O&G Written - Obs Emergencies Flashcards
Risk factors for Placental Abruption
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
Planning delivery in placental abruption
<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
Immediate management in placental abruption
A-E resus + ADMIT
- IV fluids + blood products
- Bloods - X match, clotting, FBC
ICU if severe
- Opiate analgesia
- Catheterisation + hourly urine output
Key presenting features of placental abruption
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)
Types of vasa praevia
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)
Typical presentation of vasa praevia
Painless PV bleed + foetal compromise (bradycardia) at ROM
Important rule in investigating PV bleed?
DO NOT perform vaginal exam
- can cause massive haemorrhage
- only if vasa praevia, placenta praevia definitively ruled out!