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OBGY Week 4 > Bleeding in pregnancy > Flashcards

Bleeding in pregnancy Flashcards

1
Q

What is the cutoff between early and late pregnancy?

A

24 weeks (

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2
Q

Definition of antepartum haemorrhage?

A

Bleeding from the genital tract after 24 weeks gestation

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3
Q

Causes of antepartum haemorrhage?

A 
Placenta Previa
Placental abruption
Polyps, cancer, infection
Vasa previa
Uterine rupture
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4
Q

What is placental abruption?

A

A separation of a normally implanted placenta partially or totally, before the birth of the fetus

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5
Q

Risk factors for abruption?

A 
Pre eclampsia
Trauma
Substance misuse
Multi pregnancy
Medical

etc

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6
Q

Clinical features of abruption?

A 
Small or large volume blood loss
Sudden onset Pain
Uterine tenderness/wooden hard
Uterus feels large
Difficult to feel fetal parts
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7
Q

How is abruption diagnosed?

A

Clinical diagnosis

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8
Q

What is placenta previa?

A

Placenta partially or totally implanted in lower uterine segment

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9
Q

Symptoms of placenta previa?

A

Painless recurrent 3rd trimester bleeding

Uterus soft non tender

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10
Q

How is placenta previa diagnosed?

A

Ultrasound anomaly scan at 20 weeks then 32/34

Vaginal exam should not be carried out until excluded!!!!

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11
Q

How are babies with placenta previa delivered?

A

Major degree–> C section

Minor degree–> Vaginal delivery

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12
Q

What is placenta accreta?

A

Placenta invading the myometrium

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13
Q

What is placenta percreta?

A

Placenta reaching the serosa

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14
Q

Causes of uterine rupture?

A

Previous CS/Uterine surgery
Obstructed labour
Peritonism
Fetal head high

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15
Q

What is vasa previa?

A

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

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16
Q

Symptoms of APH?

A 
Small volume
Painless
Uterus soft non tender
No fetal distress
Normally sited placenta
17
Q

Management of placenta previa?

A 
Admit
IV access, cross match
Scan
Anti D
Steroids
Delivery
18
Q

Delivery in Placenta praevia?

A

C section 37/38 if bleeding

C Section 38/39 if no bleeding

19
Q

What role do steroids play in placental abruption and previa?

A

Promote fetal lung surfactant production

Decrease RDS by up to 50% if administered 24-48h before delivery

Only significant effects up to 34 weeks

20
Q

Causes of post partum haemorrhage?

A

4 T’s

Tone
Trauma
Tissue
Thrombin

21
Q

Initial management of PPH?

A

Uterine massage

5 units IV syntocinon stat

40 units syntocinon in 500ml hartmanns- 125ml/h

22
Q

Managment of persistent PPH?

A

Confirm placenta and membranes complete

Urinary catheret

500mcg Ergometrine IV

23
Q

Non surg treatment of PPH?

A

Packs/balloons
Tissue sealants
Factor VIIa
Arterial embolisation

24
Q

Surgical treatment of PPH?

A 
Undersuturing
Brace suture
Uterine artery ligation
Internal iliac artery ligation
Hysterectomy

OBGY Week 4 (8 decks)

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