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11- Reproduction > Bleeding in Pregnancy > Flashcards

Bleeding in Pregnancy Flashcards

1
Q

which ligament attahces to the ischial spines?

A

sacrospinous

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2
Q

what are the two ligaments of the spine?

A

sacrotuberous

sacrospinous

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3
Q

what happens to the pelvic ligaments during pregnancy?

A

They relax

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4
Q

how is the female pelvis different to the male pelvis?

A

shallower than males

greater AP and transverse diameters

suprapubic angle is wider

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5
Q

what is moulding?

A

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

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6
Q

which diameter of the foetal skull is longer?

A

Occipitofrontal (OP) is longer than Biparietal (BP)

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7
Q

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

A

facing left or right (transverse direction)

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8
Q

what is the ‘station’ when reffering to childbirth?

A

distance of the foetal head from the ischial spines

superior = -ve number

inferior = +ve number

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9
Q

what marker is used to confirm pregnancy?

A

BhCG marker- high sensitivity

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10
Q

where do fertilisation and implantation take place?

A

fertilisation- ampulla of fallopian tube

implanatation- uterine cavity

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11
Q

when do trimester 1,2 and 3 compete?

A

1st trimester - 13 weeks

2nd trimester- 28 weeks

3rd trimester- 40 weeks

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12
Q

what complications can cause bleeding in early pregancy?

A

miscarriage

ectopic pregancy

molar pregnancy

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13
Q

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

A

3 or more pregnancy losses

antiphospholipid syndrome

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14
Q

what is a threatened, ineviatable and complete miscarriage?

A

threatened → os is closed

inevitable → products sited at open os

complete → products in vagina

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15
Q

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

A

ectopic pregancy

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16
Q

how are ectopic pregancies managed?

A

surgically only if woman acutely unwell

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

conservative for ‘well’ woman

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17
Q

what is the classical appearnace of molar preganncy on USS?

A

snowstorm appearance

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18
Q

define hyperemesis gravidarum

A

extreme sickness in pregancy

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19
Q

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

A

cyclizine or prochlorperazine

(odansteron/ metclopramide 2nd line)

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20
Q

what is a chorionic haemaotma?

A

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

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21
Q

anti-D is given at sensitising events such as?

A

miscarriage

evacuation

unexplained bleed/trauma

given IM deltoid

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22
Q

what week seperates esrly from late bleedign in pregnancy?

A

early <24 weeks > late

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23
Q

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

A

more prone to pulmonary oedema

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24
Q

what is antepartum ahemorrhage?

A

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

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25
Q

what can cause antpartum haemorrhage?

A

placetal problem

uterine problem i.e. rupture

local cause i.e. polyp, infection

vasa previa

26
Q

why does vesa praevia cause antepartum haemorrhage?

A

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

27
Q

how is antepartum haemorrhage quantified?

A

Spotting

Minor: <50ml

Major: 50-1000ml, no shock

Massive: >1000ml and/or shock

28
Q

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

A

placental abruption

(prematue breaking away before baby is born)

29
Q

how do tonic contractions seen in placenta abruption affect baby?

A

causes foetal hypoxia

30
Q

what are the signs of placental abruption?

A

‘woody hard’ uterus

unwell distressed

may present with maternal collapse

31
Q

how is placental abruption managed?

A

resuscitate mum

assess and deliver baby

manage complications and debrief parents

32
Q

how is the baby delivered following placental abruption?

A

urgent C-section if baby is still alive

if baby has died need to support mum and induce labour

33
Q

what are the risk factors for placental abruption?

A

pre-eclampsia

trauma

smoking/drugs

multiple pregnancy

previous rupture

34
Q

what is placenta praevia?

A

low lying placenta covering the os

35
Q

what is the mode of delivery if palcenta praevia?

A

c-section if covering os or <2cm away

vaginal if >2cm away from os

36
Q

what are the symtpoms of placenta praevia?

A

painless bleeding >24 weeks

can be caused by sex

can be mild/major bleed

37
Q

if suspected placenta praevia can digital vaginal exam be performed?

A

NO- could rupture membranes and cause further bleeding

speculum exam can be carreid out w care

38
Q

how is bleeding in placenta praevia managed?

A

resus mum and assess baby

investigate

inpatient for 24hrs until bleedign stops

advise against intercourse

39
Q

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

A

if previous PV bleeding or other risk factors pre term delivery

40
Q

what is placenta accreta?

A

morbidly adherent placenta

41
Q

if placenta has invaded the myometirum it is known as?

A

increta

42
Q

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

A

percreta

43
Q

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

A

previous C-section/uterine surgery

obstructed labour

44
Q

what are the symtpoms of uterine rupture?

A

severe abdominal pain

shoulder tip pain

maternal collapse

PV bleeding

45
Q

why does uterine rupture cause shoulder tip pian?

A

blood irritating the diaphragm

46
Q

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

A

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

47
Q

what are the two types of vasa praevia?

A

Type i: foetal vessel is connected to a velamentous umbilical cord

Type II: foetal vessels connect two placental lobes

48
Q

how is the baby delivered if vasa praevia?

A

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

49
Q

when does post partum haemorrhage occur?

A

following delivery

primary if <24hrs

secondary >24hrs to 6 weeks

50
Q

what are risk factors for post partum haemorrhage?

A

prolonged labour

operative vaginal delivery

C-section

retained placenta

51
Q

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

A

syntocinon

52
Q

how is post partum haemorrhage managed?

A

IV access

group and save, FBC, coag screen

Obvs every 15 mins

IV warmed crytalloid

53
Q

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

A

uterine massage and expel clots

5 units syntocinon

ergometrine (not in those w cardiac disease/hyertension)

54
Q

why is ergometrine used to stop heavy bleedign following delivery?

A

causes contractions decreasing blood flow to uterus

55
Q

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

A

uterine artery ligation

internal iliac ligation

hysterectomy

56
Q

what is important aftercare following treatment of post partum haemorrhage?

A

replace fluids

manage any anaemia

thromboprophylaxis

57
Q

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

A

hypotension leading to maternal collapse

tachycardia

58
Q

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

A

retained products

59
Q

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

A

c-section

need to make sure all membranes are removed

60
Q

if suspect retained products how is an exam carried out?

A

exam under anaesthetic

61
Q

how is the uterus affected by retained products?

A

poorly contracted

(boggy on palpation)

11- Reproduction (19 decks)

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