Bleeding In Late Pregnancy Flashcards
definition of bleeding in late pregnancy
> 24 weeks
definition of antepartum haemorrhage
bleeding from or into the genital tract occurring from 24 weeks gestation prior to birth of the baby
causes of antepartum haemorrhage
Placenta praevia Placental abruption Local causes- polyps, cancer, ectropion, infection Vasa previa Uterine rupture
minor antepartum haemorrhage
blood loss <50ml that has settled
major antepartum haemorrhage
blood loss 50-1000ml, no signs of shock
massive antepartum haemorrhage
blood loss >1000ml and/or signs of shock
what is placental abruption
separation of a normally implanted placenta partially, or totally, before birth
causes of placental abruption
pre-eclampsia Trauma Smoking/cocaine/amphetamine Renal disease diabetes Polyhydramnios multiple pregnancy
Pathology of placental abruption
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
what is couvelaire uterus
bleeding that penetrates through myometrium into peritoneal cavity
LIFE THREATENING
Symptoms of placental abruption
severe abdominal pain- continuous
‘Wooden hard’ abdomen
management of abruption
Resuscitate mother
Assessment + delivery of baby
what is placenta praevia
placenta is partially or totally implanted in the lower uterine segment
‘low lying placenta’
how is placenta praevia classified
major - anything covering the cervix
minor- not covering cervix
Diagnosed via ultrasound
biggest risk factor for placenta praevia
previous C-section
signs/symptoms of placenta praevia
painless bleeding >24 weeks
Uterus soft + non tender
Malpresentations- breech/transverse/oblique
High head
Investigation of placenta praevia
Transvaginal USS
management of placenta praevia
Delivery plan at/near term
C-section if major
Consider vaginal delivery if placenta >2cm away from os and no malpresentation
what is placenta accreta
placenta invades myometrium
symptoms of placenta accreta
severe bleeding
Post partum haemorrhage
risk factors for placenta accreta
placenta praevia
Prior C-Section
management of placenta accreta
prophylactic internal iliac artery balloon
caesarean hysterectomy
what is a uterine rupture
full thickness opening of the uterus
what are most uterine ruptures caused by
c-sections
symptoms of uterine rupture
severe abdo pain
shoulder tip pain
bleeding
what is vasa praevia
blood vessels within the placenta or the umbilical cord that are trapped between the foetus and the opening to the birth canal
why is vasa praevia worrying
can cause fetal death due to blood loss
risk factors for vasa praevia
placental anomalies
history of low lying placenta
IVF
multiple pregnancy
what would make you think that the cause of antepartum haemorrhage is local
small volume of blood
Painless
Uterus soft + non tender
No fetal distress
definition of post partum haemorrhage
Blood loss equal to or exceeding 500ml after the birth of the baby
primary post partum haemorrhage
within 24h of delivery
secondary post partum haemorrhage
> 24h post delivery
minor post partum haemorrhage
500ml-1000ml, no shock
major post partum haemorrhage
> 1000ml or signs of shock
causes of Post partum haemorrhage
4 T’s
Tone
Trauma
Tissue
Thrombin
risk factors for post partum haemorrhage
anaemia C-section Placenta praevia/accreta prolonged labour retained placenta
initial management of post partum haemorrhage
assess
Stop the bleeding - uterine massage, 5 units IV syntocinon
fluid replacement - crystalloid Hartmann’s 0.9% saline
Treatment of vasa praevia
C-section
Treatment of placenta accreta
Hysterectomy
why is betamethasone given before delivery in placenta praevia
promote fetal lung surfactant production- decreased risk of neonatal RDS
What drug can be given to delay the delivery of a baby by a short period of time
tocolysis
