Chapter 14: Antepartum And Intrapartum Haemorrhage Flashcards
You are a trainee intern in birthing suite admitting Talia, a 28 year old G1P0 Samoan woman at 30 weeks gestation. Talia has presented with a painless vaginal bleed. The blood was running down her legs and the toilet bowl was red. The bleeding has now settled. Talia’s previous antenatal progress had been normal and a cervical smear taken at her booking visit was normal. Her morphology scan at 20 weeks stated that the placenta was sited on the anterior wall of the uterus and was clear of the cervix. Talia’s observations are normal and a CTG trace is normal. The uterus is soft and non-tender. Which of the following options is the MOST LIKELY cause of Talia’s bleeding?
Fetal bleeding from vasa praevia with succenturiate lobe
Placenta praevia
Incidental bleeding from the lower genital tract
Placental edge bleeding
Placental abruption
Placental edge bleeding
You are a trainee intern on birthing suite seeing Rachel, a 35 year old G1P0 Pākehā woman at 34 weeks gestation. Rachel presents with a sudden onset of abdominal pain accompanied with fresh bleeding. The blood was running down her legs and there were clots on the floor. She has started to feel contractions. Her pulse and blood pressure are normal. The uterus is tense and tender and the fetus is lying longitudinally with the head just engaged. The uterine size is equivalent to 34 weeks. There is an ongoing light trickle of blood. The fetal heart rate is tachycardic. Which of the following is the MOST LIKELY cause of her bleeding?
Placental abruption
Bleeding from a cervical polyp
A bloody “show”
Placenta praevia
Vasa praevia
Placental abruption
You are a trainee intern in birthing suite admitting Sophia, a 28 year old G1P0 Pākehā woman who is 36 weeks gestation. Sophia presents with a painless, bright red vaginal bleed that has soaked two pads. The bleeding has now settled. Sophia has chosen not to have any ultrasound scans this pregnancy. Her pulse and blood pressure are normal. On abdominal examination the fundal height is 32 cm. The fetal lie is transverse with the back uppermost. There is no uterine tenderness. A CTG trace is showing no uterine activity is normal. Which of the following is the MOST LIKELY diagnosis?
Placental edge bleeding
Placenta praevia
Vasa praevia from succenturiate lobe
Incidental lower genital tract bleeding
Placental abruption
Placenta praevia
Covering cervix. No US so didn’t know. Transverse baby as placenta low
You are a trainee intern on the birthing suite admitting Sarah, a 34 year old G4P3 Pākehā woman who presents with an unprovoked APH of about 2 tablespoons of blood at 33 weeks gestation. Sarah has no pain. Sarah’s abdomen is soft and speculum exam shows a small amount of bleeding through a closed cervix. The CTG is reassuring. An ultrasound scan shows a normally grown baby and the placenta is posterior and clear of the cervical os. Sarah’s blood group is A negative. Blood is taken for a Kleihauer test. Sarah last had anti D at 28 weeks gestation when she had her routine anti D. She is booked to have her next anti D injection at 34 weeks gestation. Sarah asks you whether she needs anti D today. Which is the CORRECT answer?
As she didn’t become Rhesus isoimmunised in any of her other pregnancies then it is unlikely to be an issue for this pregnancy.
We will wait for the Kleihauer result. If it is negative then she doesn’t need the anti D
She should have an injection of 625 iU of anti D
She can wait until her scheduled anti D injection next week.
She should have an injection of 250 iU of anti D
She should have an injection of 625 iU of anti D
Sensitising event. 250 for <12 weeks
You are a trainee intern in birthing suite seeing Lanuola, a 25 year old G1P0 Samoan woman who is 36 weeks gestation. She was brought in by ambulance with vaginal bleeding and abdominal pain. The bleeding started an hour ago and Lanuola as bled approximately 1 cup of blood. Her bp is 130/85 and her pulse is 100. On abdominal examination, the uterus is tender. The baby is in a cephalic presentation. On speculum examination, more clot was removed - the cervix was 3cm dilated, and partially effaced. The CTG is abnormal with a baseline of 145 bpm with reduced variability and late decelerations. The midwife with you tells you that late decelerations are indicative of fetal hypoxia. Which of the following is the MOST APPROPRIATE management?
Vaginal reassessment in 4 hours
Forceps birth
Ultrasound scan for assessment of fetus and cervical length
IV fluid resuscitation and continue the CTG
Emergency caesarean section
Emergency caesarean section
You are a trainee intern in birthing suite when Nancy is brought in by ambulance. Nancy is a 36 year old G2P1 Pākehā woman who is 37 weeks gestation. She woke one hour ago with abdominal pain and vaginal bleeding. The blood was running down her legs initially and has now settled to a light trickle. Nancy’s antenatal care had been unremarkable other than her being a smoker of 10 cigarettes per day. She is rhesus positive and her morphology scan showed that the placenta was anterior and clear of the cervical os. She has had one previous normal vaginal birth at term. On examination Nancy is distressed and pale and sweaty. Her pulse is 120 and her bp is 95/50. Her abdomen is tense. The baby is cephalic and no fetal heart is heard or able to be seen with the portable ultrasound scan. On vaginal examination Nancy is 3cm dilated and the cervix is fully effaced. Which of the following investigations is the most important to arrange IMMEDIATELY?
Full Blood Count, coagulation screen and Cross Match
Group and Hold and Full Blood Count
Full Blood Count and U&Es
Kleihauer test and Full Blood Count
Formal ultrasound pregnancy in the radiology department
You are a trainee intern in birthing suite when Nancy is brought in by ambulance. Nancy is a 36 year old G2P1 Pākehā woman who is 37 weeks gestation. She woke one hour ago with abdominal pain and vaginal bleeding. The blood was running down her legs initially and has now settled to a light trickle. Nancy’s antenatal care had been unremarkable other than her being a smoker of 10 cigarettes per day. She is rhesus positive and her morphology scan showed that the placenta was anterior and clear of the cervical os. She has had one previous normal vaginal birth at term. On examination Nancy is distressed and pale and sweaty. Her pulse is 120 and her bp is 95/50. Her abdomen is tense. The baby is cephalic and no fetal heart is heard or able to be seen with the portable ultrasound scan. On vaginal examination Nancy is 3cm dilated and the cervix is fully effaced. Which of the following investigations is the most important to arrange IMMEDIATELY?
Full Blood Count, coagulation screen and Cross Match
Group and Hold and Full Blood Count
Full Blood Count and U&Es
Kleihauer test and Full Blood Count
Formal ultrasound pregnancy in the radiology department
Placental abruption and baby has died. She is going into shock.
You are seeing Nancy, a 36 year old G2P2-1 Pākehā lady for a post-natal check. Nancy’s daughter Isobel was sadly stillborn at 37 weeks gestation weighing 3kg after Nancy presented with a placental abruption. You review Nancy’s history. In her first pregnancy she developed pre-eclampsia at 36 weeks and labour was induced at 37 weeks. Her son was born weighing 2.5kg. Nancy required intra-partum Magnesium Sulphate. She had a post-partum haemorrhage secondary to atony and required a 2 unit blood transfusion. This pregnancy Nancy took aspirin 100mg until 36 weeks. Her ultrasound scans were normal. Her bp was normal. Nancy smoked through both her pregnancies. She consumed no alcohol or other illicit drugs during her pregnancy. She has a history of depression and took 20mg of fluoxetine through her pregnancy. Which of the following risk factors predisposed Nancy to a placental abruption?
Using fluoxetine in pregnancy
Smoking during pregnancy
Her history of pre-eclampsia
Her previous postpartum haemorrhage requiring a blood transfusion
Stopping her aspirin at 36 weeks
Smoking during pregnancy
preeclampsia risk fx but that was previous, shes normotensive now
You are a trainee intern admitting Hokaka, a 35 year old G1 P0 wahine Māori who has presented at 36 weeks gestation with a painless bright red vaginal bleed of about half a cup of blood. Her vital signs are normal. The uterus is not tender and is consistent with a 36 week gestation. The fetus is lying longitudinally and the head is not engaged. A CTG is normal. An ultrasound shows a major degree of posterior placenta praevia and the estimated fetal weight is 2500g. Hokaka lives 2 hours from hospital. Assuming that Hokaka has no further bleeding, which one of the following possible management options is the MOST APPROPRIATE?
Observation in hospital and induction of hospital at 38 weeks with prostaglandin gel or misoprostol
Observation in hospital and induction of labour at 38 weeks with a Foley balloon catheter.
Discharge home to await spontaneous labour.
Observation in hospital and await spontaneous labour
Observation in hospital and elective caesarean section at 38 weeks
Observation in hospital and elective caesarean section at 38 weeks
You are a trainee intern in an antenatal clinic seeing Xiang, a 35 year old G3P2 New Zealander of Chinese ethnicity at 24 weeks gestation. In her first 2 pregnancies Xiang had elective caesarean sections. The first one was for a breech baby and the second was for ‘x1 previous caesarean’. In this pregnancy, Xiang’s morphology scan reports that the placenta is ‘anterior and low lying and completely covers the internal os’. What placental complication should you be concerned that Xiang is at risk of in this pregnancy?
Retained placenta
Placenta Accreta
Placental Abruption
Vasa Praevia
Velamentous cord insertion
Placenta Accreta
Anterior placenta
You are a trainee intern in birthing suite seeing Mariam, a 35 year old G1 P0 Muslim woman at 37 weeks gestation with your registrar. Mariam presents with spontaneous rupture of membranes (SROM) and about 100 mls of painless fresh vaginal bleeding. SROM happened 2 hours ago and the bleeding has stopped. Mariam feels well and is getting mild contractions every 10 minutes. On examination Mariam’s bp, pulse and temperature are normal. The fundal height is consistent with 37 weeks. The fetus is longitudinal lie. The fetal heart is not heard with a Doppler and unfortunately an ultrasound scan confirms fetal demise. Mariam’s morphology scan showed an anterior placenta with a small posterior succenturiate lobe. These findings were similar at her 32 week ultrasound scan. Mariam’s cervix is 3cm dilated and fully effaced. The head is at station -1. What is the MOST LIKELY cause of the bleed?
A bloody show
Placental abruption
Vasa praevia
Placenta praevia
Placental edge bleed
Vasa praevia
You are a trainee intern in birthing suite seeing Mariam, a 35 year old G1 P0 Muslim woman at 37 weeks gestation with your registrar. Mariam presents with spontaneous rupture of her membranes (SROM) and about 100 mls of painless fresh vaginal bleeding in the last two hours. The bleeding has stopped. Mariam feels well and is getting mild contractions every 10 minutes. On examination Mariam’s bp, pulse and temperature are normal. The fundal height is consistent with 37 weeks. The fetus is longitudinal lie. The fetal heart is not heard with a Doppler and unfortunately an ultrasound scan confirms fetal demise. Mariam’s morphology scan showed an anterior placenta with a small posterior succenturiate lobe. These findings were similar at her 32 week ultrasound scan. Mariam’s cervix is 3cm dilated and fully effaced. The head is at station -1. Which one of the following management options is the MOST appropriate?
Induction of labour with a Foley balloon catheter
Discharge Mariam to await spontaneous labour
Prostaglandin induction of labour
Emergency caesarean section
Augmentation with oxytocin
Augmentation with oxytocin
Membranes ruptured so just need to augment
