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Phase 3a Obstetrics + sexual health > Bleeding, Rh disease + liver > Flashcards

Bleeding, Rh disease + liver Flashcards

1
Q

what are the causes of APH in 1/3 and 3/3?

A

1/3 = miscarriage, molar, ectopic
3/3 = placenta previa, vasa previa, placental abruption

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2
Q

What are the 2 types of haemorrhage?

A

antepartum (APH)
Postpartum (PPH)

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3
Q

Bleeding from 24 weeks to birth:
minor?
major?

A

<50ml
50-100ml

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4
Q

PPH types?

A

1^ = <24hrs
2^ = 24hrs - 6 weeks
OF BABY DELIVERY NOT PLACENTA

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5
Q

What is minor, moderate and severe blood loss in PPH?

A

Minor = 500-1000ML
Mod = 1000-2000ml
Severe = 2000+ ml

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6
Q

C section blood loss to be a PPH must be?

A

1000ml

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7
Q

RF for PPH?

A

Polyhydromnios, prolonged labour, pHx c section, APH, Recent bleeding Hx, Twins, uterine fibroid, multi-parity

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8
Q

4 causes of PPH?

A

MC = Tone (UTERINE ATONY)
Tissue (retained tissue)
Thrombin (DIC)
Trauma (perineal tears, uterine rupture)

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9
Q

Why does uterine atony cause PPH?

A

Low tone = less pressure on spiral arterioles therefore more dilation
+ blood filling —> bleed (long labour)

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10
Q

Tx for atony?

A

Fundal massage + empty bladder (inc catheterise)

2 x 14G large bore (grey) cannulae for IV fluid + transfusion (after group + save)

IV oxytocin (inject then infuse) then IV ERGOMETRINE (Uterotonics)

Fails = surgical

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11
Q

What are the surgical options for atony?

A

Intrauterine balloon tamponade
B Lynch sutures
Umbilical artery ligation
Hysterectomy

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12
Q

Tx for retained tissue?

A

surgical D+C

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13
Q

What to do in major PPH?

A

ABCDE
1. Call for help
2. cross match group + save & have blood transfusion ready

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14
Q

Complication of Haemorrhages?

A

DIC
Shock = death
Sheehan syndrome

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15
Q

What is sheehan syndrome?
sx?

A

hypopituitarism due to ischemic necrosis anterior pituitary in major PPH
Sx: 2^ amenorrhoea, agalactorrhoea, low T4

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16
Q

What is rheumatic disease in pregnancy?

A

Prior sensitisation in Rh - mum from Rh + child
2nd child = T2 hypersensitivity
Results in IgG transplacental RhIgG causing fetal distress in utero

17
Q

RF of Rh disease?

A

caucasian
having Rh + before (as Rh-)

18
Q

How can you become Sensitised?

A

APH, Placental abruption
intrauterine death, miscarriage, TOP
Ectopic
delivery
Rh+ transfusion from Rh- women
amniocentesis/CVS

19
Q

What are the Sx of Rh disease?

A

Erythroblastosis fetalis - yellow amniotic fluid due to high bilirubin (haem anemia)

Hydrops fetalis - portal htn, pul htn, congestive HF therefore Widespread oedema + resp distress

20
Q

Dx for Rh disease?

A

+ve COOMBS
+ve KLEIHAUER (fetomaternal haemorrhage size - gives idea of DOSE
Increased reticuloblasts
Amniocentesis/CVS - Yellow amniotic fluid aspirate

21
Q

Tx Rh disease?
prevention?
Tx for baby?

A

Prevent - RhoGAM (28 wk + 34wk to Rh- mums), give intrapartum + in miscarriage/TOP (IM injection)

Tx = ABCDE + Transfusion (+ jaundice)

22
Q

What are the 2 liver issues in pregnancy?

A

obstetric cholestasis
acute fatty liver of preg

23
Q

What is obstetric cholestasis?
time?

A

> 24 weeks
impaired bile flow = accumulation of bile acids

24
Q

Sx of obstetric cholestasis?

A

pruritus palms + soles
GI Sx
abdo pain 3/3
around 34 weeks
worse at night, look well

25
Q

why are bile acids bad?

A

bile acids can be teratogenic in high concs

26
Q

Dx of obs chol?

A

high total bile salts/acids (hypercholanemia) - test serum bile acid and LFT

27
Q

Tx for obs chol?

A

emollients (for itching)

Chlorphenamine (itching)

Ursdeoxycholic acid (lower serum bile acids, pruritus and good bile flow)

Deliver no later than 37 weeks

28
Q

What is acute fatty liver of pregnancy?
Sx?
when it occurs?
related to which condition?

A

severe rare liver disease
excessive fat in liver cells causing liver damage/failure
35/36 weeks
Jaundice 3/3
RUQ pain
N+V
v unwell Px
related to pre eclampsia

29
Q

differential Dx of acute fatty liver?
Dx?
Tx?

A

HELLP Syndrome
high bilirubin +/- DIC
EMERGENCY –> ABCDE + must deliver baby

Phase 3a Obstetrics + sexual health (15 decks)

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