Brainscape's Knowledge GenomeTM


Top Flashcards (Certified)
All Flashcards

Reproduction > Bleeding in late pregnancy > Flashcards

Bleeding in late pregnancy Flashcards

1
Q

Define bleeding in late pregnancy

A

Bleeding >24 weeks (UK)

>20 weeks (USA)

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

Define antepartum hemorrhage (APH)

A

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

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

List the different aetiologies of APH

A
  1. Placental problem - praevia, abruption
  2. Uterine problem - rupture
  3. Vasa praevia
  4. Local causes - ectopion, polyp, infection, Ca
  5. Indeterminate
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What are the differentials for APH

A

Heavy show
Cystitis
Haemorrhoids

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

What are the categories/quantities of APH?

A
  1. Spotting: staining, streaking, wiping
  2. Mild: <50ml, settled
  3. Moderate: 50-1000ml, no shock
  4. Severe: >1000ml and/or shock
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What is placental abruption?

A

Partial or total separation of a NORMALLY implanted placenta before birth of the fetus

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

Placental abruption can be detected via US - T or F

A

F

CLINICAL DIAGNOSIS

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

What is the pathology of placental abruption?

A

Vasospasm followed by arteriole rupture into the decidua
Blood escapes into amniotic sac or further under placenta into myometrium
This causes tonic contraction of uterus and interrupts placental circulation which causes hypoxia
Result - couvelaire uterus

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

List the risk factors for placental abruption

A
  • unknown
  • pre-eclampsia/HTN
  • Trauma - blunt/forceful
  • Polyhydramnios, multiple pregnancy, pre labour rupture of membranes
  • Diabetes/Medical thrombophillias/renal diseases
  • Abnormal placenta
  • Previous abruption - recurrence 10%
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What are the symptoms of placental abruption?

A 
Severe abdominal pain (continuous)
Backache (with posterior placenta)
Bleeding (may be concealed) 
Pre-term labour 
Maternal collapse (sometimes)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Signs of placental abruption

A

Patient appears unwell and distressed
Signs may be inconsistent with revealed blood
Uterus LFD or normal
Uterine tendernes
Uterus is woody hard
Foetal parts difficult to identify
May be in pre-term labour (with heavy show)
Foetal HR: bradycardia/absent (IUD)
CTG: irritable uterus (1 contraction/min) FH- tachycardia, deccels, loss of variability

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

Steps for managing placental abruption

A
  1. Resuscitate mother
  2. Assess & deliver baby
  3. Manage the complications
  4. Debrief the parents
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What investigations are done during management of mother with placental abruption?

A

2 large bore IV access:

  • FBC
  • Clotting
  • LFT
  • U & E
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What is administered to mother during management of her placental abruption?

A

Cross match 4-6 units red packed cells
Kleihauer test - detect transplacental hemorrhage
IV fluids (careful with pre-eclampsia)
Catheterise - hourly urine volumes

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

How to asses and deliver baby in placental abruption?

A

Assess foetal HR - CTG (uss if no foetal heart)

Delivery:

  • urgent by C-sec
  • ARM and induction of labour
  • Expectant/conservative management (only for minor, allow steroid cover)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Maternal complications of placental abruption

A 
Hypovolaemic shock
Anaemia
PPH (25% )
Renal failure  from renal tubular necrosis 
Coagulopathy ( FFP, cryoprecipitate)
Infection
Prolonged hospital stay Psychological sequelae 
Complications of blood transfusion
Thromboembolism
Mortality  rare
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Foetal complications of placental abruption

A

Fetal Death- Intrauterine death( 14%)
hypoxia
prematurity
Small for gestational age and fetal growth restriction

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

How is placental abruption prevented?

A

Antiphospholipid syndrome: LMWH & LDA
Smoking cessation
LDA

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

Placenta praaevia vs low-lying placenta

A

Placenta praevia: placenta lies directly over internal os

Low-lying placenta: >16/40, placental edge is less than 20mm from internal os on TA or TVS

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

What are the anatomical, physiological and mechanical definitions of the lower segment of the uterus?

A

ANATOMICAL:

  • Part of the uterus below the utero-vesical peritoneal pouch superiorly and internal os inferiorly
  • thinner, less muscle and fibre than upper uterus

MECHANICAL:
- Part of the uterus 7cm from the level of internal os

PHYSIOLOGICAL:
- part of the uterus which does not contract in labour but passively dilates

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Risk factors for placenta praevia

A 
Previous C-Sec **
Previous placenta praevia 
Previous termination of pregnancy
Smoking
Assisted reproductive technology and maternal smoking
Multiparity
>40 years
Multiple pregnancy
History of: uterine scar, endometriosis, fibroids, curettage, manual removal of placenta (these cause deficient endometrium)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

When is placenta praevia screening carried out?

A

Mid-trimester foetal anomaly scan

Rescan at 32 and 36 weeks if persistent placenta praevia or LLP

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Which type of scan is best to detect placenta praevia?

A

TVS> TA

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

How to asses risk of preterm labour in placenta praevia?

A

Asses cervical length before 34 weeks

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Symptoms of placenta praevia
Painless bleeding > 24 weeks Usually unprovoked but can be triggered by coitus Bleeding can be minor Patient's condition proportional to amount of bleeding observed
26
Signs of placenta praevia
Uterus: - soft, non tender - Presenting part high Malpresentations: - breech - Trasnsverse - Oblique CTG: NORMAL DO NOT PERFORM VAGINAL EXAM UNTIL PLACENTA PRAEVIA RULED OUT
27
How to diagnose placenta praevia
Check anomaly scan Confirm by TV ultrasound MRI to rule out accreta
28
How to manage a non-bleeding placenta praevia
Advise patient to: - attend immediately if bleeding, spotting, contractions or pain - No sex Antenatal corticosteroids b/w 34 to 35+6 weeks or < 34+0 weeks of gestation in women with increased risk of preterm delivery MgSO4 - neuro-protection at 24-32 wks if planning delivery Consider delivery at 34 to 36+6 wks if histroy of PV bleeding or other risks of preterm delivery If uncomplicated placenta praevia, delivery b/w 36 and 37 weeks
29
How to manage a bleeding placenta praevia
Admit and resuscitate (ABCDE) - MDT (obs, anaesthetist, neonatal team, theatre, haematologist) - 2 large bore IV access - FBC, cloting, LFT, U&E, Kleihauer (if rh -ve) - Cross match 4-6 units red packed cells - major hermorrhage protocol - IV fluids or transfuse - Anti D (if Rh neg) Assess foetal wellbeing - Foetal HR - CTG after 28 weeks - Steroids (24 to 34+6 wks) - MGSO4 (if planning delivery) - Expectant/conservative management if stable
30
When is C-sec indicated in delivery of placenta praevia?
If placenta covers os or <2cm from cervical os Note: Consent to include hysterectomy and risk of General Anaesthesia Cell salvage Skin and uterine incisions vertical <28weeks if transverse lie Aim to avoid cutting through the placenta
31
When is vaginal delivery indicated in placenta preavia?
If placenta >2cm from os and no malpresentation
32
Define placenta accreta
Morbidly adherent placenta
33
What are the major risk factors of placenta accreta?
Placenta praevia | Prior C-sec
34
What is it called when placenta invades myometrium?
Increta
35
What is it called when placenta invades uterus to bladder?
Percreta
36
How to manage placenta accreta?
``` Multidisciplinary management Prophylctic internal iliac artery balloon Caesarean hysterectomy Blood loss - >3L expected Conservative management ```
37
Define uterine rupture
Full thickness opening of uterus
38
What are the risk factors of uterine rupture?
Previous C-sec/uterine surgery Multiparity and use of prostaglandins/syntocinon Obstructed labour
39
Symptoms of uterine rupture
Severe abdominal pain Shoulder-tip pain Maternal collapse PV bleeding
40
Signs of uterine rupture
``` Intrapartum - loss of contractions Acute abdomen Loss of contractions Peritonism Fetal distress/IUD ```
41
Management of a uterine rupture
Urgent Resuscitation & Surgical management Communication( Midwives, Obstetrics, Anaesthetists, Neonatal team, Theatre, Haematologist) 2 Large bore IV access, FBC, clotting , LFT, U& E , Kleihauer ( if Rh Neg) Cross match 4-6 units Red packed cells May need Major Haemorrhage protocol IV fluids or transfuse Anti D ( if Rh Neg)
42
Define vasa praevia
Unprotected foetal vessels traverse the membranes below the presenting part over the internal cervical os Will rupture during labour or at amniotomy
43
How is Vasa praevia diagnosed?
USS - TA and TV with doppler
44
What are the two types of Vasa Praevia?
Type I - vessel connected to a velamentous umbilical cord Type II - when it connects the placenta with a succenturiate or accessory lobe
45
Risk factors for Vasa praevia
Placental anomalies: bi-lobed or succenturiate lobes where the foetal vessels run through the membranes joining the separate lobes together History of low lying placenta in 2nd trimester Multiple pregnancy IVF
46
Management of Vasa Praevia for antenatal diagnosis
Steroids from 32 weeks Consider inpatient management if risks of preterm birth (32-34 weeks) Deliver by elective c/section before labour (34-36 weeks)
47
Management of vasa praevia if diagnosed antenatally
Steroids from 32 weeks Consider inpatient management if risks of preterm birth (32-34 weeks) Deliver by elective c/section before labour (34-36 weeks)
48
Management of vasa praevia if diagnosed during labour
Emergency caesarean delivery and neonatal resuscitation, including the use of blood transfusion if required
49
Define post-partum hemorrhage
Blood loss equal to or exceeding 500ml after the birth of the baby Primary within 24h of delivery Secondary >24h - 6/52 post delivery
50
What are the 2 classifications of PPH?
Minor: 500-1000ml (without clinical shock) Major: >1000ml or signs of CV collapse or on-going bleeding
51
List the causes of PPH
"4 T's" Tone Trauma Tissue Thrombin
52
Antenatal risk factors of PPH
``` anaemia previous caesarean section placenta praevia, percreta, accreta previous PPH Previous retained placenta Multiple pregnancy Polyhydramnios Obesity Fetal macrosomia ( Caution with Jehovah’s Witness- Advanced Directive) ```
53
Intrapartum risk factors for PPH
Prolonged labour operative vaginal delivery Caesarean section Retained placenta
54
How to prevent PPH?
Identify antenatal and intrapartum risk factors Active management of 3rd stage: syntocinon/syntometrine IM/IV
55
Initial management of pPH
``` Call for help Simulatenous management: - Assess - Stop the bleeding - Fluid replacement ```
56
Assess in PPH (step 1 of management)
Vital Signs: Pulse, BP, Capillary refill time, Saturations every 15min Give Oxygen Determine Cause of bleeding- 4Ts Blood Samples: FBC, clotting, fibrinogen, U&E, LFT, Lactate Cross-match 6 units red packed cells May need Major Haemorrhage protocol
57
How to stop thebleeding when managing PPH (step 2) .
``` Uterine massage- bimanual compression Expel clots 5 units IV Syntocinon stat 40 units Syntocinon in 500ml Hartmann's - 125 ml/h Foleys Catheter Most cases respond Confirm placenta and membranes complete Urinary Catheter 500 micrograms Ergometrine IV (Avoid if Cardiac Disease / Hypertension) ? Vaginal / perineal trauma - ensure prompt repair ? cervical trauma Carboprost /Haemabate ( PGF2α) 250mcg IM every 15min ( Max 8 doses) Misoprostol 800mcg PR Tranexamic acid 0.5g-1g IV EUA in theatre if persistent bleeding CALL CONSULTANT ```
58
Non surgical techniques to stop bleeding in PPH
Packs & Balloons – Rusch Balloon, Bakri Balloon Tissue Sealants Interventional Radiology : Arterial Embolisation
59
Surgical techniques to stop bleeding in PPH
``` Undersuturing Brace Sutures – B-Lynch Suture Uterine Artery Ligation Internal Iliac Artery Ligation Hysterectomy ```
60
Fluid replacement in PPH (Step 3)
2 Large bore IV access Rapid fluid resuscitation- Crystalloid Hartmann’s , 0.9% N/Saline Blood Transfusion early Consider O Neg if life threatening haemorrhage If DIC/coagulopathy – FFP, Cryoprecipitate, platelets Use Blood warmer Cell saver
61
Post delivery management of PPH
Thromboprophylaxis De-brief couple Manage anaemia (IV Iron/oral) Datix and risk management

Reproduction (32 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2025 Bold Learning Solutions. Terms and Conditions