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4th Year Reproduction > Bleeding in Pregnancy > Flashcards

Bleeding in Pregnancy Flashcards

1
Q

What is considered “early pregnancy”

A

<24 weeks

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2
Q

What 4 main infections put pregnant woman at risk of miscarriage

A
  • Cytomegalovirus (CMV)
  • Rubella
  • Toxoplasmosis
  • Liseria
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3
Q

In miscarriage is the bleeding usually greater than the pain or the pain greater than the bleeding?

A

Bleeding > pain

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4
Q

What is a complication of miscarriage

A

Cervical shock

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5
Q

What conditions can cause recurrent miscarriages

A
  • Antiphospholipid Syndrome
  • Thrombophilia
  • Balanced translocation
  • Uterine abnormality
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6
Q

Where is the most common place to get an ectopic pregnancy

A

Ampullary

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7
Q

Where is referred pain during an ectopic pregnancy sometimes felt?

A

Shoulder-tip pain

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8
Q

What drug is used in the medical management of ectopic pregnancy?

A

Methotrexate

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9
Q

Histologically, placental tissue shows chorionic villi swollen with fluid giving picture of “grape like clusters”. What does this indicate?

A

Molar pregnancy

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10
Q

What is the difference between incomplete and complete molar pregnancies

A

Complete = egg without DNA + 1 or 2 sperm (paternal contribution only)

Incomplete = haploid egg + o 1 sperm (reduplicating DNA material) or 2 sperms fertilising egg, result in triploidy (69XXY)

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11
Q

Which of the 2 types of molar pregnancies may also include a fetus?

A

Incomplete

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12
Q

What does a complete molar pregnancy look like on ultrasound?

A

A snowstorm appearance

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13
Q

What cancer does molar pregnancy put you more at risk of?

A

Choriocarcinoma

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14
Q

What is the definition of an antepartum haemorrhage?

A

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

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15
Q

What test should be given to RhD negative women who present with antepartum haemorrhage

A

Kleihauer test - to quantify fetomaternal

haemorrhage in order to gauge the dose of anti-D immunoglobulin required

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16
Q

What drug should be given to babies between 24-34 weeks at risk of preterm birth

A

Corticosteroids

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17
Q

What is the definition of placental abruption?

A

Separation of a normally implanted placenta before the birth of the fetus

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18
Q

What are the risk factors for placental abruption?

A
  • Pre-eclampsia/ Hypertension
  • Trauma
  • Smoking/Cocaine/Amphetamine
  • Medical Thrombophilias/Renal diseases/Diabetes
  • Poly-hydramnios
  • Multiple pregnancy
  • Premature rupture of membranes (PROM)
  • Abnormal placenta
  • Previous Abruption = recurrence 10%
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19
Q

How does the uterus feel in placental abruption?

A

Woody hard uterus

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20
Q

How do you diagnose placental abruption?

A

It’s a clinical diagnosis - you don’t have time to look for the clot that caused the vasospasm/rupture

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21
Q

What are the risk factors for placental praevia?

A
  • Previous c-section
  • Smoking
  • Assisted reproduction
  • Previous TOP
  • Multiparity
  • > 40 years
  • Multiple pregnancy
  • Deficient endometrium (uterine scar, endometritis etc)
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22
Q

What does the placenta cover in placental praevia?

A

The internal os

23
Q

What other cause of antepartum haemorrhage is associated with placental praevia?

A

Placenta accreta

24
Q

What examination should you not do in placental praevia?

A

Vaginal examination

25
Q

What is the difference between placenta accreta, placenta increta and placenta percreta?

A

Accreta = placenta adherent to uterine wall

Increta = placenta invading myometrium

Percreta = placenta penetrating to uterus and bladder

26
Q

What are the risk factors for placenta accreta?

A
  • Placenta praevia

- Multiple c-sections

27
Q

What are the risk factors for uterine rupture?

A
  • Previous c-section / uterine surgery
  • Multiparity
  • Use of prostaglandins/ syntocinon
  • Obstructed labour
28
Q

Describe briefly the pathophysiology behind placental abruption

A

Vasospasm causes arteriole rupture. Blood escapes under placental and into myometrium which causes contraction and interruption of placental circulation. Baby becomes hypoxic

29
Q

Describe the pain of placental abruption

A

Severe and continuous (labour pain is intermittent)

30
Q

If a placenta is posterior and placental abruption occurs, what symptom may be present that would not be present with an anterior placenta

A

Backache

31
Q

If a patient presents with severe continous abdominal pain and a woody hard uterus but only minimal bleeding, what would you be concerned about?

A

That it is placental abruption but the bleeding is concealed

32
Q

What would the CTG show during placental abruption?

A

Abnormal fetal heart and irritable uterus

33
Q

A complication of placental abruption is a couvelaire uterus. Describe this

A

A haematoma bruised uterus - a life-threatening condition in which placental abruption causes bleeding that penetrates into the uterine myometrium forcing its way into the peritoneal cavity

34
Q

How severe is the painless bleeding in placenta praevia?

A

Any severity from spotting to severe

35
Q

Bleeding in placenta praevia is usually unprovoked. What is the one thing that is likely to provoke it?

A

Penetrative vaginal sex

36
Q

If a woman with placenta praevia is not bleeding, what is the management?

A
  • No sex
  • Corticosteroids between 34+0 and 35+6 weeks
  • Mg SO4 for neuro-protection at 24-32 weeks
  • Delivery via planned c-section at 36-37 weeks
37
Q

If a woman with placenta praevia is bleeding, what is the management?

A
  • Conservative management if stable / ABCDE
  • Anaemia prevention / treatment
  • Steroids and magnesium sulphate
  • • Delivery – 34+0 to 36+6 weeks
38
Q

What drug can be used to conservatively manage placenta accreta?

A

Methotrexate

39
Q

What is the last resort if bleeding from placenta accreta cannot be controlled?

A

Caesarean hysterectomy

40
Q

Where can the pain be felt in uterine rupture?

A

Severe abdominal pain +/- shoulder-tip pain

41
Q

What will a CTG show during uterine rupture?

A

Loss of contractions and fetal distress

42
Q

What happens to the presenting part in uterine rupture?

A

It rises

43
Q

What treatment should be given to RhD negative women who present with antepartum haemorrhage

A

ABCDE + anti-D + steroids

44
Q

What drug can be used to conservatively manage ectopic pregnancies?

A

Methotrexate

45
Q

What is implantation bleeding?

A

bleeding from fertilised egg when it implants in the uterine wall at around 10 days post ovulation

46
Q

What is a chorionic haematoma?

A

Pooling of blood between endometrium and the embryo due to separation

47
Q

What is the treatment of chorionic haematoma?

A

Surveillance - usually self-limiting

48
Q

What is a complication of chorionic haematoma?

A

Miscarriage

49
Q

What is vasa previa?

A

Unprotected fetal vessels traverse the membranes below the presenting part over the internal cervical os

50
Q

What are the symptoms of vasa previa?

A

Waters breaking + sudden dark read bleeding and fetal bradycardia

51
Q

What is the mortality rate of vasa previa?

A

60%

52
Q

What are the 4 Ts of PPH?

A
  • Tone
  • Trauma
  • Tissue
  • Thrombin
53
Q

What is the timeline of primary vs secondary PPH?

A 
Primary = within 24hrs of delivery
Secondary = 6 weeks post delivery
54
Q

What uteri-tonic agents can be given in uterine atony causing PPH

A

Syntocinon, misoprostol, ergometrine (not in cardiac disease)

4th Year Reproduction (5 decks)

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