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PP - PAM 3 > Complications during pregnancy - Haemorrhage > Flashcards

Complications during pregnancy - Haemorrhage Flashcards

1
Q

Antepartum Haemorrhage

A

Early gestation bleeding:
Ectopic or ruptured ectopic
Miscarriage

Late gestation bleeding:
Placenta praaevia
Placental abruption

Vaginal bleeding during pregnancy is abnormal

Pregnant women may appear well even with large blood loss

visible 50mls of blood is a red flag

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2
Q

Revealed haemorrhage cause

A

Miscarriage

Placenta previa

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3
Q

Concealed haemorrhage cause

A

Ruptured ectopic

Placental abruption

S and S: pain, hypovolaemic shock

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4
Q

Causes of haemorrhaging in early pregnancy 24 weeks and under

A

Miscarriage

Ectopic

Ruptured ectopic

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5
Q

Causes of haemorrhaging in late pregnancy >24 weeks

A

Placenta previa

Placental abruption

NB. late bleeding will always be placenta related

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6
Q

Miscarriage aetiology

A

loss of pregnancy before 23 weeks gestation

Majority occur in first trimester (12 weeks)

Commonly seen at 6-14 weeks.

15% of confirmed pregnancy result in miscarriage

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7
Q

Miscarriage pathophysiology

A

Products of conception are partly passed through the cervix, become trapped leading to blood loss

Situation resolves with removal or expulsion of the products

Incomplete miscarriage - remnants of placenta remain within the uterus causing excessive bleeding and can be fatal. Common complication of septic miscarriage.

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8
Q

Miscarriage risk factors

A

previous miscarriage

Previously identified as potential miscarriage at scan

Smoker including passive

Excessive consumption caffeine

Poor management of medical conditions (diabetes, thyroid dysfunction, renal disease)

Risk increases with age

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9
Q

Miscarriage Signs and Symptoms

A

Bleeding: light or heavy with clots or jelly like tissue.

Pain: Central, cramps, suprapubic, backache. Can be as intense as labour pains.

Signs of pregnancy subsiding: nausea, breast tenderness.

Hypotension and bradycardia: could indicate cervical shock due to retained tissue in the cervix. consider signs of shock.

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10
Q

Syntometrine for miscarriage?

A

Life threatening bleeding if its a confirmed diagnosis by HCP

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11
Q

Ectopic pregnancy usually presents at what stage?

A

6-8 weeks

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12
Q

Ectopic risk factors

A

Previous ectopic

Previous surgery on the uterine tube

An intra-uterine contraceptive device fitted

Sterilisation or reversal of sterilisation

Endometriosis

Previous infects: Pelvic inflammatory disease, Chlamydia, Gonorrhoea

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13
Q

Ectopic pregnancy:

Typical S and S

A

Acute localised, lower abdominal pain

Vaginal bleeding or spotting. May present as brownish vaginal discharge.

Amenorrhoea (absence of periods).

Signs of blood loss in the abdomen with tachycardia and skin coolness

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14
Q

Ectopic pregnancy:

Atypical S and S

A

Shoulder tip pain - indicative of bleeding into peritoneal cavity.

Nausea, vomiting and unusual bowel symptoms

Unexplained dizziness and fainting

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15
Q

Antepartum Haemorrhage

A

Vaginal bleeding in late pregnancy (from 24 weeks) is confined to placental separation.

Placenta praaevia

Placental Abruption

NB. 70% of placental abruption occurs in low risk pregnancies without mitigating risk factors.

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16
Q

Placenta praevia

A

The placenta is partially or wholly impacted in the lower uterine segment

Segment grows and stretches after 12 weeks of pregnancy

Later week may cause placenta to separate and sever bleeding can occur

Usually presents at 24-32 weeks with small episodes of painless bleeding

more common in multigravidae (2nd+ pregnancy) pregnancy

Mother and foetus at high risk = medical emergency

17
Q

Placenta praevia risk factors

A

Previous history of placenta praevia

Previous c-section or other uterine surgery

Advanced maternal age

Multiparity (twins and up) or increasing parity (>2nd birth)

Smoking

Cocain use during pregnancy

Previous spontaneous or induced abortion

Deficient endometrium due to pat history of: Endometriosis, Manual removal of placenta, Curettage (scooping out)

Assisted conception

18
Q

Placental abruption

A

Premature separation of a normally situated placenta occurring after the 22nd week of pregnancy.

Bleeding occurs between he placenta and the wall of the uterus, where the placenta has detached from the uterine wall

May be revealed or concealed bleeding.

19
Q

Placental abruption risk factors

A

Previous abruption

pregnancy induced HTN/pre-eclampsia

Trauma

Multiple pregnancy (twins)

Threatened miscarriage earlier in current pregnancy

Smoking and substance abuse

previous c-section

Intrauterine infections

Polyhydramnios (excess of amniotic fluid in the amniotic sac)

20
Q

Haemorrhage occurring in late pregnancy:

Placenta praevia S and S

A

Continuous severe, sudden abdominal or back pain

commonly concealed bleeding but may have revealed bleeding

50ml of revealed blood loss in pregnancy is considered significant

Tender abdomen - rigid or woody. no signs of relaxation

warning bleeding presentation

usually no abdominal pain

Bright red, fresh blood

Degree of shock proportional to blood loss,

Uterus feels soft, non-tender

abdominal girth equal to gestation

21
Q

Haemorrhage occurring in late pregnancy:

Placental abruption S and S

A

May or may not have vaginal bleeding

Sudden continuous severe abdominal pain

Back pain; uterine contractions

Degree of shock disproportional to blood loss (if revealed)

Uterus feels tense, hard, woody, no signs of relaxation

Abdominal girth: concealed haemorrhage may lead to uterine enlargement in excess of gestation.

22
Q

Haemorrhage occurring in late pregnancy:

Uterine rupture

A

One of the most serious complications of obstetric emergencies.

Complete - tear in the wall of the uterus(with or without expulsion of the foetus)

Incomplete - tearing of the uterine wall but not perimetrium.

Rare and tends to occur during labour

Often fatal for foetus and can cause maternal death

If complete, may require immediate C-section to deliver foetus and may require emergency hysterectomy for the mother.

23
Q

Causes of uterine rupture:

A

Previous C-section

High parity

Obstructed labour e.g. shoulder dystocia, pressure or excess thinning of uterus

Previous uterine trauma from assisted birth e.g. forceps

Trauma e.g. blast injury, seatbelt injury

24
Q

Uterine rupture S and S:

Complete rupture

A

Maternal tachycardia and signs of shock

Sudden collapse of mother

Sever abdominal pain

Vaginal bleeding

Uterine contractions may stop

Fetus may be palpable in abdomen

Scar pain and tenderness

Movement away of the presenting part

25
Q

Uterine rupture S and S:

Incomplete rupture

A

May have minimal pain or blood loss

Labour may progressive’s normally

Disproportionate signs of haemorrhagic shock in the third stage of labour. - May manifest as postpartum haemorrhage.

Movement away of the presenting part

PP - PAM 3 (7 decks)

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