bleeding + pain in pregnancy Flashcards
what drug is used for IOL?
syntocinon
anti-D - when to give + how much?
even if prophylactic anti-D given, always give if sensitising event
Kleihauer blood test detects/quantifies foetal cells in maternal circulation + determines how much to give
placenta praevia - presentation, detection, types, risks, management
features: abnormal lie - blocks baby ± painless bleeding minor - partially covers cervix major - totally covers detected 20wk scan → do TVUSS
management:
caesarean
advise against sex if bled + eat high iron
safety net - anaemia symptoms? come in if bleeding - may need admission
causes of abdo pain in pregnancy
OBSTETRIC
- labour
- placental abruption
- preeclampsia
- miscarriage
- ectopic
- red degen
- intraperitoneal haemorrhage
- trauma
- HELLP
NON-OBSTETRIC
- appendicitis
- UTI
what is HELLP?
haemolysis
elevated liver enzymes
low platelets
abdo pain in pregnancy - investigation
USS
foetal fibronectin - + indicates preterm labour
RFs for preterm labour
maternal age extremes low BMI LLETZ smoking previous hx polyhydramnios/twins/other causes of uterine overdistension
preterm labour - management
betamethasone 2h apart - lungs
tocolysis - nifedipine
MgSO4 - foetal neuroprotection
delays labour to allow steroids to work - prevent CP
what is placental abruption?
separation of placenta from uterine wall
→ maternal haemorrhage into intervening space
RFs for placental abruption
maternal thrombophilia abdo trauma preeclampsia smoking cocaine prev hx >35y twins
placental abruption - symptoms
constant pain bleeding - (partially/) revealed / concealed (abdo pain ++) uterus - tender + tense shock, coagulopathy, preeclampsia foetal compromise
placental abruption - management
minor, <37wk - expectant, + steroids if <36
maternal/foetal compromise - deliver
placental abruptions - complications
MATERNAL: shock + AKI DIC ischaemia of myometrium bleed into myometrium + peritoneum → uterus can't contract properly → PPH on delivery
FOETAL:
IUGR
foetal death
uterine rupture - what is it, RFs, symptoms?
rupture through uterus → blood into abdo
symptoms - shock, pain, bleeding, CTG abnormalities, halted contractions, palpation of foetus outside uterus
RFs: hx caesarean, current IOL,
what are the common non-obs causes of abdo pain in pregnany?
appendicitis UTI acute cholecystitis pancreatitis renal stones ovarian torsion
appendicitis in pregnancy: symptoms, risks, investigations + mgmt
trim 1 - RLQ pain
trim 2 - umbilicus pain
trim 3 - RUQ / diffuse pain
rebound + abdo tenderness; mcburney point pain
risks - rupture, foetal loss
inv - WCC, MRI
mgmt - laparoscopy/otomy
what are the 3 classes of antepartum bleeding?
lower anogenital tract + cervix
placental
unexplained
lower anogenital tract bleeding - causes
post coital - vaginal abrasion or cervical (trauma - ectropion)
anal fissures
candidasis
early cervical dilation - not problem unless <37wk (risk labour)
cancer
placental causes of bleeding
abruption
praevia
vasa praevia
what is vasa praevia?
cord fails to insert into placental body
foetal blood can rapidly bleed into vagina
rupture of membranes → bleeding + foetal brady
antepartum haemorrhage - investigation
don’t VE in case praevia
need resus? preg women decompensate late
ABC + obs
abdo - tender, contracted, woodiness (abrup)
vagina VE can make praevia worse - laceration/erosion/infection, blood on spec, cervix
?FBC, crossmatch, clotting
FBC + G+S - G+S determines rh status too
clotting screen - abruption can → coagulopathy
kleihauer - ?foetomaternal haemorrhage
CTG - ?foetal heart
APH - history
first time bleeding? how heavy? abdo pain - episodic? itchy, sore, discharge? post-coital? smears? placenta localised at 20wk?
APH - mgmt of minor bleeds
treat cause + observe
whats a risk of APH? how can you investigate it in non-acute setting?
FGR - USS to assess placental site + foetal growth
