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Reproduction Year 3 > Bleeding In Late Pregnancy > Flashcards

Bleeding In Late Pregnancy Flashcards

1
Q

definition of bleeding in late pregnancy

A

> 24 weeks

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2
Q

definition of antepartum haemorrhage

A

bleeding from or into the genital tract occurring from 24 weeks gestation prior to birth of the baby

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3
Q

causes of antepartum haemorrhage

A 
Placenta praevia
Placental abruption 
Local causes- polyps, cancer, ectropion, infection 
Vasa previa
Uterine rupture
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4
Q

minor antepartum haemorrhage

A

blood loss <50ml that has settled

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5
Q

major antepartum haemorrhage

A

blood loss 50-1000ml, no signs of shock

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6
Q

massive antepartum haemorrhage

A

blood loss >1000ml and/or signs of shock

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7
Q

what is placental abruption

A

separation of a normally implanted placenta partially, or totally, before birth

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8
Q

causes of placental abruption

A 
pre-eclampsia 
Trauma 
Smoking/cocaine/amphetamine
Renal disease
diabetes
Polyhydramnios 
multiple pregnancy
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9
Q

Pathology of placental abruption

A

vasospasm followed by arteriole rupture into the decidua- blood escapes into the amniotic sac/myometrium
Causes tonic contraction and interrupts placental circulation which causes hypoxia
Results in couvelaire uterus

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10
Q

what is couvelaire uterus

A

bleeding that penetrates through myometrium into peritoneal cavity
LIFE THREATENING

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11
Q

Symptoms of placental abruption

A

severe abdominal pain- continuous

‘Wooden hard’ abdomen

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12
Q

management of abruption

A

Resuscitate mother

Assessment + delivery of baby

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13
Q

what is placenta praevia

A

placenta is partially or totally implanted in the lower uterine segment
‘low lying placenta’

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14
Q

how is placenta praevia classified

A

major - anything covering the cervix
minor- not covering cervix

Diagnosed via ultrasound

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15
Q

biggest risk factor for placenta praevia

A

previous C-section

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16
Q

signs/symptoms of placenta praevia

A

painless bleeding >24 weeks
Uterus soft + non tender
Malpresentations- breech/transverse/oblique
High head

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17
Q

Investigation of placenta praevia

A

Transvaginal USS

18
Q

management of placenta praevia

A

Delivery plan at/near term

C-section if major
Consider vaginal delivery if placenta >2cm away from os and no malpresentation

19
Q

what is placenta accreta

A

placenta invades myometrium

20
Q

symptoms of placenta accreta

A

severe bleeding

Post partum haemorrhage

21
Q

risk factors for placenta accreta

A

placenta praevia

Prior C-Section

22
Q

management of placenta accreta

A

prophylactic internal iliac artery balloon

caesarean hysterectomy

23
Q

what is a uterine rupture

A

full thickness opening of the uterus

24
Q

what are most uterine ruptures caused by

A

c-sections

25
Q

symptoms of uterine rupture

A

severe abdo pain
shoulder tip pain
bleeding

26
Q

what is vasa praevia

A

blood vessels within the placenta or the umbilical cord that are trapped between the foetus and the opening to the birth canal

27
Q

why is vasa praevia worrying

A

can cause fetal death due to blood loss

28
Q

risk factors for vasa praevia

A

placental anomalies
history of low lying placenta
IVF
multiple pregnancy

29
Q

what would make you think that the cause of antepartum haemorrhage is local

A

small volume of blood
Painless
Uterus soft + non tender
No fetal distress

30
Q

definition of post partum haemorrhage

A

Blood loss equal to or exceeding 500ml after the birth of the baby

31
Q

primary post partum haemorrhage

A

within 24h of delivery

32
Q

secondary post partum haemorrhage

A

> 24h post delivery

33
Q

minor post partum haemorrhage

A

500ml-1000ml, no shock

34
Q

major post partum haemorrhage

A

> 1000ml or signs of shock

35
Q

causes of Post partum haemorrhage

A

4 T’s

Tone
Trauma
Tissue
Thrombin

36
Q

risk factors for post partum haemorrhage

A 
anaemia 
C-section 
Placenta praevia/accreta 
prolonged labour
retained placenta
37
Q

initial management of post partum haemorrhage

A

assess
Stop the bleeding - uterine massage, 5 units IV syntocinon
fluid replacement - crystalloid Hartmann’s 0.9% saline

38
Q

Treatment of vasa praevia

A

C-section

39
Q

Treatment of placenta accreta

A

Hysterectomy

40
Q

why is betamethasone given before delivery in placenta praevia

A

promote fetal lung surfactant production- decreased risk of neonatal RDS

41
Q

What drug can be given to delay the delivery of a baby by a short period of time

A

tocolysis

Reproduction Year 3 (36 decks)

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