Intrapartum Care: Placental and Cord Conditions Flashcards
(96 cards)
1
Q
What is umbilical cord prolapse
A
when umbilical cord is below presenting part of the foetus
2
Q
What is umbilical cord prolapse
A
when umbilical cord is below presenting part of the foetus
3
Q
What are the two types of umbilical cord prolapse
A
occult (incomplete)
overt (complete)
4
Q
What does occult prolapse also mean
A
incomplete
5
Q
What is an occult prolapse
A
when umbilical cord descends alongside presenting part of the foetus
6
Q
What is an overt prolapse also known as
A
complete
7
Q
What is an overt prolapse
A
when umbilical cord descends below (before) presenting part of the foetus
8
Q
What is the biggest risk factor for cord prolapse
A
amniotomy
9
Q
What are 5 risk factors for cord prolapse
A
- Amniotomy
- Breech
- Unstable lie
- Polyhydramnios
- Pre-maturity
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
11
Q
What is an unstable lie
A
Switch between transverse, breech, cephalic.
12
Q
What are 3 factors that decrease the risk of cord prolapse
A
- Cephalic
- Nulliparity
- Prolonged labour
13
Q
When should cord prolapse be suspected
A
Abnormal CTG in presence of ruptured membranes
14
Q
How is cord prolapse confirmed
A
Vaginal exam
15
Q
what will be seen on CTG in cord prolapse
A
Foetal bradycardia
16
Q
Define bradycardia on CTG
A
HR <120 for >3-minutes
17
Q
How can a placenta praevia/abruption be differentiated from cord prolapse on CTG
A
Praevia/abruption will present with bleeding
18
Q
On CTG there is the presence of foetal bradycardia. On examination the membranes are ruptured. What is going on?
A
Cord prolapse
19
Q
What does cord prolapse lead to
A
Foetal hypoxia
20
Q
How does cord prolapse cause ischemia
A
- Compression
2. Vasospasm - arteries exposed to outside will undergo vasospasm
21
Q
Explain management of cord prolapse (6 steps)
A
- Call for help
- Elevate presenting part
- Left lateral position
- Avoid handling cord
- Tocolytics
- Emergency C-Section
22
Q
why should handling the cord be avoided
A
causes vasospasm
23
Q
what is given as tocolysis
A
Terbutaline
24
Q
what is the role of tocolysis
A
Uterine relaxation
25
what is the prognosis of cord prolapse and why is this thought to occur
High mortality - as cord prolapse more common in pre-mature infants with high mortality regardless
26
what is placental abruption
placenta prematurely separates from uterine wall
27
what is the presenting complaint of placental abruption
antepartum haemorrhage
28
what is antepartum haemorrhage
bleeding from 24W until delivery
29
what is the biggest RF for placental abruption
previous abruption
30
what are 7 RFs for placental abruption
1. Previous abruption
2. Smoking
3. Cocaine-use
4. Pre-eclampsia
5. Abnormal lie
6. Polyhydramnios
7. Thrombophillia
8. Multiple pregnancy
31
how does placental abruption present clinically
Painful PV Bleed
32
what will be found on examination in placental abruption
Woody uterus
33
what is a woody uterus
Tense painful uterus
34
explain pathophysiology of placental abruption
Rupture of vessels in basal layer of endometrium causes blood to accumulate and placenta to split
35
what are the two types of placental abruption
Revealed
| Concealed
36
what is revealed placental abruption
Blood tracks down from site of placental seperation draining through the cervix
37
what is concealed placental abruption
Blood remains in uterus forming a retroperitoneal clot - meaning it is not visible and causes systemic shock
38
if a major bleed, how should it be approached
A-E
39
what investigations are performed for placental abruption
```
FBC
G+S, X Match
Kleinhauer test
Coagulation studies
U+E
LFT
```
40
what is the kleihauer test
Use to determine how much someone has bleed if rhesus negative - to determine how much anti-D to give
41
why are LFTs and U+Es ordered
Check for HELLP syndrome
42
what is the initial approach to placental abruption
A-E
43
when is emergency C-section performed
Foetal or maternal compromise
44
when is labour induced for placental abruption
Haemorrhage at term - with no maternal or foetal comprise
45
what should be given in 72h of placental abruption
anti-D
46
What are the two types of umbilical cord prolapse
occult (incomplete)
| overt (complete)
47
What does occult prolapse also mean
incomplete
48
What is an occult prolapse
when umbilical cord descends alongside presenting part of the foetus
49
What is an overt prolapse also known as
complete
50
What is an overt prolapse
when umbilical cord descends below (before) presenting part of the foetus
51
What is the biggest risk factor for cord prolapse
amniotomy
52
What are 5 risk factors for cord prolapse
1. Amniotomy
2. Breech
3. Unstable lie
4. Polyhydramnios
5. Pre-maturity
53
What type of breech is most common for cord prolapse and why
Footling - as it is easy for cord to pass by foot
54
What is an unstable lie
Switch between transverse, breech, cephalic.
55
What are 3 factors that decrease the risk of cord prolapse
1. Cephalic
2. Nulliparity
3. Prolonged labour
56
When should cord prolapse be suspected
Abnormal CTG in presence of ruptured membranes
57
How is cord prolapse confirmed
Vaginal exam
58
what will be seen on CTG in cord prolapse
Foetal bradycardia
59
Define bradycardia on CTG
HR <120 for >3-minutes
60
How can a placenta praevia/abruption be differentiated from cord prolapse on CTG
Praevia/abruption will present with bleeding
61
On CTG there is the presence of foetal bradycardia. On examination the membranes are ruptured. What is going on?
Cord prolapse
62
What does cord prolapse lead to
Foetal hypoxia
63
How does cord prolapse cause ischemia
1. Compression
| 2. Vasospasm - arteries exposed to outside will undergo vasospasm
64
Explain management of cord prolapse (6 steps)
1. Call for help
2. Elevate presenting part
3. Left lateral position
4. Avoid handling cord
5. Tocolytics
6. Emergency C-Section
65
why should handling the cord be avoided
causes vasospasm
66
what is given as tocolysis
Terbutaline
67
what is the role of tocolysis
Uterine relaxation
68
what is the prognosis of cord prolapse and why is this thought to occur
High mortality - as cord prolapse more common in pre-mature infants with high mortality regardless
69
Define placental praevia
Placenta either partially or completely attaches to lower uterine segment
70
What is the main risk factor for placenta praevia
Previous C-Section
71
What are 5 risk factors for placenta praevia
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
How will placenta pravia present clinically
Antepartum haemorrhage: painless PV bleed
73
What is the different between placenta praavia and abruption in presentation
```
Praevia = painless
Abruption = painful
```
74
What are the two types of placenta praevia
Major
| Minor
75
What is major placenta praevia
Placenta covers internal OS
76
What is minor placenta praevia
Placenta does not cover internal OS
77
Why is a low-lying placenta more susceptible to haemorrhage
- Poor attachment to uterus: increases risk spontaneous haemorrhage
- Examination - causes damaged
78
What should never be performed in investigation of placenta praevia
Speculum = can damage placenta
79
What investigations are performed for placenta pravia/APH
```
FBC
Coagulation studies
Kleihaur test (Rhesus negative)
Cross-match
U+E
LFT
```
80
If antepartum haemorrhage >26W what should be assessed
CTG
81
What imaging is performed in placenta praevia
AUS
82
How is placenta pavia first approached
A-E approach (as for antepartum haemorrhage)
83
If placenta praevia minor, how is it managed
Re-scan at 36W as it is likely placenta has migrated
84
If placenta praevia major, how is it managed
Scan at 32W to enable planning
| C-section at 38W
85
What should rhesus negative women with placenta praevia be offered
anti-D
86
What is vasa praevia
Foetal blood vessels attach to chorion opposed to placenta
87
What is the problem with vasa praevia
Risk of haemorrhage when sac ruptures
88
How does vasa praevia present clinically
PV bleeding following membrane rupture
89
How is vasa praevia managed
C-Section
90
What does placenta accreta refer to
Abnormal adherence of placenta to uterine wall
91
Define placenta accreta
Chorionic villi attach to myometrium opposed to remaining in decidua basalis
92
Define placenta increta
Chorionic villi invade myometrium
93
Define placenta percreta
Chorionic villi invade perimetrium
94
What is the perimetrium
Outer serosal layer of the uterus
95
What are three risk factors for placenta accreta
1. PID
2. Previous C-section
3. Previous placenta praevia
96
What is the main complication of placenta accreta and why
PPH - due to abnormal separation of placenta from the uterus
