Haem: Obstetric Haematology pt.3 Flashcards
What complications of pregnancy are associated with thrombophilia?
It is hypothesised that an increased tendency to thrombosis is associated with impaired placental circulation.
This results in:
- Fetal growth restriction (IUGR)
- Recurrent miscarriage
- Late fetal loss
- Placental abruption
- Severe preeclampsia
What is the diagnostic criteria of antiphospholipid syndrome?
At least 1 clinical and 1 biochemical criteria
Clinical criteria:
- Vascular thrombosis
- Pregnancy morbidity
Biochemical criteria
(all must be on 2 occasions >12 weeks apart)
- Lupus anticoagulant
- High anticardiolipin antibodies
- Anti-b2-glycoprotein 1 antibodies
What are the diagnositic criteria of pregnancy morbidity in anti-phospholipid syndrome?
- Adverse pregnancy outcome: three or more consecutive miscarriages before 10 weeks of gestation (where anatomical, hormonal, and chromosomal causes have been excluded)
- One or more morphologically normal fetal losses after the 10th week of gestation
- One or more preeterm births before the 34th week of gestation owing to placental disease
What treatment may be given to improve outcome in women who have had recurrent miscarriages?
Aspirin
OR
Aspirin + Heparin
What is placenta praevia?
When the placenta covers the cervical os
What is placenta accreta?
When the placenta is attached to the surface of the myometrium
What are placenta increta and percreta?
Placenta increta: the placenta penetrates into the myometrium
Placenta percreta: the placenta penetrates through the myometrium to the uterine serosa
What do C-sections increase the risk of in future pregnancies?
- Placenta praevia
- Placenta accreta
C-sections increase the likelihood of having issues with the site of placental implantation
What is the definition of post-partum haemorrhage?
> 500 ml blood loss
What are the main causes of postpartum haemorrhage?
4 T’s:
Tone: uterine atony (main cause)
Trauma: perineal tears
Tissue: placenta accreta
Thrombin: hypocoagulative state (DIC in aminotic fluid embolism)
Name some obstetric causes of DIC
- Amniotic fluid embolism
- Placental abruption
- Retained products of conception
- Severe preeclampsia
- Sepsis
What is amniotic fluid embolism?
AFE is a rare childbirth (obstetric) emergency in which amniotic fluid enters the bloodstream of the mother to trigger a serious reaction.
Very catastrophic with high mortality rate (86%)
What are the symptoms of AFE?
- ARDS - SoB, hypoxia
- Shock
- Neurological - confusion, coma, seizures
- DIC
Manifests during labour or immediately after but can occur up to 48 hours postpartum
Which haemoglobinopathies are screened for?
- Sickle cell disease
- Alpha thalasaemia
- Beta thalasaemia
How are individuals selected for the haemoglobinopathy screening program
- If from high prevalance area
- Family Origin Questionnaire