Complications of Pregnancy Flashcards
Definition of abortion/spontaneous miscarriage
Termination/loss of pregnancy before 24 weeks gestation with no evidence of life
Types of spontaneous miscarriage
threatned inevitable incomplete complete septic missed (early foetal demise)
Definition of threatned miscarriage
Bleeding from the gravid uterus before 24 weeks gestation when there is a viable foetus and no evidence of cervical dilatation
Definition of an inevitable miscarriage
Abortion becomes inevitable if the cervix has already begun to dilate
Definition of incomplete miscarriage
Only partial expulsion of the products of conception
What is there a risk of after an incomplete miscarriage?
Ascending infection into the uterus which can spread throughout the pelvis (septic abortion)
Definition of complete miscarriage
Complete expulsion of all the products of conception
Definition of septic miscarriage
After incomplete abortion then risk of ascending infection which can spread throughout the pelvis
Presentation of threatened miscarriage
Vaginal bleeding and pain
Viable pregnancy
Closed cervix on speculum examination
Presentation of inevitable miscarriage
Viable pregnancy
Open cervix
Bleeding that may be heavy +/- clots
Presentation of missed miscarriage (early foetal demise)
No symptoms possibly
Bleeding/brown loss vaginally
Gestational sac seen on scan
No clear foetus (empty gestational sac) or a foetal pole with no foetal heart seen in the gestational sac
Presentation of an incomplete miscarriage
Most of the pregnancy expelled out but some of the products remaining in the uterus
Open cervix
Vaginal bleeding (may be heavy)
Presentation of complete miscarriage
Passed all products of conception
Cervix has closed
Bleeding has stopped
Causes of spontaneous miscarriage
Abnormal conceptus (genetic, chromosomal, structural)
Uterine abnormality (congenital, fibroid)
Cervical incompetence (primary - born with it or secondary - treatment to the cervix due to a bad smear i.e. iatrogenic)
Maternal increasing age
Maternal diabetes
Maternal SLE
Maternal thyroid disease
Maternal infection e.g. appendicitis
Hormonal imbalances (corpeus luteum, progesterone level lower)
Unknown
Treatment of missed miscarriage
Conservative
Prostaglandins (misoprostol)
SMM
What does SMM stand for?
Surgical management of miscarriage
Treatment of an inevitable miscarriage if the bleeding is really heavy
Evacuation
Treatment of septic abortion
Antibiotics
Evacuate uterus
Definition of ectopic pregnancy
Pregnancy implanted outside the uterine cavity
Most common site of ectopic pregnancy
Ampulla
How common is an ectopic pregnancy?
1 in 90 pregnancies
Risk factors for ectopic pregnancies
History of PID Previous tubal surgery/scarring previous ectopic pregnancy Assisted conception (IVF) Mirena or copper coil
Presentation of ectopic pregnancy
period of amenorrhoea (wih +ve urine pregnancy test)
vaginal bleeding
pain in abdomen
GI or urinary symptoms
If has ruptured, usually features of hypovolaemic shock
Investigations of ectopic pregnancy
History and examination
- pain more prominent on one side
Serum BhCG levels
- increased levels in pregnancy by 66% ish and serially track levels over 48 hour intervals
USS
- No intrauterine gestational sac
- empty uterine cavity
- May see adnexal mass (outside uterine cavity)
- fluid in pouch of douglas
Serum progesterone levels
- viable IU pregnancy levels >25ng/ml
Treatment of ectopic pregnancy
Methotrexate
Surgical - mostly laparoscopically (Salpingectomy)
Conservative
When is surgery indicated in the treatment for ectopic pregnancy?
If it Is close to rupture
Salpingectomy vs Salpingotomy
Salpingectomy = removal of one or both fallopian tubes Salpingotomy = incision on the tube, remove pregnancy tissue and leave the tube
Definition of antepartum haemorrhage
Haemorrhage from the genital tract after the 24th week of pregnancy but before the delivery of the baby
Antepartum definition
Before delivery
Causes of antepartum haemorrhage
Placenta praevia Placental abruption (APH of unknown origin) Local lesions of the genital tract (including cervical or vaginal e.g. cervix erosions and polyps or thrush infections) Vasa praevia Uterine rupture
Placenta praevia definition
Placenta is attached to the lower segment of the uterus
Placental abruption definition
Placenta starts to separate from uterine wall before the birth of the baby and is associated with retroplacental clot
Vasa praevia definition
Rupture of foetal blood vessels that sit near the internal opening of the uterus. Blood loss from the foetus can be catastrophic
Treatment of antepartum haemorrhage
Sometimes just settles
Attempting vaginal delivery
C section
Treatment for antepartum haemorrhage depends on…
Amount of bleeding
General condition of mother and baby
Gestation
Incidence of placenta praevia
1 in 200 pregnancies
Placenta praevia is more common in …..
multiparous women
multiple pregnancies
previous C section
Classification of placenta praevia
Grade I - Placenta encroaching on the lower segment but not the internal cervical OS
Grade II - Placenta reaches the internal OS
Grade III - Placenta eccentrically covers the OS
Grade IV - central placenta praevia = i.e. completely covering the surface of the cervix
Pathology of placenta praevia
Separation of the placenta causes bleeding as the lower uterine segments forms and the cervix effaces. the blood loss from the venous sinuses in the lower segment
Presentation of placenta praevia
Painless PV bleeding (APH) recurrent Malpresentation of the foetus soft, non-tender uterus Maternal condition correlates with amount of bleeding PV Incidental by USS
Investigations of placenta praevia
Transvaginal USS to locate placental site
MRI (if USS not confirmatory)
What should NOT be done in placenta praevia
Vaginal exam
Treatment of placental praevia depends on…..
Gestation at presentation
Severity of blood loss
Treatment for placenta praevia
Caesarean section
Watch for PPH!
Treatment for PPH
Medical (to contract the uterus) - oxytocin - ergometrine - carbaprost - tranexamic acid Balloon tamponade Surgical (sutures) - B lynch culture - Ligation of uterine - Iliac vessels - Hysterectomy
Placental abruption is associated with
Retroplacental clot
Pathology of placental abruption
Placenta is in an abnormal site but there is separation from the wall and so bleeding behind the placenta
Factors associated with placental abruption
Pre-eclampsia/hypertension Multiple pregnancy Polyhydramnios Smoking Cocaine use Increasing age Parity Previous abruption
Types of placental abruption
Revealed
Concealed
Mixed
What is a revealed placental abruption?
Major haemorrhage is apparent externally as blood released escapes through the cervical OS
What is a concealed placental abruption?
Haemorrhage occurs between placenta and uterine wall. Uterine contents increase in volume and fundal height is larger than would be consistent for gestation
What can a concealed placental abruption result in?
Couvelaire uterus
What is a couvelaire uterus?
In concealed placental abruption, in some situations blood penetrates the uterine wall and the uterus appears bruised
What is a mixed placental abruption?
Concealed and revealed types together
What type of placental abruption is seen in the majority?
A mixed placental abruption
Presentation of placental abruption
Pain - severe abdominal pain Vaginal bleeding (may be minimal) Increased uterine activity - tender and irritable uterus - having contractions Foetal lie is longitudinally with the presenting part fixed in the pelvis
Complications of placental abruption
Maternal shock, collapse (may be disproportionate to the amount of bleeding seen)
Foetal death
Maternal DIC, renal failure
PPH (couvelaire uterus)
Definition of Pre Term Labour
Onset of labour before 37 weeks completed of gestation (259 days)
Spectrum of pre term labour
32-36 weeks = midly preterm
28-32 weeks = very preterm
24-28 weeks = extremely preterm
Types of pre term labour
Spontaneous
Induced (Iatrogenic)
Incidence of preterm labour in singletons vs multiple pregnancy
Singletons = 5-7%
Multiple pregnancy = 30-40%
Predisposing factors to preterm labour
Multiple pregnancy Polyhydramnios APH Pre-eclampsia Infection e.g. UTI Prelabour premature rupture of membranes
Treatment of preterm labour
Consider tocolysis to allow steroids/transfer
Steriods unless contraindicated
What do tocolysis drugs do?
Slow down contractions
How long can tocolysis drugs be used for?
12-24 hours
What do steroids do in preterm labour?
Help the babys lungs cope better when it is born
Also allows for transfer
Neonatal prematurity can result in …..
Respiratory distress syndrome Intraventricular haemorrhage CP Nutrition Temp control Jaundice Infections Visual impairment Hearing loss
Essential/chronic hypertension in pregnancy is commoner in which age of mothers?
Older mothers
Definition of Pre-eclampsia
Mild Hypertension on two occasions more than 4 hours apart or moderate to severe hypertension on one occasion
PLUS
Proteinuria >300mgm/s 24 hours
Risk factors for developing pre eclampsia
First pregnancy Extremes of maternal age Pre eclampsia in previous pregnancy Pregnancy interval > 10 years BMI > 35 FH of pre eclampsia Multiple pregnancy Underlying medical disorders (Chronic HTN, pre-existing renal disease, pre-existing diabetes, autoimmune disorders like SLE)
Maternal complications of pre-eclampsia
Eclampsia Severe HTN leads to cerebral haemorrhage, stroke HELLP DIC Renal failure Pulmonary oedema and cardiac failure
What does HELLP stand for?
Haemolysis, elevated liver enzymes, low platelets
What does DIC stand for?
Disseminated intravascular coagulation
Foetal complications of pre eclampsia
Impaired placental perfusion
What does impaired placental perfusion lead to?
IUGR
Foetal distress
Prematurity
increased PN mortality
Symptoms/Signs of Pre eclampsia
Headache Blurring of vision Vomiting Epigastric pain Pain below ribs sudden swelling of hands, face and legs Severe HTN + >3 urine proteinuria Clonus/brisk reflexes Papilloedema Reduced urine output Convulsions (eclampsia)
Biochemical abnormalities of pre eclampsia
Raised liver enzymes
Bilirubin in HELLP present
Raised urea and creatinine
Raised urate
Haematological abnormalities of pre eclampsia
Low platelets
Low haemoglobin
Signs of haemolysis
Features DIC
Investigations for pre eclampsia
Frequent BP checks
Urine protein
Check symptomatology
Bloods (FBC, LFTs, RFTs, coagulation if needed)
Foetal investigations (scan for growth, CTG)
Only cure for pre eclampsia
Delivery of the baby and the placenta
Treatment of seizures/impending seizures in pre-eclampsia
Magnesium sulphate bolus + IV bolus
Control of BP - IV labetolol, hydralazine (if >160/110)
Avoid fluid overload - aim for 80ml/hr for fluid intake
Prophylaxis for pre eclampsia in subsequent pregnancy is …..
Low dose aspirin from 12 weeks until delivery
Women with pre eclampsia are at a higher risk of developing what later in life?
Hypertension
Effects of diabetes in pregnancy
Insulin requirements of mother increase Foetal hyperinsulinaemia occurs -> macrosomnia More risk of neonatal hypoglycaemia Increased risk of respiratory distress Increased risk of foetal cardiac abnormalities Miscarriage Feotal macrosomnia, polyhydramnios Operative delivery Shoulder dystocia Stillbirth Increased risk of pre-eclampsia Worsening of maternal nephropathy, retinopathy, hypoglycaemia, reduced awareness of hypoglycaemia Infections impaired lung maturity of neonatal neonatal hypoglycaemia Jaundice
Treatment of Diabetes in pregnancy - Pre-conception
Better glycaemic control
Folic acid 5mg
Diet
retinal and renal assessment
Treatment of diabetes during pregnancy
Optimise glucose control
Can continue oral diuretic agents (metformin) but may need to change to insulin for tighter control
Provide treatment for hypos
Labour induced usually 38-40 weeks
C section possible if macrosomnia
Early feeding of baby to reduce neonatal hypoglycaemia
Insulin requirements increase during pregnancy
Risk factors for gestational diabetes
Increased BMI > 30
Previous macrosomia baby >4.5kg
Previous GDM
FH of DM
High risk groups for developing DM e.g. Asians
Polyhydramnios
Big baby currently in pregnancy
Recurrent glycosuria in current pregnancy
GDM associated with some increased in maternal or foetal complications
Screening for gestational diabetes
If risk factor
HbA1c
OGTT
Treatment for gestational diabetes
Control blood sugars (diet, insulin, metformin)
Post delivery - check OGTT 6 to 8 weeks
Yearly check of HbA1c/blood sugars as increased risk for developing DM
Virchows triad
Stasis
Vessel wall injury
Hypercoagulability
Why is there a risk of thrombo-embolism in pregnancy?
It is a hypercoagulable state (to protect the mother against bleeding post delivery)
What happens in the blood to make pregnancy a hypercoagulable state?
Increased fibrinogen, factor VIII, VW factors, Platelets
Decrease in natural anticoagulants -> antithrombin III
Increase in fibrinolysis
Vircows triad in respect to pregnancy
- STASIS - progesterone and effects of enlarging uterus cause increases stasis
- HYPERCOAGULABILITY - hypercoagulable state in pregnancy
- VESSEL WALL INJURY - maybe vascular damage at delivery/ caesarean section
Increased risk of VTE seen in …..
Older mothers Increasing parity smokers IVDU PET increased BMI Dehydration - hyperemesis Decreased mobility Infections FH of VTE Sickle cell disease Operative delivery/prolonged labour Haemorrhage, blood loss > 2L Previous VTE not explained by predisposing factors Those with thrombophilia
Prophylaxis of VTE in pregnancy
TED stockings
Increased mobility
Hydration
Prophylactic anticoagulation if increased risk factors
Presentation of VTE
Pain in calf Increased girth of affected leg Calf muscle tenderness Breathlessness Pain on breathing Cough Tachycardia Hypoxic Pleural rub
Investigations of VTE
ECG
Blood gases
Doppler V/Q lung scan
CTPA
Treatment of VTE
anticoagulation
Effects of progesterone on the uterus
Thickens the lining
Changes the cells
Turns the endometrium into decidua
What happens when the endometrium is turned into a decidua?
Increases vascularity
Between glands and vessels the stromal cells enlarge and become procoagulant -> stops bleeding
Monthly shredding occurs here and is akin to falling of leaves from a decidual tree
Another name for the egg
Chorion
Where are trophoblast cells found?
On the outside of a fertilised egg
What do trophoblast cells produce?
Beta human chorionic gonadotrophin (B-hCG)
Function of BhCG
It is to keep and stimulate the corpeus luteum to produce progesterone throughout pregnancy, and stops the decidua from shredding
Clinical implication of BhCG
Forms the basis of pregnancy tests
What do trophoblast cells do once the fertilised egg is buried into the decidua?
Stem off to invade mothers blood vessels and (eventually) link those vessels up with those of the foetus, so try to turn into placental cells to form the placenta
Where are the decidual stromal cells found?
Between the vessels (foetal and maternal)
What is the function of the decidual stromal cells?
The cells are procoagulant and stop the trophoblast cells causing too much bleeding when they invade the mothers blood vessels
How is the forerunner of the placenta eventually formed?
Chorionic villi, covered by trophoblast cells, are bather in the mothers blood, forming the forerunner of the placenta
Why are ectopic pregnancies predisposed to haemorrhage and rupture?
Lack of decidual layer
Small size of tube
A major anomaly of Downs Syndrome
Duodenal atresia
What does macrosomnia of babys in mothers with DM predispose the baby to?
Intrauterine death (IUD)
Acute chorioamnionitis definition
Acute inflammation with neutrophils present in the membranes (chorioamnionitis), cord and foetal plate of the placenta
Pathology of acute chorioamnionitis
Perineal or perianal bacteria ascend vaginally and get into the amniotic sac
Presentation of acute chorioamnionitis
Mother - ill - fever - raised neutrophils - can be well Baby - IUD - ill in first days of life - CP later on in life
How does the ascending infection in acute chorioamnionitis affect the babys brain?
Neutrophils produce ‘cytokine storm’ which activates some brain cells, which then get damaged by the normal hypoxia of labour
When does the withdrawal hit the baby is the mother is on heroin vs methadone?
Heroin => immediate withdrawal
Methadone => later withdrawal
When the mother is addicted to opiates, the pregnancy often proceeds well if the mother does what?
If she eats properly
Conditions associated with cyclical abdominal pain
Endometriosis
Imperforate Hymen
What heart rate is defined as foetal tachycardia?
> 160bpm
Most common cause of PPH
Uterine atony
Definition of uterine atony
The uterus fails to contract after the delivery of the placenta
What heart rate is defined as fetal bradycardia?
<100 bpm
What is the cervical os?
Opening in the lower part of the cervix between the uterus and the vagina
- internal os
- external os
Definition of recurrence miscarriage
3 or more miscarriages
What is the most common cause of miscarriage?
Foetal chromosomal abnormality
If someone is passing clots, what does this indicate?
A miscarriage
If someone is passing small amounts of blood, what does this indicate?
An ectopic pregnancy
If you can see the foetal heart on transvaginal scan, what is the chance of miscarriage?
< 50 %
How to tell difference between ectopic pregnancy or complete miscarriage on scan
BhCG levels
- redo after 48 hours and if the levels have come down = complete miscarriage
If the serum progesterone is < 20, what does this indicate?
Likely to be a failing pregnancy
What on the scan indicates a delayed/missed miscarriage?
Foetal pole but no heart OR
Foetal sac but no foetus
What is the most important aspect in the management of miscarriage?
Psychological help
Types of management of miscarriage
- SMM
- Medical
- Expected
Which of the types of management of miscarriage have the highest rate of infection?
SMM
What are the risks of having an increased age of mum?
Increased risk of foetal chromosomal abnormalities Increased risk to the mother - placenta praevia - pre eclampsia - DVT Contractions in labour not as effective Stillbirth risk
What BhCG level indicates a viable foetus on USS?
> 1500
What is a heterotopic pregnancy?
A rare complication of pregnancy in which both extra-uterine (ectopic pregnancy) and intra uterine pregnancy occur simultanoeusly
Risk factors for heterotopic pregnancy
Same for ectopic pregnancy
Treatment of heterotopic pregnancy
Salpingectomy or salinpingotomy
What is a molar pregnancy?
An abnormal form of pregnancy in which a non viable fertilized egg implants in the uterus and will fail to come to term. It grows into a mass in the uterus that has swollen chorionic villi
What is the growth grown in molar pregnancy called?
Hydatidiform mole
Types of molar pregnancy
Complete
Partial
What is a complete molar pregnancy?
There is a mass of abnormal cells with NO foetal parts
What is a partial molar pregnancy?
An abnormal foetus starts to form but it cannot survive or develop into a baby
Presentation of molar pregnancy
Often asymptomatic Vaginal bleeding / dark discharge Swollen abdomen Morning sickness Hyperemesis Pain
Investigations of a molar pregnany
High BhCG
USS
Risk factors for molar pregnancy
> 35 y/o or < 20 y/o
Previous molar pregnancy
Treatment of a molar pregnancy
Suction removal and evacuation
Methotrexate if persistent
Hysterectomy
What is a complication that can happen after a molar pregnancy? What is this called?
Some abnormal cells can be left in the womb
It is called persistent trophoblastic disease
Treatment of persistent trophoblastic disease
Chemotherapy
What can develop if the cells left behind in a pregnancy become cancerous?
Choriocarcinoma
What type of molar pregnancy is a choriocarcinoma more common in?
Complete
A choriocarcinoma can occur after what?
Normal birth Miscarriage Ectopic pregnancy Abortion Molar pregnancy
What is the most common origin of a cholangiocarcinoma?
Molar pregnancy
Treatment of a cholangiocarcinoma
Chemotherapy
Pregnancy after treatment for a molar pregnancy
Should not get pregnant for 6 months
Contraception after treatment for a molar pregnancy
Cannot use IUD
Can use any other form of contraception
Serum alpha-feto protein (AFP) can be raised in pregnancy due to what?
Foetal abdominal wall defects e.g. omphalocele
Neural tube defects e.g. mengiocele
Multiple pregnancy
In a women with severe pre-eclampsia or eclampsia, when should the IV magnesium infusion be stopped?
24 hours after last seizure
Presentation of acute fatty liver of pregnancy
Jaundice Mild pyrexia Hepatic LFTs Raised WBC Coagulopathy Malaise Fatigue Nausea
Who is offered expectant management of ectopic pregnancy?
Low B-hCG
No symptoms
Tubal ectopic pregnancy < 35mm with no heartbeat
Treatment of thrush in pregnancy
Clotrimazole pessary
Another name for thrush
Vaginal candidadis
Risk factors for thrush
DM Drugs - antibiotics - steriods Pregnancy Immunosuppression - HIV - Iatrogenic
Presentation of thrush
"Cottge cheese" Discharge Non offensive discharge Itch Vulvitis - dysuria - dyspanureia Vulval erythema, fissuring, satellite lesions may be seen
Treatment of thrush
Local treatment - clotrimazole pessary Oral treatment - itraconazole or fluconazole If pregnant then only local treatment can be used
What % of preterm deliveries are assosiated with pre term prelabour rupture of membrane?
40%
Complications of pre term pre labour rupture of membranes
Foetal - prematurity - infection - pulmonary hypoplasia Maternal chorioamniotiis
Management of pre term pre labour rupture of membranes
Admit
Regular observations to check chorioamniotitis is not occuring
Oral erythromycin for 10 days
Corticosteriods
Delivery should be considered at 34 weeks gestation
What does an ovarian torsion look like on USS?
Whirlpool sign
Free fluid
Definition of oligohydramnios
Reduced amniotic fluid
- less than 500ml at 32 - 36 weeks
- AFI < 5th percentile
Causes of oligohydramnios
Premature rupture of membranes Foetal renal problems e.g. renal agenesis IUGR Post term gestation Pre eclampsia
What should be given to all women with premature prelabour rupture of membranes?
10 days erythromycin
What is the location of an ectopic pregnancy that has the biggest risk of rupture?
Isthmus
What is sensitisation?
A process whereby foetal red blood cells (RhD-positive) enter the maternal circulation, when the mother is RhD-negative. The foetal maternal haemorrhage (FMH) can cause antibodies to form in the maternal circulation that can haemolyse foetal red blood cells
What is a complication of sensitization in subsequent pregnancies?
Haemolytic disease of the foetus and newborn
How is the risk of sensitisation is reduced in people at risk?
Anti-D immunoglobulin
What are the potentially sensitizing events in pregnancy?
Ectopic pregnancy Evacuation of retained products of conception or a molar pregnancy Vaginal bleeding < 12 weeks if heavy, painful or persistent Vaginal bleeding > 12 weeks CVS and amniocentesis APH Abdominal trauma External cephalic version IUD Post delivery (if baby RhD positive)
In the abscence of a observable sensitising event, when is prophylactic anti-D given to mothers?
Previously non sensitised women at 28 and 34 weeks
Causes of bleeding in the 1st trimester
Spontaneous abortion
Ectopic pregnancy
Hydatiform mole
Causes of bleeding in the 2nd trimester
Spontaneous abortion
Hydatiform mole
Placental abruption
Causes of bleeding in the 3rd trimester
Bloody show
Placental abruption
Placenta praevia
Vasa praevia
Presentation of hydatiform mole
Bleeding in first or second trimester
Exagerated symptoms of pregnancy e.g. hyperemesis gravidarum
Uterus large for dates
Very high serum hCG
Define significant proteinuria
300 mg > 24 hours
Mild - 1 + on dipstick
Moderate - 2+ on dipstick
Severe - 3 + on dipstick
Definition of eclampsia
Seizure in the presence of PET
What is the issue with a pregnant women on their back?
Caval compression
What happens to your reflexs in severe PET?
Hyperreflexia
Blood results in PET
FBC Urate HELLP - microangipathy - haemolytic anaemia
What HTN value does it have to be in PET?
130 / 86
Common causes of proteinuria in pregnancy
UTI
Vaginal discharge
Does PET have warning signs?
Yes
BP for severe PET
160 / 110
Features of severe PET
BP 160/110 3 + protein Oliguria < 400ml PO PCO CO Cerebral neurologial symptoms
How does severe PET cause neurological symptoms?
Vasospasm due to HTN
Risk factors for miscarriage
Older age Previous miscarriages Chronic conditions e.g. uncontrolled diabetes Uterine or cervical problems Smoking / alcohol / drugs Underweight / overweight Invasive prenatal tests
What is placenta accreta?
Morbidly adherent placenta
What is the most common cause of APH?
Cervical ectropion
What is cervical ectropion a diagnosis of?
Exclusion
When is vasa praevia most common?
When rupturing the membranes
Causes of APH
Placenta praevia Placental abruption Early labour Scar rupture UTI
How much Rh is given and when?
1500 units at 28 weeks if Rh -ve
Extra if sensitising events
Why are transvaginal USS scans done?
To look at the placenta
What do recurrent small bleeds require?
Growth scans
What is a marginal abruption?
Tiny bit of placenta breaks off
When is syntocin given?
C section
When is syntometrin given?
Delivery
What contraindication does syntometrine have and why?
High BP
Ergometrine raised BP
Who in C sections gets given tranexamic acid?
EBL > 500
What does EBL stand for?
Estimated blood loss
If Lochia persists beyond 6 weeks, what should be done?
USS to investigate the possibility of RPOC
When can magnesium be stopped in eclampsia?
24 hours after delivery or 24 hours after last seizure
What test is given to rheus negative women after they get their 28 week dose of anti D?
Kleihaur test
Classic triad of vasa praevia
Rupture of membranes
Painless vaginal bleeding
Foetal bradycardia
