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3 reproduction and sexual health > Bleeding in Late Pregnancy > Flashcards

Bleeding in Late Pregnancy Flashcards

1
Q

bleeding in late pregnancy is identified as bleeding >_ weeks

A

24

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2
Q

causes of PPH?

A

atonic uterus

genital tract trauma

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3
Q

don’t give more than _ litres of crystalloid to a pregnant woman as resus

A

2

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4
Q

the placenta becomes the sole source of baby’s nutrition from _ weeks gestation

A

6

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5
Q

functions of the placenta?

A

gas transfer
metabolism/waste disposal
hormone production
prtection

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6
Q

when does APH become PPH?

A

after 2nd stage of labour

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7
Q

local causes of APH?

A

cervical ectropion
polyps
cervical cancer
infection eg cervicitis, STI

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8
Q

placental causes of APH?

A

placenta praevia

placental abruption

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9
Q

what is heavy show?

A

mucus and blood that comes before labour

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10
Q

DDx of APH?

A

heavy show
UTI
haemorrhoids

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11
Q

minor APH is

A

50

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12
Q

major APH is

A

50 to 100

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13
Q

massive APH is >___ml

A

1000

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14
Q

shock is present in ___ APH

A

massive

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15
Q

if the blood from the patient has extended to their feet on the bed it indicates what kind of haemorrhage?

A

minor to major

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16
Q

define placental abruption

A

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

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17
Q

describe the pattern of pain in placental abruption?

A

continuous

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18
Q

pathology of placental abruption?

A

vasospasm -> arteriole rupture into the decidua -> blood escapes into amniotic sac or into myometrium -> causes tonic contraction -> less blood in placenta = hypoxia

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19
Q

placental abruption results in what kind of uterus?

A

couvelaire (haematoma bruises uterus)

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20
Q

symptoms of PA?

A

severe continuous abdo pain
backache if posterior placenta
bleeding
preterm labour

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21
Q

risk factors for PA?

A 
hypertensive cause eg PET
trauma eg RTA
smoking/cocaine/amphetamine
thrombophilias
renal disease
diabetes
polyhydramnios
multiple pregnancy
abnormal placenta
previous abruption
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22
Q

signs of PA?

A 
unwell distressed patient
uterus large or normal
uterine tenderness
woody hard uterus
fetal parts hard to identify
preterm labour with heavy show
fetal heart in bradycardia/absent
CTG shows irritable uterus
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23
Q

irritable uterus on CTG appears like..

A

1 contraction a min

fetal heart in tachycardia, loss of variability, presence of decelerations

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24
Q

Ix of PA?

A 
clinical diagnosis
FBC
clotting factors
LFT
U+Es
crossmatch
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25
Q

Tx of PA

A

resuscitate mother - fluids, blood, catheter
assess and delivery baby
manage complications - steroids
debrief patients

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26
Q

what MDT members are involved in a category 1 CS?

A 
midwives
obstetrician
anasthetists
neonatal team
theatre nurses
haematologist
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27
Q

how is FH assessed in PA?

A

CTG

do USS if undetectable

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28
Q

complications for the mother in PA?

A 
hypovolaemic shock
anaemia
kidney failure - renal tubular necrosis
coagulopathies
thromboembolism
PPH
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29
Q

complications for fetus in PA?

A 
RDS if lack of steroids given 
intrauterine death
prematurity
SGA
FGR
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30
Q

how can you prevent PA in some patients?

A

if APS: LMWH and LDA
smoking cessation
LDA

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31
Q

define minor and major placenta praevia

A

MINOR: if leading edge of placenta is in the lower uterine segment but not covering the os
MAJOR: placenta lying over the internal os of the cervix - “a low lying cervix”

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32
Q

the __ segment of the uterus is thinner and contains less muscle fibres

A

lower

33
Q

the lower segment of the uterus is about _cm from the internal os

A

7

34
Q

CS rate in UK?

A

25-30%

35
Q

risk factors for placenta praevia?

A 
previous CS
previous PP
asian
smoking
previous ToP esp surgical
multiparity
age
ART
36
Q

what can cause a mother’s endometrium to become deficient?

A 
uterine scar
endometritis
manual removal of placenta
curettage
submucous fibroid
37
Q

scans are done at what gestation to check the placental position?

A

20 weeks

32 weeks

38
Q

why should you not do a digital VE in PP?

A

putting finger into placenta and triggering bleeding

39
Q

painless bleeding >24 weeks…

A

PP

40
Q

describe the bleeding in PP and what can cause it

A

unprovoked/triggered by coitis
painless
can be spotting or severe

41
Q

signs of PP

A

condition proportional to bleeding
uterus soft non tender
presenting part high
baby’s position abnormal

42
Q

describe CTG in PP

A

normal

43
Q

Ix of PP

A

transvaginal USS
check previous anomaly scans
MRI to exclude placenta accreta

44
Q

Tx of PP

A

resus mother
assess baby
conservative mananagement until stable (keep in for 24hrs)
avoid sex

45
Q

when should you deliver the baby if you spot a PP in a mother?

A

36 weeks (planned CS)

46
Q

what extra precautions are taken management wise for Rh negative mothers

A

kleihauer test

give anti D

47
Q

how many units of blood are given in placental bleeding emergencies?

A

4-6 units

48
Q

what medication is given in advance ifa PP is known?

A

steroids from 24-35 weeks

MgSO4 from 24-32 weeks

49
Q

what determines whether you do a vaginal or CS delivery in PP?

A

CS if placenta <2cm from os

SVD if placenta >2cm from os and baby’s position is fine

50
Q

define placenta accreta

A

morbidly adherent placenta

51
Q

what increases risks of PAcc?

A

multiple C sections

PP

52
Q

presentation of PAcc?

A

severe bleeding

PPH

53
Q

Tx of PAcc?

A

prophylactic internal iliac artery balloon
CS hysterectomy
resus for expected blood loss

54
Q

blood loss of >_ml is expected in PAcc

A

3l

55
Q

define uterine rupture

A

full thickness opening of uterus

56
Q

risks for uterine rupture?

A

previous CS
IOL (induced labour)
multiparity
use of PGs/syntocinon

57
Q

symptoms of uterine rupture

A

shoulder tip pain from inflam of diaphragm
severe abdo pain
collapse of mum
PV bleeding

58
Q

why do you get shoulder tip pain in uterine rupture?

A

inflammation of diaphram (referred)

59
Q

signs of uterine rupture?

A 
loss of contractions
acute abdomen
PP
loss of uterine contractions
peritonism
fetal distress or IUD
60
Q

Tx of uterine rupture

A

resus - IV fluids
laparotomy if complete rupture/CS
4-6 units blood
anti-D

61
Q

define vasa praevia

A

unprotected fetal vessels traverse the fetal membranes over the internal cervical os

62
Q

Ix of vasa praevia

A

doppler TA and TV USS

63
Q

symptoms of VP

A

sudden bleeding

fetal bradycardia or death

64
Q

risk factors for VP

A

placental anomalies
history of PP in 2T
multiple pregnancy
IVF

65
Q

Tx of VP

A

steroids from 32 weeks

deliver by elective CS 34-36wks

66
Q

PPH is blood loss equal to or exceeding ___ml after birth

A

500

67
Q

what time frame divides primary and secondary PPH

A

24hrs (if under = primary)

68
Q

name the 4 T’s causes of PPH

A

tone - uterine atony
trauma - vaginal tear, cervical laceration, rupture
tissue - anything left inside
thrombin - coagulopathy?

69
Q

antenatal risk factors for PPH

A 
anaemia 
previous CS/PPH/retained placenta
multiple pregnancy
polyhydramnios
big baby or big mother
70
Q

intrapartum risk factors for PPH

A

prolonged labour
operative vaginal delivery
CS
retained PPH

71
Q

Tx of mother with PPH?

A

syntocinon/syntometrine IM/IV
IV grey/orange cannula for taking bloods and giving warmed crystalloid infusion and blood (6 units)
vitals every 15 mins

72
Q

what bloods should always be taken in obstetric emergencies?

A 
G+S
FBC
coag screen
LFTs
lactate
cross match
73
Q

how often should vitals be assessed in PPH?

A

every 15 mins

74
Q

_ units of blood should be given in PPH

A

6

75
Q

how can you stop the blood in PPH

A 
uterine massage by bimanual compression
expel clots manually
5 units IV syntocinon
misoprostol 800mcg PR
transexamic acid 0.5-1mg IV
balloons eg rusch balloon
IR - arterial embolisation
76
Q

surgical Tx of PPH

A

brace sutures
uterine artery/IIA ligation
hysterectomy last option

77
Q

Ix of secondary PPH

A

USS

78
Q

common causes of secondary PPH

A

retained products of conception (RPOC)

infection

3 reproduction and sexual health (51 decks)

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