O&G Written - Obs Emergencies Flashcards

1
Q

Risk factors for Placental Abruption

A

ABRUPTION

Abruption (previously)
Blood pressure - HTN, PET
Ruptured membranes - prolonged, premature
Uterine injury
Polyhydramnios
Twins
Infection - chorioamnionitis
Older maternal age (>35)
Narcotics - cocaine, meth

+ Smoking, multiparity

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2
Q

Planning delivery in placental abruption

A

<34 weeks gestation + both stable –> monitor on ward + give steroids

> 37 weeks + no foetal compromise –> IOL with amniotomy

  • close foetal monitoring
  • CS if distress

Severe haemorrhage or foetal distress –> EMCS

Foetal death –> IOL + blood products

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3
Q

Immediate management in placental abruption

A

A-E resus + ADMIT

  • IV fluids + blood products
  • Bloods - X match, clotting, FBC

ICU if severe

  • Opiate analgesia
  • Catheterisation + hourly urine output
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4
Q

Key presenting features of placental abruption

A

Pain - severe, constant with exacerbations

PV bleed - dark if visible, may be ‘concealed’

Tender, contracting uterus + ‘woody’ if severe

Maternal shock - out of keeping with visible loss (esp. if concealed)

Tachycardia, hypotension in profound - massive blood loss

Foetal HR abnormalities or absence (distress or death)

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5
Q

Types of vasa praevia

A

Type 1 - velamentous umbilicus inserts into foetal / chorioamniotic membranes instead of centre of foetus

Type 2 - bilobed placenta with thin chorion tissue connecting (‘succenturiate’ lobe if 1 is much smaller)

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6
Q

Typical presentation of vasa praevia

A

Painless PV bleed + foetal compromise (bradycardia) at ROM

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7
Q

Important rule in investigating PV bleed?

A

DO NOT perform vaginal exam

  • can cause massive haemorrhage
  • only if vasa praevia, placenta praevia definitively ruled out!
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