Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

3 Reproduction > Bleeding in Late Pregnancy > Flashcards

Bleeding in Late Pregnancy Flashcards

1
Q

what bleeding counts as early pregnancy

A

<24 weeks

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

what bleeding is late pregnancy

A

> 24 weeks

bc this is when the baby is viable

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

what is antepartum haemorrhage

A

bleeding from the genital tract after 24 weeks gestation and before the second stage of labour

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

causes of antepartum haemorrhage

A

placental problems (praaevia, abruption)

Uterine problems (rupture)

Local causes (ectropion, polyp. infection, carcinoma)

Vasa praaevia

Unknown

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

what are some differentials for antepartum haemorrhage

A

heavy show
cystitis
haemorrhoids

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

what is a minor APH

A

<50ml settled

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

what is a major APH

A

50-1000ml

no shock

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

what is a massive APH

A

> 1000ml and/or shock

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

what is placental abruption

A

premature breaking away of a normal placenta from the uterus partially or totally before birth

is a CLINICAL diagnosis - no investigations done

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

cause placental abruption

A

vasospasm then arteriole rupture into the decider

blood escapes into the amniotic sac or further under the placenta into myometrium

causes myometrium contraction and interrupts placental circulation causing hypoxia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

what is couvelaire uterus

A

placental abruption causes bleeding that penetrates the myometrium and goes into the peritoneal cavity

medical emergency

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

risk factors for placental abruption

A 
unknown 
pre-eclampsia/hypertension 
trauma
smoking/cocaine/amphetamine 
thrombiphilias/ renal disease/ diabetes
polyhydraminos 
multiple pregnancy 
preterm baby
abnormal placenta 
previous abruption
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

symptoms of placental abruption

A 
continuous severe abdominal pain 
backache with posterior placenta
bleeding 
preterm labour 
maternal collapse
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

signs of placental abruption

A 
unwell distressed patient 
Large for dates or normal uterus 
uterine tenderness 
woody hard uterus 
fetal parts difficult to identify 
may be in preterm labour

fetal Bradycardia/absent HR

CTG shows irritable uterus

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

management of placental abruption

A

resuscitate mother
assess and deliver the baby (urgent CS or IOL)
manage the complications
debrief parents

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

how do you resuscitate the mother in placental abruption

A

2 large bore IV access
bloods: FBC, clotting, LFT U&Es, cross match, kleihauer (RH-)
IV fluids
catheterise

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

complications of placental abruption

A 
Hypovolaemic shock 
Anaemia 
PPH 
Renal failure from renal tubular necrosis 
Coagulopathy 
infection 
complications of blood transfusion 
thromboembolism 
prolonged hospital stay 
psychological sequelae 
fetal heath 
fetal hypoxia 
prematurity 
small for gestational age, FGR
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

what is placenta praevia

A

placenta is low lying directly over the internal os

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

what is a low lying placenta

A

at 16/40 weeks when the placenta is less than 20 mm from the internal os on trans abdominal or transvaginal scanning

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

risk factors for placenta praaevia

A 
previous CS
previous TOP 
advanced maternal age 
multiparty 
multiple pregnancy
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

when is placenta praaevia screened for

A

mid trimester fetal anomaly scan includes placental localisation

rescan at 32 and 36 weeks is persistent placenta praevia or low lying placenta

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

symptoms of placenta praaevia

A

Painless bleeding >24 weeks

can be triggered by sex but usually unprovoked

fetal movements present

23
Q

signs of placenta praaevia

A

uterus soft and non tender

presenting part high

malpresentation (breech, transverse, oblique)

normal CTG

do not perform a digital vaginal exam until excluded PP (speculum examination instead)

24
Q

how do you diagnose placental praaevia

A

Check anomaly scan
Confirm with transvaginal US
MRI to exclude placenta accrete (placenta invades into the myometrium)

25
Q

how do you manage placenta praevia

A 
Resuscitate mother (ABCDE) 
Asses baby's condition 
Investigations 
Steroids 
Anti D if Rh- 
Conservative management if stable
Steroids between 24 and 35+6 weeks 
delivery plan at/near term
26
Q

how do you manage a placenta praevia which isn’t bleeding

A

advise patient to attend immediately if any bleeding - including spotting

contractions or pain

advice no sexual intercourse

27
Q

how do you manage a significant bleed from placenta praevia

A

Admit and resuscitate

2 large bore IV access
FBC, clotting, LFTs, U+Es, kleihauer, cross match

major haemorrhage protocol

IV fluids or blood transfusion

Anti D if RH -

asses fetal well being, monitor fetal heart, give steroids and magnesium sulphate (24-32 weeks if planning delivery)

expectant management if stable

expedite delivery if active bleeding

28
Q

how do you delivery the baby in placenta praevia

A

C/Section if placenta covers os or <2cm from cervical os

Vaginal if placenta is >2cm from os and no malpresentation

29
Q

what is placenta accreta

A

morbidly adherent placenta (placenta starts to invade the uterine wall)

30
Q

what is placenta increta

A

when the placenta invades the myometrium

31
Q

what is placenta percreta

A

when the placenta penetrates the uterus through to the bladder

32
Q

how do you manage placenta accreta

A

prophylactic internal iliac artery balloon
caesarian hysterectomy
blood loss >3L expected
conservative management

33
Q

what is a uterine rupture

A

full thickness opening of uterus
including the serosa

if the serosa is intact it is called uterine dehiscence

34
Q

what are some risk factors for uterine rupture

A

previous C/Section or uterine surgery

multiparty and use of prostaglandins (eg. syniocin in IOL)

obstructed labour

35
Q

symptoms of uterine rupture

A

severe abdominal pain
shoulder-tip pain
maternal collapse PV bleeding

36
Q

signs of uterine rupture

A

Intra-partum loss of contractions

Acute abdomen

peritonism

fetal distress/ IU death

37
Q

management of uterine rupture

A

urgent resuscitation and surgical management

2 large bore IV access

FBC, clotting, LFT, U+Es, Kleihauer

cross match

major haemorrhage protocol

IV fluids/blood transfusion

Anti D

send to theatre

38
Q

what is vasa praevia

A

unprotected free fetal vessels transverse the membranes below the presenting part of the internal cervical os

will rupture during labour or amniotomy

39
Q

How do you diagnose vasa praevia

A

ultrasound (trans abdominal and transvaginal with doppler)

40
Q

risk factors for vasa praevia

A

placental anomalies
low lying placenta
multiple pregnancy
IVF

41
Q

how do you manage vasa praevia

A

antenatal diagnosis
steroids from 32 weeks
delivery by elective CS before labour

if there’s an antepartum haemorrhage from vasa praevia - emergency c section

42
Q

what are some other causes of bleeding in late pregnancy

A 
ectropion 
polyp 
carcinoma
vaginal causes 
unexplained
43
Q

what is a post part haemorrhage

A

blood loss >500ml after the brith of the baby

primary - within 24 hours

secondary - >24 hours

44
Q

what is a minor PPH

A

500ml-1000ml without clinical shock

45
Q

what is a major PPH

A

> 1000ml or signs of shock or ongoing bleeding

46
Q

4Ts - causes of post partum haemorrhage

A

Tone (uterine atony)
Trauma
Tissue (retained placental/membrane tissue)
Thrombin (bleeding disorders)

47
Q

risk factors for PPH

A 
anaemia 
previous CS
Placental praevia, percreta, accreta
previous PPH 
previous retained placenta
multiple pregnancy 
Polyhydramnios 
obesity 
fetal Macrosomia
48
Q

how do you prevent PPH

A

Active management of third stage

syntocinon/syntometrine IM/IV

49
Q

management of PPH

A

Asses
Stop bleeding
Fluid replacement

50
Q

how do you stop the bleeding in PPH

A 
Uterine passage - bimanual compression 
Expel clots 
5 units IV syntocinin 
urinary catheter 
ergometrine IV 
prompt repair of trauma 
Carboprost/haemabate 
Misoprostol 
Tranexemic acid

examination under anaesthetic in theatre if persistent bleeding

51
Q

what is done in theatre to stop PPH

A

packs and balloons
tissue sealants
interventional radiology

undersuturing 
brace sutures 
uterine artery ligation 
internal iliac artery ligation 
hysterectomy
52
Q

management for a secondary PPH (>24hr - 6 weeks postnatally)

A

exclude retained products of conception with US

often caused by infection

53
Q

how do you manage PPH post delivery

A

thrombophylaxis
debrief couple
manage anaemia

3 Reproduction (49 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions