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YEAR 3 REVISION > Haemorrhage > Flashcards

Haemorrhage Flashcards

1
Q

What is an antepartum haemorrhage?

A

Bleeding from the vagina >24/40

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2
Q

What condition is an APH associated with?

A

Cerebral palsy

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3
Q

What are the 2 main causes of an APH?

A
  1. Placenta praevia

2. Abruption

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4
Q

What are some other causes of an APH?

A
  • Cervicitis
  • Cervical polyp
  • Cervical cancer
  • Vaginal trauma
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5
Q

What are the 2 classifications of placenta praevia?

A 
Major = <2cm from or covering cervical os
Minor = >2cm from cervical os
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6
Q

What are some possible causes of placenta praevia?

A
  • Previous CS (scarring)
  • Multiparity
  • Multiple pregnancy
  • Placental abnormalities
  • Uterine tumours
  • Smoking and drugs
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7
Q

What are the signs of placenta praevia?

A
  • No pain
  • Hard abdomen
  • Pv bleeding
  • Maternal shock
  • Foetal distress
  • Malpresentation/ unstable lie
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8
Q

What should never be done in a case of placenta praevia/ abruption?

A

Vaginal examination

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9
Q

What is vasa praevia?

A
  • Foetal blood vessels within the membranes cover the cervical os
  • Associated with velamentous insertion of the cord
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10
Q

What are the signs of placental abruption?

A
  • Pv bleeding
  • Abdominal pain
  • Irritable/ hypertonic uterus
  • Backache
  • Foetal distress
  • Maternal shock
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11
Q

What are the 3 classifications of uterine rupture?

A
  1. Complete - involves whole uterine wall and pelvic peritoneum
  2. Incomplete - involves myometrium only
  3. Scar Dehiscence
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12
Q

What are some possible causes of uterine rupture?

A
  • Previous CS
  • Hyperstimulation
  • Prolonged labour
  • Shoulder dystocia
  • Difficult 3rd stage
  • Placental abruption
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13
Q

What are some signs of uterine rupture?

A
  • Foetal distress/ no FH
  • Maternal collapse
  • Abdominal pain
  • Tachycardia
  • Pv bleeding
  • Haematuria
  • Cessation of contractions
  • Shoulder tip pain
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14
Q

What are the 3 categories of PPH?

A 
Minor = 500-1000ml
Major = >1000ml
Severe = >2000ml
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15
Q

What are the 2 types of PPH?

A 
Primary = within 24 hours of delivery
Secondary = 24 hours - 6 weeks after delivery
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16
Q

What is the main clinical sign of a significant haemorrhage?

A

Tachycardia/ Bradycardia

Hypotension as a late sign

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17
Q

What are the 4 possible causes of PPH?

A

Tone
Tissue
Thrombin
Trauma

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18
Q

What is the management for a PPH caused by tone?

A
  • Rub up a contraction
  • Medication
  • Bi-manual compression
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19
Q

What must always be checked during a PPH?

A

Placenta for completeness

20
Q

What are the usual drugs used for PPH?

A
  • Syntocinon 10iu IM
  • Syntometrine 5iu IM
  • 40iu Syntocinon in 500ml N. Saline IV
21
Q

What are the 3 additional drugs that can be used for PPH?

A
  • Carboprost 250mcg IM (every 15 mins max 8 doses)
  • Tranexamic acid 1g IV
  • Misoprostol 1mg PR
22
Q

What is the additional management for a severe PPH?

A
  • Balloon tamponade
  • B-lynch suture
  • Iliac artery ligation
  • Hysterectomy
23
Q

If the uterus inverts, what should be done immediately?

A

Manually replace the uterus if possible

24
Q

What are the 3 abnormal placental implantations?

A
  • Accreta (adheres to endometrium)
  • Increta (invades myometrium)
  • Percreta (through myometrium into serosa)
25
Q

What are the 2 treatment options for abnormal placental implantation?

A
  1. Conservative (leave in situ and give abx)

2. Surgical (manual removal/ hysterectomy)

26
Q

What are 3 examples of conditions affecting thrombin?

A
  • Idiopathic thrombocytopenia
  • Von Willibrand’s disease
  • Thrombophilia
27
Q

What bloods must be taken for an APH/PPH?

A

FBC, G+S, Us+Es, LFTs, clotting, X match 4 units

28
Q

What is the basic management for a haemorrhage?

A
  • Oxygen 15L
  • Lie patient in left lateral (APH)/ flat (PPH)
  • Keep patient warm
  • Catheterise
  • Fluids (2L Hartmann’s solution)
  • Weigh all swabs for EBL
29
Q

What is the process of blood clotting called?

A

Haemostasis

30
Q

What are the 3 mechanisms of clotting?

A
  1. Vasoconstriction
  2. Aggregation of platelets
  3. Coagulation
31
Q

What is DIC?

A

An acquired disorder of haemostasis (in obstetric patients, is ALWAYS secondary to another condition)

32
Q

What are some possible complications of DIC?

A
  • Renal failure
  • Jaundice
  • Cyanosis + difficulty breathing
  • Brain damage
  • Sheehan’s syndrome
  • Hypovolaemia
33
Q

What is Sheehan’s syndrome?

A

Necrosis of the pituitary gland

34
Q

What are some signs of DIC?

A
  • Low platelet count
  • Blood not clotting on bed
  • Woman continues to bleed when rubbing up a contraction
  • Thin, pale blood
35
Q

Which drug must NOT be given IV and why?

A

Carboprost - causes tissue damage and sudden drop in BP

36
Q

What is Von Willibrand’s disease?

A

Thromin disorder in pregnancy characterised by deficiency of clotting factor V111

37
Q

What is thrombophilia?

A

Sticky blood (blood likes to clot)

38
Q

What is the thrombophilia disorder most commonly seen in obstetrics?

A

Factor V Leiden

39
Q

Why are pregnancy women more at risk of a DVT?

A
  1. Reduced blood flow
  2. Hypercoagulability
  3. Abnormalities to vessel walls
40
Q

What are the signs of a DVT?

A
  • Pain
  • Unilateral swelling
  • Redness
  • Unusual lumps
41
Q

How is a DVT treated?

A
  • Low molecular weight heparin
  • Pain relief
  • Fluids
  • TEDs
42
Q

What are the symptoms of a PE?

A
  • Chest pain
  • SOB
  • Cough with blood
43
Q

What is idiopathic thrombocytopenia?

A

An immune disorder characterised by an unusually low level of platelets, often resulting in bruising and bleeding

44
Q

What is the management in ANDU for a woman with a pv bleed?

A
  • Ask about pain and movements
  • Note colour and amount
  • Take bloods (inc. X match)
  • SHO speculum
45
Q

What are the signs and symptoms of uterine inversion?

A
  • Lower abdo/ back pain
  • Haemorrhage
  • Fundus feels dimpled
  • Uterine protrusion through cervix/ seen at introitus
  • Shock

YEAR 3 REVISION (49 decks)

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