Bleeding in Pregnancy

Question 1

which ligament attahces to the ischial spines?

Answer 1

sacrospinous

Question 2

what are the two ligaments of the spine?

Answer 2

sacrotuberous

sacrospinous

Question 3

what happens to the pelvic ligaments during pregnancy?

Answer 3

They relax

Question 4

how is the female pelvis different to the male pelvis?

Answer 4

shallower than males

greater AP and transverse diameters

suprapubic angle is wider

Question 5

what is moulding?

Answer 5

movement if bone over another allowng the foetal head to pass through the pelvis during labour

Question 6

which diameter of the foetal skull is longer?

Answer 6

Occipitofrontal (OP) is longer than Biparietal (BP)

Question 7

what way should the foetus face ideally when entering the pelvis?

Answer 7

facing left or right (transverse direction)

Question 8

what is the ‘station’ when reffering to childbirth?

Answer 8

distance of the foetal head from the ischial spines

superior = -ve number

inferior = +ve number

Question 9

what marker is used to confirm pregnancy?

Answer 9

BhCG marker- high sensitivity

Question 10

where do fertilisation and implantation take place?

Answer 10

fertilisation- ampulla of fallopian tube

implanatation- uterine cavity

Question 11

when do trimester 1,2 and 3 compete?

Answer 11

1st trimester - 13 weeks

2nd trimester- 28 weeks

3rd trimester- 40 weeks

Question 12

what complications can cause bleeding in early pregancy?

Answer 12

miscarriage

ectopic pregancy

molar pregnancy

Question 13

recurrent miscarriage is defined as how many pregnancy losses? this is common in which condition?

Answer 13

3 or more pregnancy losses

antiphospholipid syndrome

Question 14

what is a threatened, ineviatable and complete miscarriage?

Answer 14

threatened → os is closed

inevitable → products sited at open os

complete → products in vagina

Question 15

a woman presenting with pain, bleeding, dizziness/collapse is likely to be what?

Answer 15

ectopic pregancy

Question 16

how are ectopic pregancies managed?

Answer 16

surgically only if woman acutely unwell

medical if woman is stable and ectopic is small (methotrexate)

conservative for ‘well’ woman

Question 17

what is the classical appearnace of molar preganncy on USS?

Answer 17

snowstorm appearance

Question 18

define hyperemesis gravidarum

Answer 18

extreme sickness in pregancy

Question 19

what drug is used frist line in the treatment of hyperemesis gravidarum?

Answer 19

cyclizine or prochlorperazine

(odansteron/ metclopramide 2nd line)

Question 20

what is a chorionic haemaotma?

Answer 20

bleeding between the chorion (outer layer of embyro) and the uterine wall

Question 21

anti-D is given at sensitising events such as?

Answer 21

miscarriage

evacuation

unexplained bleed/trauma

given IM deltoid

Question 22

what week seperates esrly from late bleedign in pregnancy?

Answer 22

early <24 weeks > late

Question 23

why do we need to be more careful with fluid resus in pregnant women?

Answer 23

more prone to pulmonary oedema

Question 24

what is antepartum ahemorrhage?

Answer 24

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

Question 25

what can cause antpartum haemorrhage?

Answer 25

placetal problem uterine problem i.e. rupture local cause i.e. polyp, infection vasa previa

Question 26

why does vesa praevia cause antepartum haemorrhage?

Answer 26

foetal blood vessels cross or run near internal opening of uterus and so are at high risk of rupture when supporting membranes rupture as they are unsupported by the umbiical cord or placental tissue

Question 27

how is antepartum haemorrhage quantified?

Answer 27

Spotting Minor: \<50ml Major: 50-1000ml, no shock Massive: \>1000ml and/or shock

Question 28

continous pain possibly presenting as back pain in pregnancy not in waves like contractions is likely what?

Answer 28

placental abruption (prematue breaking away before baby is born)

Question 29

how do tonic contractions seen in placenta abruption affect baby?

Answer 29

causes foetal hypoxia

Question 30

what are the signs of placental abruption?

Answer 30

'woody hard' uterus unwell distressed may present with maternal collapse

Question 31

how is placental abruption managed?

Answer 31

resuscitate mum assess and deliver baby manage complications and debrief parents

Question 32

how is the baby delivered following placental abruption?

Answer 32

urgent C-section if baby is still alive if baby has died need to support mum and induce labour

Question 33

what are the risk factors for placental abruption?

Answer 33

pre-eclampsia trauma smoking/drugs multiple pregnancy previous rupture

Question 34

what is placenta praevia?

Answer 34

low lying placenta covering the os

Question 35

what is the mode of delivery if palcenta praevia?

Answer 35

c-section if covering os or \<2cm away vaginal if \>2cm away from os

Question 36

what are the symtpoms of placenta praevia?

Answer 36

painless bleeding \>24 weeks can be caused by sex can be mild/major bleed

Question 37

if suspected placenta praevia can digital vaginal exam be performed?

Answer 37

NO- could rupture membranes and cause further bleeding speculum exam can be carreid out w care

Question 38

how is bleeding in placenta praevia managed?

Answer 38

resus mum and assess baby investigate inpatient for 24hrs until bleedign stops advise against intercourse

Question 39

why would delviery be considered at 34-36 weeks in placenta praevia?

Answer 39

if previous PV bleeding or other risk factors pre term delivery

Question 40

what is placenta accreta?

Answer 40

morbidly adherent placenta

Question 41

if placenta has invaded the myometirum it is known as?

Answer 41

increta

Question 42

if placenta has penetrated uterus to bladder it is known as?

Answer 42

percreta

Question 43

uterus rupture is full thickness opening of the uterus- what are the risk factors?

Answer 43

previous C-section/uterine surgery obstructed labour

Question 44

what are the symtpoms of uterine rupture?

Answer 44

severe abdominal pain shoulder tip pain maternal collapse PV bleeding

Question 45

why does uterine rupture cause shoulder tip pian?

Answer 45

blood irritating the diaphragm

Question 46

what complications arise if the foetal vessels cross the internal cervical os?

Answer 46

**Vasa Praevia** → vessels will rupture at labour as no supporting membranes

Question 47

what are the two types of vasa praevia?

Answer 47

Type i: foetal vessel is connected to a velamentous umbilical cord Type II: foetal vessels connect two placental lobes

Question 48

how is the baby delivered if vasa praevia?

Answer 48

steroids from 32 weeks and devliery by elective c-section about 34-36 weeks

Question 49

when does post partum haemorrhage occur?

Answer 49

following delivery primary if \<24hrs secondary \>24hrs to 6 weeks

Question 50

what are risk factors for post partum haemorrhage?

Answer 50

prolonged labour operative vaginal delivery C-section retained placenta

Question 51

what can be given as active management of third stage in labour?

Answer 51

syntocinon

Question 52

how is post partum haemorrhage managed?

Answer 52

IV access group and save, FBC, coag screen Obvs every 15 mins IV warmed crytalloid

Question 53

what can be done to stop the bleeding in post partum haemorrhage?

Answer 53

uterine massage and expel clots 5 units syntocinon ergometrine (not in those w cardiac disease/hyertension)

Question 54

why is ergometrine used to stop heavy bleedign following delivery?

Answer 54

causes contractions decreasing blood flow to uterus

Question 55

if persistent bleeding following delivery what are the surgical management options?

Answer 55

uterine artery ligation internal iliac ligation hysterectomy

Question 56

what is important aftercare following treatment of post partum haemorrhage?

Answer 56

replace fluids manage any anaemia thromboprophylaxis

Question 57

following rupture of membranes if foetal cells/amniotic fluid enter mothers circulation what can happen?

Answer 57

hypotension leading to maternal collapse tachycardia

Question 58

heavy bleeding and offensive discharge day after delivery is suggestive of what?

Answer 58

retained products

Question 59

is retained products more common following vaginal delivery or c-section?

Answer 59

c-section need to make sure all membranes are removed

Question 60

if suspect retained products how is an exam carried out?

Answer 60

exam under anaesthetic

Question 61

how is the uterus affected by retained products?

Answer 61

poorly contracted | (boggy on palpation)