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Reproduction > Bleeding in Late Pregnancy > Flashcards

Bleeding in Late Pregnancy Flashcards

1
Q

What is defined as bleeding in late pregnancy?

A

Bleeding after 24 weeks

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2
Q

Obstetric haemorrhage is a leading cause of maternal death in the UK. True/false?

A

False - uncommon cause of death

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3
Q

What is antepartum haemorrhage?

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

Give some causes of APH

A 
Placenta praevia
Placental abruption
Local causes (polyps/cervical cancer)
Vasa previa
Uterine rupture
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5
Q

What is placental abruption?

A

The separation of a normally implanted placenta before the birth of the fetus

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6
Q

What occurs in placental abruption?

A

Vasospasm causes blood to escape into the amniotic sac/myometrium
Tonic contraction occurs interrupting placental circulation causing hypoxia

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7
Q

Give some risk factors for placental abruption

A 
Pre-eclampsia/hypertension
Trauma
Drug use
Thrombophilia
Polyhydramnios
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8
Q

Give some clinical features of placental abruption

A 
Severe continuous abdominal pain
Bleeding
Preterm labour
Uterine tenderness
Woody hard uterus
Fetal bradycardia
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9
Q

How should the mother be managed in placental abruption?

A

Rapid assessment and delivery
2 large bore IV cannulas
FBC/LFT/U+Es/Crossmatch
IV fluid

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10
Q

In an emergency how should the fetus be delivered in placental abruption?

A

Category I C-section

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11
Q

Give some potential maternal complications of placental abruption

A 
Hypovolaemic shock
Anaemia
PPH
Renal failure
Infection
Thromboembolism
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12
Q

Give some potential fetal complications of placental abruption

A

Fetal death
Hypoxia
Prematurity
SGA

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13
Q

What is placenta praevia?

A

When the placenta lies directly over the internal os

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14
Q

Give some risk factors for placenta praevia

A 
Previous C-section/placenta praevia
Asian
Smoking
Previous surgical TOP
Multiple pregnancy
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15
Q

Give some clinical features of placenta praevia

A

Painless bleeding after 24 weeks (especially post-coital)

Soft non-tender uterus

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16
Q

A vaginal examination is indicated in patients with placenta praevia. True/false?

A

False - should not be performed until excluded

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17
Q

What investigation is used to diagnose placenta praevia?

A

USS

18
Q

How is placenta praevia managed if the woman starts bleeding?

A

2 large bore IV cannulas
FBC/LFT/U+Es/Crossmatch
Anti-D

19
Q

What can be done to manage the fetus in placenta praevia?

A

Steroids

Magnesium sulfate

20
Q

How should the baby be delivered in placenta praevia?

A

C-section if placenta <2cm from cervical os

Vaginal delivery if placenta >2cm from cervical os

21
Q

What is placenta accreta?

A

A placenta that is morbidly adherent to the uterine wall

22
Q

Give some risk factors for placenta accreta

A

Placenta praevia

Prior C-section

23
Q

What is it called when the placenta starts invading the myometrium?

A

Placenta increta

24
Q

What is it called when the placenta starts penetrating the bladder?

A

Placenta percreta

25
Q

How is placenta accreta managed?

A

Prophylactic internal iliac artery balloon

C-section and abdominal hysterectomy

26
Q

What occurs in uterine rupture?

A

Full thickness opening of the uterus

27
Q

Give some risk factors for uterine rupture

A

Previous C-section
Multiparity
Obstructed labour

28
Q

Give some clinical features of uterine rupture

A

Severe abdominal/shoulder-tip pain
PV bleeding
Loss of contractions
Peritonism

29
Q

How is uterine rupture managed?

A

Urgent C-section and resuscitation

30
Q

What is vasa praevia?

A

Unprotected fetal vessels traverse fetal membranes over the internal os

31
Q

How is vasa praevia detected?

A

Doppler USS

32
Q

Give some risk factors for vasa praevia

A

Placental anomalies
Low-lying placenta in second trimester
Multiparity
IVF

33
Q

How is vasa praevia managed?

A

Steroids from 32 weeks

Elective C-section

34
Q

What is post partum haemorrhage?

A

Blood loss >500ml after birth of baby

35
Q

What is the difference between primary and secondary PPH?

A 
Primary = within 24hrs of delivery
Secondary = from 24hrs - 6 weeks post delivery
36
Q

What is the difference between major and minor PPH?

A

Minor - 500-1000ml blood loss without clinical shock

Major - >1000ml blood loss or clinical shock

37
Q

What are the 4 main causes of PPH?

A

Tone
Trauma
Tissue
Thrombin

38
Q

Give some antenatal risk factors for PPH

A 
Anaemia
Previous C-section
Placenta praevia
Previous PPH
Multiple pregnancy
39
Q

What can be done to actively manage the third stage in patients with PPH?

A

Syntometerine IM/IV

Syntocinon (hypertensive patients)

40
Q

What methods can be used to stop bleeding in PPH?

A

Uterine massage
Expel clots
Foley’s catheter

41
Q

What drugs may be used in PPH to stop bleeding?

A

Carboprost/Haemabate
Misoprostol
Tranexamic acid

42
Q

Give some surgical methods that can be used to stop bleeding in PPH

A

Brace sutures
Uterine/internal iliac artery ligation
Hysterectomy

Reproduction (33 decks)

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