Complications of childbirth Flashcards
What is Antepartum Haemorrhage (APH)?
APH is vaginal blood loss that occurs prior to birth, after the 20th week of gestation and before the onset of labour
What are the 3 major causes of APH?
Placebra Praevia
Placental Abruption
Vasa Praevia
What is placenta praevia?
Implation of the placenta over the lower non-contractable uterus, adjacent to the opening to the cervix.
What is the impact of placenta praevia on birth?
It will impact birth, due to its position it will often be birthed first and cause signifcant haemorrhage due to vasculairty
What are risk factors of placenta praevia
Large placental area i.e multiple births
Advanced age
High Parity
Deficent endometrium
Uterine scarring
Endometeritis
Submocus fibroid (abrnormal growth that impacts placentas ability to embed in correct spot in uterus
What are the clinical manifesations of placenta preavia?
Painless vaginal bleeding Bleeding is bright red vasuclar blood Uterus is soft and relaxed Potenial shock symtoms depending on severity of bleed Occurs in 3rd trimester (28-30 weeks) May have preterm contractions
What causes the onset of placenta praevia?
Onset may be spontaneous or may be caused by straining, coughing, sexual intercourse etc
What is the management plan for Placenta Preavia?
Because patient is time critical rapid transport
Postion mother left lateral
Consider fluid replacement
Prepare for birth and resus of the newborn
What is placental abruption?
Premature seperation of placenta from uterine wall. Allows for bleeding to occur which may be concelaed or open.
What is a conceled haemorrhage in relation to placental abruption?
Blood loss is in uterus behind seperated placenta. Allows for blood to pool and be trapped behind fetus.
Risk factors for placental abruption?
Hypertension, Membrane rupture Trauma Increased Maternal Age Multiple pregnancies Diabetes Domestic violence
Complications of placental abruption in relation to haemorrhage?
To stop haemorrhage, uterus must contract to stem bleeding however it cannot contract while baby is there
What is the pathophysiology of Placental abruption?
- Placenta abrupts and is torn from uterine wall
- Blood vessels are torn
- Haemorrhage
- Uterine muscles unable to contract and stem bleeding
- Blood vessels continue to bleed
- Foetal Hypoxia and Maternal Hypovolemia
- Disseminated Intravascualr Coagulation (DIC) may occur due to pregant blood becoming hypercoagulant.
What is Dissminated Intravasuclar Coagulation?
Causes blood clotting throughout the body’s blood vessels. This uses up the body’s coaguilation supply and allows for free bleeding in other parts of the body
How to diagnose Placental Abruption?
mild cramping to sevre Pain (hallmark symtom as placenta praveia is painless)
Bleeding -dark red/venous
Potenitoal symtoms of shock
Membranes rupture - bloody amniotic fluid if ruptured
Rigid/hard uterus on palpation
Tetanic contractions (constant not intermeitent contarctions) caused by blood irritating lining of uterus
What is Vasa Praevia?
A rare condintion where the fetal vessels traverse the lower section of the uterus beneath the presenting part of the fetus. Baby cannot descened without breaking/putting pressure on vessels
What happens when pressure is placed on fetal vessels in placenta previa?
Placing pressure will block nutrients and oxygen to baby as well as potenional rupture or laceration
What is pre-eclampsia?
A pregnancy compication that is characterised by high BP and proteninruia
Clinical features of Pre-eclampsia
hypertension of 140 systolic and 90 dyastolic
Protenuriua
Multi-system damage/disorder most commonly liver/kidneys
headache, blurred vision and clonus (involintary muscle contractions)
Epigastric pain, nausea and Right Upper Quandrant pain (where liver/kidneys live)
What are the complications of seziures in the pre-eclampsic patient?
Sustained pre-eclampsia can lead to tonic-clonic seizures. These seziures will lead to significant issues due to hypoxia from seizure. issues such as: Fetal comprimise/death
WHat is the management for a pre-eclampsic patient?
Time critical: the lobger they are pre-eclampsic the more tissue/organ damage is done
Manage pain and seizures
Airway support, decrease stress and envriomental stimuli
BIRTH IS THE DEFINITVE TREATMENT (most of the time)
TRANSPORT AND PRE-NOTIFY
What is post-partnum eclampsia?
Post-Partnum eclampisa is when high BP is sustained after birth
What is PPPH?
PPPH is maternal blood loss greater tgen 500mls within 24 hours after birth
WHat is Secondary Post Partnum Haemorrhage
Maternal blood loss of greater then 500mls after 24hrs of birth and to 6 weeks weeks post birth
