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Bleeding in Late Pregnancy Flashcards

1
Q

What is bleeding in early pregnancy defined as?

A

<24 weeks

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2
Q

What is bleeding in late pregnnacy known as?

A

antepartum haemorrhage

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3
Q

What is antepartum haemorrhage defined as?

A

bleeding from the genital tract after 24 weeks gestation and before the end of the second stage of labour

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4
Q

What are the causes of APH?

A

placenta praevia; placental abruption; local causes; vasa previa; uterine rupture

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5
Q

What is the differential diagnosis of APH?

A

heavy show; cystitis; haemorrhoids

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6
Q

What is spotting?

A

staining; streaking or blood spotting noted on underwear or saintary protection

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7
Q

What is a minor haemorrhage in APH?

A

<50ml

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8
Q

What is a major haemorrhage in APH?

A

50-1000ml loss with no signs of shock

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9
Q

What is a massive haemorrhage in APH?

A

> 1000ml and/or chock

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10
Q

What is placental abruption?

A

separation of a normally implanted placenta- partially or totally before the birth of the fetus

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11
Q

How is a diagnosis of placental abruption made?

A

Clinically

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12
Q

How common is placental abruption?

A

1%

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13
Q

What percentage of APH does placental aburption accoutn for?

A

40%

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14
Q

What happens in placental abruption?

A

vasospasm followed by arteriole rupture into the decidua which causes tonic contraction and interrupts placental circulation

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15
Q

What is a complication of placental abruption?

A

couvelaire uterus

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16
Q

what is a couvelaire uterus?

A

blood from the placental abruption has penetrated the uterine myometrium and is working its way into the peritoneal cavity

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17
Q

What are the risk factors for placental abruption?

A

pre-eclampsia/HT; trauma; smoking/cocaine/amphetamine; medical- thrombophilia/renal/DM; polyhydramnios; multiple prengnacy;

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18
Q

What are the symptoms of placental abruption?

A

severe continous abdo pain; bleeding; preterm labour; maternal collapse

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19
Q

What are the signs of placetnal abruption?

A

uterus LFD; uterine tenderness; woody hard uterus; fetal parts hard to identify; FH- bradycardia/absent; irritable uterus

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20
Q

What is an irritable uterus?

A

1 contraction/min/ FH abnormality

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21
Q

Why is placental abruption a clinical diagnosis?

A

USS will fail to detect 75% of aburptions

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22
Q

What is the rate of PPH following placental abruption?

A

25%

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23
Q

What is placenta praevia?

A

placenta is partially or totally implanted in the lower uterine segment

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24
Q

What is the lower segment defined as?

A

part of the uterus below the utero-vesical peritoneal pouch superiorly and internal os inferioyl

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25
Q

What percentage of APH does placenta praevia account for?

A

20%

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26
Q

What is the biggest risk factor for placenta praeiva?

A

prev C/S

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27
Q

What are the risk factors for placenta praevia?

A

prev C/S; asian; smoking; prev TOP; multiparity; >40yo; mulitple pregnnacy; assisted conception; defieinnt endmetrium

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28
Q

What is major praevia?

A

placenta lies over the internal cervical os

29
Q

what is minor/partial praevia?

A

leading edgeo f hte placenta is in the lower uterine segment but not covering hte cervical os

30
Q

What is the differnece betwen the bleeding seen with placental abruption and with placenta praevia?

A

in placenta praevia the bleeding is painless

31
Q

What should not be done before placenta praevia is excluded?

A

vaginal examination

32
Q

How is placenta praevia diagnosed?

A

TVUSS

33
Q

What is give nfor neuro-protection between 24-32 weeks?

A

magnesium sulphate

34
Q

What should couples be told to avoid with expectant mx of placenta praevia?

A

avoid penetrative sex

35
Q

When should C/S be done with placenta praevia?

A

placenta <2cm from cervical os

36
Q

When can vaginal deliery be done with placental praevia?

A

placenta >2cm from os and no malpresentation

37
Q

What is placenta accreta?

A

morbidly adherent placenta to uterine wall

38
Q

What increases the risk of placenta accreta?

A

multiple C/S and placenta praevia

39
Q

What is placenta accreta known as if placenta is invading myometrium?

A

increta

40
Q

What is placenta accreta known if placenta is peentrating uterus to bladder?

A

precreta

41
Q

What is the blood loss expected with placenta accreta?

A

> 3L

42
Q

What is a Klleihauer test done to asses?

A

degree of fetomaternal haemorrhage

43
Q

What is the managemtn of placenta accreta?

A

prophlyactic internal ilac artery balloon; caesarean hysterectomy

44
Q

What is the approximate blood volume in pregnnacy?

A

100ml/kg

45
Q

What is uterine rupture?

A

full thickness opening of uterus

46
Q

What are the risk factors for uterine rupture?

A

prev C/S/uterine surgery; multiparity; IOL; obstructed labour

47
Q

What are the symptoms of uterine rupture?

A

severe abdo pain; shoulder-tip pain; maternal collapse; PV bleeding

48
Q

What are the signs of uterine rupture?

A

intra-partum- loss of contractions; acute abdo; presenting part rises; peritnosim; fetal distress

49
Q

What is vasa praevia?

A

unprotected fetal vessels traverse the fetal membraens over the interal cervical os

50
Q

What is seen with artifical rupture of membranes in vasa praevia?

A

sudden bleeding and fetal bradycardia/ death

51
Q

What are the risk factors for vasa praevia?

A

placental anomalies; hx of placental praevia; multiple pregnancy; IVF

52
Q

What is PPH defined as?

A

blood loss >=500ml after second stage of labour

53
Q

What is primary PPH?

A

within 24hr of delivery

54
Q

What is secondary PPH?

A

> 24hrs-6/52 post delivery

55
Q

What is minor PPH?

A

500-1000ml without shock

56
Q

What is major PPH?

A

> 1000ml or signs of CVS collpse or ongoing bleeding

57
Q

What are the 4Ts in PPH causes?

A

tone; trauma; tissue ; thrombin

58
Q

What are the antenatal PPH?

A

anaemia; prev C/S; placenta praevia; percreta; prev PPH; multiple pregnancy; polyhydramnios; obesity; macrosomia

59
Q

What are hte intra-partum RF for PPH?

A

prolonged labour; operative vaginal delivery; C/S; retianed section

60
Q

What should be done to prevent PPH?

A

active mx of thrid stage

61
Q

What is active mx of the thrid stage of labour?

A

syntocinon/ syntometrin IM/IV

62
Q

What are hte measures for minor PPH?

A

IV access; bloods; obs; IV warmed crystalloid infusion

63
Q

How can bleeding be stopped in PPH?

A

uterine massage- bimanual compression; expel clots; IV syntocinon; foleys catheter; ergoemtrine

64
Q

Who should ergometrine be avoided in?

A

cardiac disease and HT

65
Q

What fluids are used in PPH?

A

crystalloid Hartmann’s

66
Q

What should be exclusded with secondary PPH?

A

retained products of conception

67
Q

Waht is likely to play a role in secodnary PPH?

A

infection

68
Q

What are the 3 important things to remmebr in APH?

A

Kleihauer; anti-D and steroids

Reproduction (52 decks)

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