Haemorrhage Flashcards
What is an antepartum haemorrhage?
Bleeding from the vagina >24/40
What condition is an APH associated with?
Cerebral palsy
What are the 2 main causes of an APH?
- Placenta praevia
2. Abruption
What are some other causes of an APH?
- Cervicitis
- Cervical polyp
- Cervical cancer
- Vaginal trauma
What are the 2 classifications of placenta praevia?
Major = <2cm from or covering cervical os Minor = >2cm from cervical os
What are some possible causes of placenta praevia?
- Previous CS (scarring)
- Multiparity
- Multiple pregnancy
- Placental abnormalities
- Uterine tumours
- Smoking and drugs
What are the signs of placenta praevia?
- No pain
- Hard abdomen
- Pv bleeding
- Maternal shock
- Foetal distress
- Malpresentation/ unstable lie
What should never be done in a case of placenta praevia/ abruption?
Vaginal examination
What is vasa praevia?
- Foetal blood vessels within the membranes cover the cervical os
- Associated with velamentous insertion of the cord
What are the signs of placental abruption?
- Pv bleeding
- Abdominal pain
- Irritable/ hypertonic uterus
- Backache
- Foetal distress
- Maternal shock
What are the 3 classifications of uterine rupture?
- Complete - involves whole uterine wall and pelvic peritoneum
- Incomplete - involves myometrium only
- Scar Dehiscence
What are some possible causes of uterine rupture?
- Previous CS
- Hyperstimulation
- Prolonged labour
- Shoulder dystocia
- Difficult 3rd stage
- Placental abruption
What are some signs of uterine rupture?
- Foetal distress/ no FH
- Maternal collapse
- Abdominal pain
- Tachycardia
- Pv bleeding
- Haematuria
- Cessation of contractions
- Shoulder tip pain
What are the 3 categories of PPH?
Minor = 500-1000ml Major = >1000ml Severe = >2000ml
What are the 2 types of PPH?
Primary = within 24 hours of delivery Secondary = 24 hours - 6 weeks after delivery
What is the main clinical sign of a significant haemorrhage?
Tachycardia/ Bradycardia
Hypotension as a late sign
What are the 4 possible causes of PPH?
Tone
Tissue
Thrombin
Trauma
What is the management for a PPH caused by tone?
- Rub up a contraction
- Medication
- Bi-manual compression
What must always be checked during a PPH?
Placenta for completeness
What are the usual drugs used for PPH?
- Syntocinon 10iu IM
- Syntometrine 5iu IM
- 40iu Syntocinon in 500ml N. Saline IV
What are the 3 additional drugs that can be used for PPH?
- Carboprost 250mcg IM (every 15 mins max 8 doses)
- Tranexamic acid 1g IV
- Misoprostol 1mg PR
What is the additional management for a severe PPH?
- Balloon tamponade
- B-lynch suture
- Iliac artery ligation
- Hysterectomy
If the uterus inverts, what should be done immediately?
Manually replace the uterus if possible
What are the 3 abnormal placental implantations?
- Accreta (adheres to endometrium)
- Increta (invades myometrium)
- Percreta (through myometrium into serosa)
What are the 2 treatment options for abnormal placental implantation?
- Conservative (leave in situ and give abx)
2. Surgical (manual removal/ hysterectomy)
What are 3 examples of conditions affecting thrombin?
- Idiopathic thrombocytopenia
- Von Willibrand’s disease
- Thrombophilia
What bloods must be taken for an APH/PPH?
FBC, G+S, Us+Es, LFTs, clotting, X match 4 units
What is the basic management for a haemorrhage?
- Oxygen 15L
- Lie patient in left lateral (APH)/ flat (PPH)
- Keep patient warm
- Catheterise
- Fluids (2L Hartmann’s solution)
- Weigh all swabs for EBL
What is the process of blood clotting called?
Haemostasis
What are the 3 mechanisms of clotting?
- Vasoconstriction
- Aggregation of platelets
- Coagulation
What is DIC?
An acquired disorder of haemostasis (in obstetric patients, is ALWAYS secondary to another condition)
What are some possible complications of DIC?
- Renal failure
- Jaundice
- Cyanosis + difficulty breathing
- Brain damage
- Sheehan’s syndrome
- Hypovolaemia
What is Sheehan’s syndrome?
Necrosis of the pituitary gland
What are some signs of DIC?
- Low platelet count
- Blood not clotting on bed
- Woman continues to bleed when rubbing up a contraction
- Thin, pale blood
Which drug must NOT be given IV and why?
Carboprost - causes tissue damage and sudden drop in BP
What is Von Willibrand’s disease?
Thromin disorder in pregnancy characterised by deficiency of clotting factor V111
What is thrombophilia?
Sticky blood (blood likes to clot)
What is the thrombophilia disorder most commonly seen in obstetrics?
Factor V Leiden
Why are pregnancy women more at risk of a DVT?
- Reduced blood flow
- Hypercoagulability
- Abnormalities to vessel walls
What are the signs of a DVT?
- Pain
- Unilateral swelling
- Redness
- Unusual lumps
How is a DVT treated?
- Low molecular weight heparin
- Pain relief
- Fluids
- TEDs
What are the symptoms of a PE?
- Chest pain
- SOB
- Cough with blood
What is idiopathic thrombocytopenia?
An immune disorder characterised by an unusually low level of platelets, often resulting in bruising and bleeding
What is the management in ANDU for a woman with a pv bleed?
- Ask about pain and movements
- Note colour and amount
- Take bloods (inc. X match)
- SHO speculum
What are the signs and symptoms of uterine inversion?
- Lower abdo/ back pain
- Haemorrhage
- Fundus feels dimpled
- Uterine protrusion through cervix/ seen at introitus
- Shock
