Bleeding in pregnancy Flashcards
What is the cutoff between early and late pregnancy?
24 weeks (
Definition of antepartum haemorrhage?
Bleeding from the genital tract after 24 weeks gestation
Causes of antepartum haemorrhage?
Placenta Previa Placental abruption Polyps, cancer, infection Vasa previa Uterine rupture
What is placental abruption?
A separation of a normally implanted placenta partially or totally, before the birth of the fetus
Risk factors for abruption?
Pre eclampsia Trauma Substance misuse Multi pregnancy Medical
etc
Clinical features of abruption?
Small or large volume blood loss Sudden onset Pain Uterine tenderness/wooden hard Uterus feels large Difficult to feel fetal parts
How is abruption diagnosed?
Clinical diagnosis
What is placenta previa?
Placenta partially or totally implanted in lower uterine segment
Symptoms of placenta previa?
Painless recurrent 3rd trimester bleeding
Uterus soft non tender
How is placenta previa diagnosed?
Ultrasound anomaly scan at 20 weeks then 32/34
Vaginal exam should not be carried out until excluded!!!!
How are babies with placenta previa delivered?
Major degree–> C section
Minor degree–> Vaginal delivery
What is placenta accreta?
Placenta invading the myometrium
What is placenta percreta?
Placenta reaching the serosa
Causes of uterine rupture?
Previous CS/Uterine surgery
Obstructed labour
Peritonism
Fetal head high
What is vasa previa?
A complication of pregnancy in which babies blood vessels cross or run near the internal opening of the uterus, the vessels are at risk of rupture when membranes rupture
Symptoms of APH?
Small volume Painless Uterus soft non tender No fetal distress Normally sited placenta
Management of placenta previa?
Admit IV access, cross match Scan Anti D Steroids Delivery
Delivery in Placenta praevia?
C section 37/38 if bleeding
C Section 38/39 if no bleeding
What role do steroids play in placental abruption and previa?
Promote fetal lung surfactant production
Decrease RDS by up to 50% if administered 24-48h before delivery
Only significant effects up to 34 weeks
Causes of post partum haemorrhage?
4 T’s
Tone
Trauma
Tissue
Thrombin
Initial management of PPH?
Uterine massage
5 units IV syntocinon stat
40 units syntocinon in 500ml hartmanns- 125ml/h
Managment of persistent PPH?
Confirm placenta and membranes complete
Urinary catheret
500mcg Ergometrine IV
Non surg treatment of PPH?
Packs/balloons
Tissue sealants
Factor VIIa
Arterial embolisation
Surgical treatment of PPH?
Undersuturing Brace suture Uterine artery ligation Internal iliac artery ligation Hysterectomy
