Bleeding, Rh disease + liver Flashcards
what are the causes of APH in 1/3 and 3/3?
1/3 = miscarriage, molar, ectopic
3/3 = placenta previa, vasa previa, placental abruption
What are the 2 types of haemorrhage?
antepartum (APH)
Postpartum (PPH)
Bleeding from 24 weeks to birth:
minor?
major?
<50ml
50-100ml
PPH types?
1^ = <24hrs
2^ = 24hrs - 6 weeks
OF BABY DELIVERY NOT PLACENTA
What is minor, moderate and severe blood loss in PPH?
Minor = 500-1000ML
Mod = 1000-2000ml
Severe = 2000+ ml
C section blood loss to be a PPH must be?
1000ml
RF for PPH?
Polyhydromnios, prolonged labour, pHx c section, APH, Recent bleeding Hx, Twins, uterine fibroid, multi-parity
4 causes of PPH?
MC = Tone (UTERINE ATONY)
Tissue (retained tissue)
Thrombin (DIC)
Trauma (perineal tears, uterine rupture)
Why does uterine atony cause PPH?
Low tone = less pressure on spiral arterioles therefore more dilation
+ blood filling —> bleed (long labour)
Tx for atony?
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
What are the surgical options for atony?
Intrauterine balloon tamponade
B Lynch sutures
Umbilical artery ligation
Hysterectomy
Tx for retained tissue?
surgical D+C
What to do in major PPH?
ABCDE
1. Call for help
2. cross match group + save & have blood transfusion ready
Complication of Haemorrhages?
DIC
Shock = death
Sheehan syndrome
What is sheehan syndrome?
sx?
hypopituitarism due to ischemic necrosis anterior pituitary in major PPH
Sx: 2^ amenorrhoea, agalactorrhoea, low T4
What is rheumatic disease in pregnancy?
Prior sensitisation in Rh - mum from Rh + child
2nd child = T2 hypersensitivity
Results in IgG transplacental RhIgG causing fetal distress in utero
RF of Rh disease?
caucasian
having Rh + before (as Rh-)
How can you become Sensitised?
APH, Placental abruption
intrauterine death, miscarriage, TOP
Ectopic
delivery
Rh+ transfusion from Rh- women
amniocentesis/CVS
What are the Sx of Rh disease?
Erythroblastosis fetalis - yellow amniotic fluid due to high bilirubin (haem anemia)
Hydrops fetalis - portal htn, pul htn, congestive HF therefore Widespread oedema + resp distress
Dx for Rh disease?
+ve COOMBS
+ve KLEIHAUER (fetomaternal haemorrhage size - gives idea of DOSE
Increased reticuloblasts
Amniocentesis/CVS - Yellow amniotic fluid aspirate
Tx Rh disease?
prevention?
Tx for baby?
Prevent - RhoGAM (28 wk + 34wk to Rh- mums), give intrapartum + in miscarriage/TOP (IM injection)
Tx = ABCDE + Transfusion (+ jaundice)
What are the 2 liver issues in pregnancy?
obstetric cholestasis
acute fatty liver of preg
What is obstetric cholestasis?
time?
> 24 weeks
impaired bile flow = accumulation of bile acids
Sx of obstetric cholestasis?
pruritus palms + soles
GI Sx
abdo pain 3/3
around 34 weeks
worse at night, look well
why are bile acids bad?
bile acids can be teratogenic in high concs
Dx of obs chol?
high total bile salts/acids (hypercholanemia) - test serum bile acid and LFT
Tx for obs chol?
emollients (for itching)
Chlorphenamine (itching)
Ursdeoxycholic acid (lower serum bile acids, pruritus and good bile flow)
Deliver no later than 37 weeks
What is acute fatty liver of pregnancy?
Sx?
when it occurs?
related to which condition?
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
differential Dx of acute fatty liver?
Dx?
Tx?
HELLP Syndrome
high bilirubin +/- DIC
EMERGENCY –> ABCDE + must deliver baby
