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Obstetrics > Intrapartum Care: Placental and Cord Conditions > Flashcards

Intrapartum Care: Placental and Cord Conditions Flashcards

1
Q

What is umbilical cord prolapse

A

when umbilical cord is below presenting part of the foetus

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2
Q

What is umbilical cord prolapse

A

when umbilical cord is below presenting part of the foetus

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3
Q

What are the two types of umbilical cord prolapse

A

occult (incomplete)

overt (complete)

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4
Q

What does occult prolapse also mean

A

incomplete

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5
Q

What is an occult prolapse

A

when umbilical cord descends alongside presenting part of the foetus

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6
Q

What is an overt prolapse also known as

A

complete

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7
Q

What is an overt prolapse

A

when umbilical cord descends below (before) presenting part of the foetus

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8
Q

What is the biggest risk factor for cord prolapse

A

amniotomy

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9
Q

What are 5 risk factors for cord prolapse

A
  1. Amniotomy
  2. Breech
  3. Unstable lie
  4. Polyhydramnios
  5. Pre-maturity
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10
Q

What type of breech is most common for cord prolapse and why

A

Footling - as it is easy for cord to pass by foot

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11
Q

What is an unstable lie

A

Switch between transverse, breech, cephalic.

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12
Q

What are 3 factors that decrease the risk of cord prolapse

A
  1. Cephalic
  2. Nulliparity
  3. Prolonged labour
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13
Q

When should cord prolapse be suspected

A

Abnormal CTG in presence of ruptured membranes

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14
Q

How is cord prolapse confirmed

A

Vaginal exam

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15
Q

what will be seen on CTG in cord prolapse

A

Foetal bradycardia

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16
Q

Define bradycardia on CTG

A

HR <120 for >3-minutes

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17
Q

How can a placenta praevia/abruption be differentiated from cord prolapse on CTG

A

Praevia/abruption will present with bleeding

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18
Q

On CTG there is the presence of foetal bradycardia. On examination the membranes are ruptured. What is going on?

A

Cord prolapse

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19
Q

What does cord prolapse lead to

A

Foetal hypoxia

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20
Q

How does cord prolapse cause ischemia

A
  1. Compression

2. Vasospasm - arteries exposed to outside will undergo vasospasm

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21
Q

Explain management of cord prolapse (6 steps)

A
  1. Call for help
  2. Elevate presenting part
  3. Left lateral position
  4. Avoid handling cord
  5. Tocolytics
  6. Emergency C-Section
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22
Q

why should handling the cord be avoided

A

causes vasospasm

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23
Q

what is given as tocolysis

A

Terbutaline

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24
Q

what is the role of tocolysis

A

Uterine relaxation

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25
Q

what is the prognosis of cord prolapse and why is this thought to occur

A

High mortality - as cord prolapse more common in pre-mature infants with high mortality regardless

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26
Q

what is placental abruption

A

placenta prematurely separates from uterine wall

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27
Q

what is the presenting complaint of placental abruption

A

antepartum haemorrhage

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28
Q

what is antepartum haemorrhage

A

bleeding from 24W until delivery

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29
Q

what is the biggest RF for placental abruption

A

previous abruption

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30
Q

what are 7 RFs for placental abruption

A
  1. Previous abruption
  2. Smoking
  3. Cocaine-use
  4. Pre-eclampsia
  5. Abnormal lie
  6. Polyhydramnios
  7. Thrombophillia
  8. Multiple pregnancy
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31
Q

how does placental abruption present clinically

A

Painful PV Bleed

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32
Q

what will be found on examination in placental abruption

A

Woody uterus

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33
Q

what is a woody uterus

A

Tense painful uterus

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34
Q

explain pathophysiology of placental abruption

A

Rupture of vessels in basal layer of endometrium causes blood to accumulate and placenta to split

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35
Q

what are the two types of placental abruption

A

Revealed

Concealed

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36
Q

what is revealed placental abruption

A

Blood tracks down from site of placental seperation draining through the cervix

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37
Q

what is concealed placental abruption

A

Blood remains in uterus forming a retroperitoneal clot - meaning it is not visible and causes systemic shock

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38
Q

if a major bleed, how should it be approached

A

A-E

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39
Q

what investigations are performed for placental abruption

A 
FBC
G+S, X Match 
Kleinhauer test 
Coagulation studies 
U+E
LFT
40
Q

what is the kleihauer test

A

Use to determine how much someone has bleed if rhesus negative - to determine how much anti-D to give

41
Q

why are LFTs and U+Es ordered

A

Check for HELLP syndrome

42
Q

what is the initial approach to placental abruption

A

A-E

43
Q

when is emergency C-section performed

A

Foetal or maternal compromise

44
Q

when is labour induced for placental abruption

A

Haemorrhage at term - with no maternal or foetal comprise

45
Q

what should be given in 72h of placental abruption

A

anti-D

46
Q

What are the two types of umbilical cord prolapse

A

occult (incomplete)

overt (complete)

47
Q

What does occult prolapse also mean

A

incomplete

48
Q

What is an occult prolapse

A

when umbilical cord descends alongside presenting part of the foetus

49
Q

What is an overt prolapse also known as

A

complete

50
Q

What is an overt prolapse

A

when umbilical cord descends below (before) presenting part of the foetus

51
Q

What is the biggest risk factor for cord prolapse

A

amniotomy

52
Q

What are 5 risk factors for cord prolapse

A
  1. Amniotomy
  2. Breech
  3. Unstable lie
  4. Polyhydramnios
  5. Pre-maturity
53
Q

What type of breech is most common for cord prolapse and why

A

Footling - as it is easy for cord to pass by foot

54
Q

What is an unstable lie

A

Switch between transverse, breech, cephalic.

55
Q

What are 3 factors that decrease the risk of cord prolapse

A
  1. Cephalic
  2. Nulliparity
  3. Prolonged labour
56
Q

When should cord prolapse be suspected

A

Abnormal CTG in presence of ruptured membranes

57
Q

How is cord prolapse confirmed

A

Vaginal exam

58
Q

what will be seen on CTG in cord prolapse

A

Foetal bradycardia

59
Q

Define bradycardia on CTG

A

HR <120 for >3-minutes

60
Q

How can a placenta praevia/abruption be differentiated from cord prolapse on CTG

A

Praevia/abruption will present with bleeding

61
Q

On CTG there is the presence of foetal bradycardia. On examination the membranes are ruptured. What is going on?

A

Cord prolapse

62
Q

What does cord prolapse lead to

A

Foetal hypoxia

63
Q

How does cord prolapse cause ischemia

A
  1. Compression

2. Vasospasm - arteries exposed to outside will undergo vasospasm

64
Q

Explain management of cord prolapse (6 steps)

A
  1. Call for help
  2. Elevate presenting part
  3. Left lateral position
  4. Avoid handling cord
  5. Tocolytics
  6. Emergency C-Section
65
Q

why should handling the cord be avoided

A

causes vasospasm

66
Q

what is given as tocolysis

A

Terbutaline

67
Q

what is the role of tocolysis

A

Uterine relaxation

68
Q

what is the prognosis of cord prolapse and why is this thought to occur

A

High mortality - as cord prolapse more common in pre-mature infants with high mortality regardless

69
Q

Define placental praevia

A

Placenta either partially or completely attaches to lower uterine segment

70
Q

What is the main risk factor for placenta praevia

A

Previous C-Section

71
Q

What are 5 risk factors for placenta praevia

A
  1. Previous C-Section
  2. > 40-years
  3. Previous praevia
  4. Multiple pregnancy
  5. Multiparous
  6. Previous curretage for TOP or miscarriage
  7. Endometritis
72
Q

How will placenta pravia present clinically

A

Antepartum haemorrhage: painless PV bleed

73
Q

What is the different between placenta praavia and abruption in presentation

A 
Praevia = painless
Abruption = painful
74
Q

What are the two types of placenta praevia

A

Major

Minor

75
Q

What is major placenta praevia

A

Placenta covers internal OS

76
Q

What is minor placenta praevia

A

Placenta does not cover internal OS

77
Q

Why is a low-lying placenta more susceptible to haemorrhage

A
  • Poor attachment to uterus: increases risk spontaneous haemorrhage
  • Examination - causes damaged
78
Q

What should never be performed in investigation of placenta praevia

A

Speculum = can damage placenta

79
Q

What investigations are performed for placenta pravia/APH

A 
FBC 
Coagulation studies 
Kleihaur test (Rhesus negative) 
Cross-match 
U+E
LFT
80
Q

If antepartum haemorrhage >26W what should be assessed

A

CTG

81
Q

What imaging is performed in placenta praevia

A

AUS

82
Q

How is placenta pavia first approached

A

A-E approach (as for antepartum haemorrhage)

83
Q

If placenta praevia minor, how is it managed

A

Re-scan at 36W as it is likely placenta has migrated

84
Q

If placenta praevia major, how is it managed

A

Scan at 32W to enable planning

C-section at 38W

85
Q

What should rhesus negative women with placenta praevia be offered

A

anti-D

86
Q

What is vasa praevia

A

Foetal blood vessels attach to chorion opposed to placenta

87
Q

What is the problem with vasa praevia

A

Risk of haemorrhage when sac ruptures

88
Q

How does vasa praevia present clinically

A

PV bleeding following membrane rupture

89
Q

How is vasa praevia managed

A

C-Section

90
Q

What does placenta accreta refer to

A

Abnormal adherence of placenta to uterine wall

91
Q

Define placenta accreta

A

Chorionic villi attach to myometrium opposed to remaining in decidua basalis

92
Q

Define placenta increta

A

Chorionic villi invade myometrium

93
Q

Define placenta percreta

A

Chorionic villi invade perimetrium

94
Q

What is the perimetrium

A

Outer serosal layer of the uterus

95
Q

What are three risk factors for placenta accreta

A
  1. PID
  2. Previous C-section
  3. Previous placenta praevia
96
Q

What is the main complication of placenta accreta and why

A

PPH - due to abnormal separation of placenta from the uterus

Obstetrics (27 decks)

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