bleeding in late pregnancy Flashcards
what is antepartum haemorrhage
bleeding in pregnancy >24 weeks
causes of antepartum haemorrhage
placenta praevia placental abruption local causes (cervical cancer etc) vasa previa uterine rupture unexplained
minor haemorrhage volume
<50mls
major haemorrhage volume
50-1000mls (no shock)
massive haemorrhage
50-1000ml with shock
OR
blood loss >1000mls
what is placental abruption
separation of a normally implanted placenta
what is placenta paevia
placenta lies low in uterus
pathology of placental abruption
vasospasm followed by arteriole rupture into the decidua
blood in amniotic sac/myometrium
causes tonic contraction and interrupts placental circulation
where is lower segment of uterus
below utero-vesical peritoneal pounch
difference between major praevia and minor/partial praevia
major - lies over cervical os
minor - doesn’t cover cervical os
constant painful bleeding
tender uterus
normal lie/presentation
foetal heart absent/distressed
placental abruption
painless bleeding
no pain/tender uterus
lie and presentation may be abnormal
normal foetal heart
placental praevia
backache, tender uterus, distressed foetal heart
posterior placental abruption
management of placental abruption
resuscitation
fluids?
catheter
urgen CS
complications of placental abruption to mother
hypovalaemic shock anaemia PPH renal failure (tubular necrosis) coagulopathy infection thromboembolism
foetal complications of placental abruption
foetal death hypoxia prematurity small for gestational age foetal growth restriction
risk factors for placental abruption
pre-eclampsia trauma smoking/cocaine/amphetamine thrombophilia/diabetes/renal multiple pregnancy previous
risk factors for placental praevia
previous c section/placental praevia Asian smoker prev TOP advanced maternal age assisted conception deficient endometrium
what must not be performed until placental praevia has been excluded
vaginal exam
how is placental praevia diagnosed
USS
what medications can be given before delivery in placental praevia
steroids 24-34+6 weeks
magnesium sulphate 24-32 weeks
when should C section be considered in placental praevia
placenta <2cm from os
mispresentation
what is placenta accrete
placenta is abnormally adherent to uterine wall
risk factor for placenta accrete
multiple c sections
risk factors for uterine rupture
previous c section/uterine surgery
multiparous
use of prostaglandins
obstructed labour
symptoms of uterine rupture
severe abdo pain
shoulder tip pain
collapse
PV bleed
what is vasa praevia
unprotected foetal vessels transverse the foetal membranes over the cervical os
risk factors for vasa praevia
placental anomalies
history of low lying placenta
multiple pregnancy
IVF
what is post-partum haemorrhage
blood loss equal to or exceeding 500ml after birth of baby
primary post partum haemorrhage
within 24 hours of delivery
secondary pph
more that 24 hours after delivery
minor PPH volume
500-1000ml
no shock
major PPH volume
> 100mls
signs of CV collapse/ongoing bleeding
causes of PPH
4Ts: tone (most likely) trauma tissue thrombin (least likely)
intrapartum risk factors of PPH
prolonged labour operative vaginal delivery C section retained placenta active management in 3rd stage (syntocinon)
management for minor PPH
IV warmed crystalloid infusion uterine massage - bimanual compression expel clots syntocinon Foley's catheter
