenta previa?

A

5% at anomaly scan

1:200 at term

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What are the classifications of placenta previa?

A

Lateral/Marginal/Incomplete/Centralis/Complete centralis
Grade I-IV
Major/Minor - distance from cervix by ultrasound

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

How is placenta previa diagnosed?

A

By Ultrasound
Painless ‘causeless’ recurrent 3rd trimester bleeding
Variable blood amount
Uterus is soft not tender
High head
CTG usually normal
Malpresentations - Breech/Transverse/Oblique

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What should not be done until placenta previa is EXCLUDED?

A

Vaginal examination

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

When is the diagnosis of placenta previa made?

A

20 week scan then 32/34 week scan

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What type of delivery is used in major degrees of placenta previa?

A
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What type of delivery is used in minor degrees of placenta previa

A

> 2cm from OS = Consider vaginal delivery

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What is Placenta Accreta?

A

When placenta invades myometrium

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

What has the placenta reached in Percreta?

A

The serosa

18
Q

What is Placenta accreta associated with?

A

Severe bleeding

PPH and may end up having a hysterectomy

19
Q

What are major risk factors for placenta accreta?

A

Placenta previa and prior caesarean delivery

20
Q

Describe a Uterine Rupture?

A 
Small/large blood volume
Intra-partum-loss of contractions
Previous CS/Uterine surgery
Obstructed labour
Peritonism
Fetal head high
Fetal distress/IUD
Haematuria
21
Q

What is Vasa Praevia?

A 
Valementous insertion of cord/Succenturate lobe
Fetal vessels within membranes
Can be diagnosed ante-natally
Fetal blood (200ml at term)
Fetal death
22
Q

What is the management of Placenta previa?

A 
Admit
IV access, blood tests/Cross match
Scan
Anti-D
Steroids
Delivery
23
Q

How do you time delivery with placenta praevia?

A

May be preterm
CS at 37-38 weeks if been prior bleeding/ placenta accreta
CS at 38-39 weeks if not been bleeding in pregnancy

24
Q

How do manage a Placental Abruption?

A 
Admit
IV access, bloods and cross match
Resuscitate/Manage DIC
Deliver viable baby-CS versus vaginal
Stillbirth - vaginal delivery
Anti-D
Steroids if expectant management
25
Q

What is the Antenatal admission criteria for any history of acute bleeding (23-32 weeks)

A

Min. stay of 24 hours clear of bleeding

26
Q

What is the Antenatal admission criteria for recurrent bleeding after 28 weeks?

A

Min stay of 72 hours

Consider need to be admitted until delivery

27
Q

What is the Antenatal admission criteria for any bleeding after 32 weeks?

A

Min stay of 72 hours

Consider need to be admitted until delivery

28
Q

What is the Antenatal admission criteria for major placneta praevia after 36 weeks with no bleeding?

A

Consider the social circumstances
Consider other obstetric factors
Consider need for admission until delivery
Consultant decision

29
Q

What antenatal benefit do steroids have?

A

Promote fetal lung surfactant production
Decrease respiratory distress syndrome by up to 50% if given 24-48 hours before delivery
Given up to 36 weeks

30
Q

What dose of steroids are given ante-natally?

A

Betamethasone preferred to Dexamethasone

1 course = 12mg Betamethasone IM X2 injections, 12 hours apart

31
Q

What other checks should be carried out?

A 
Cervical - Colposcopy
Infection - Swabs/Specific treatment
PTL- Steroids +/- tocolysis
Vasa praevia - CS
Rupture - Laparotomy / CS
Unknown - Conservative
32
Q

Describe the delivery for suspected/Confirmed placenta accreta?

A

Ninewells delivery
CS at 37 weeks
Surgical plan clearly documented (including planned hysterectomy)
Cross match 6 units of blood
Cell salvage set up
Prior to surgery, consider inserting arterial line

33
Q

What should be done regarding an antenatal admission with a pv bleed?

A 
Secure wide bore venous access
Check FBC
Take blood group and save
Cross match 2-4 units 
Check Kleihauer test + give anti-D
34
Q

What should not be given in an antenatal admission with a pvbleed and what should be done?

A

NO - Enoxaparin thromboprophylaxis

YES - TEDS, Mobilisation, Hydration

35
Q

What are antenatal risk factors for PPH?

A 
Anaemia
Previous CS
Placenta praevia, placenta accreta
Previous PPH or retained placenta
Multiple pregnancy
36
Q

What are intrapartum risk factors for PPH?

A

Prolonged labour
Operative vaginal delivery / CS
Retained placenta

37
Q

What is the initial management for PPH?

A

Uterine massage
5 units IV Syntocinon stat
40 units Syntocinon in 500ml
Hartmanns - 125ml/h

38
Q

What is the management for persistent PPH?

A 
Confirm placenta and membranes complete
Urinary catheter
500 micrograms Ergometrine IV
(Avoid if cardiac disease/Hypertension
Promptly repair and vaginal or perineal trauma
39
Q

What are the non-surgical treatments of a PPH over 1500ml?

A

Packs & Balloons
Tissue sealants
Factor VIIa
Arterial embolisation

40
Q

What is the surgical management of a PPH over 1500ml

A 
Undersuturing
Brace sutures
Uterine artery ligation
Internal iliac artery ligation
hysterectomy

Repro (46 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions