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Obs/Gynae > Obstetric Hemorrhage > Flashcards

Obstetric Hemorrhage Flashcards

1
Q

Define obstetric hemorrhage ?

A

This encompasses bleeding that can occur at any stage during pregnancy, delivery or puerperium period.

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2
Q

Which conditions form the triad of maternal mortality?

A

Hemorrhage
Sepsis
Pre-eclampsia-Eclampsia

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3
Q

What are the risk factors for obstetrics hemorrhage?

A

Abnormal placentation (placenta previa, placenta abruption, ectopic pregnancy)
Birth canal injuries (Forcep/vacuum delivery, Caesarean delivery)
Obstetric factors (Previous post partum haemorrhage, preeclampsia/ eclampsia)
Vulnerable patients (chronic renal insufficiency, constitutionally small size)
Uterine atony ( uterine over distension, multiple foetuses, hydramnios)
Coagulation Defects (HELLP, massive transfusions, prolonged retention of dead foetus)

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4
Q

Define Antepartum hemorrhage ?

A

This refers bleeding from the genital tract at 28 weeks or more of gestation but before the onset of labour.

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5
Q

What is the initial approach to managing a obstetric hemorrhaging patient.

A

Call for help! Mobilise staff to initiate maternal resuscitation!
Maternal resuscitation includes;
General patient evaluation & vital sign check
IV access with 2 large bore cannulae
Foley catheter placement to monitor urine output
Send blood for FBC, U&Es, Cr, clotting time and cross matching
Heavy bleeding order 2 units each of packed red blood cells, fresh frozen plasma/ 2 units of whole blood.
Ultra sound scan to determine foetal condition and to rule out placenta previa

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6
Q

What are the differentials for antepartum bleeding?

A

Obstetric causes
-Placental: Placenta previa ,placental abruption, vasa previa
-Maternal: Uterine Rupture
-Fetal: Fetal vessel Rupture

Non-obstetrics causes
-Cervical : Severe cervicitis, polyps, cervical dysplasia/cancer
-Vaginal/vulvar: Lacerations, varices, Cancer
-Other : Hemorrhoids, congenital bleeding disorder, abdominal and pelvic trauma, hematuria

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7
Q

Define Placenta Previa? And when along the the pregnancy does it usually occur?

A

Implantation of the placenta near or over the cervical opening.
3rd trimester

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8
Q

What are the risk factors of placenta previa?

A

-Advanced age
-Multiparity
- Multiple gestation
-Prior caesarian section
-Substance abuse-(smoking and illicit drug use)
-Prior history of placenta previa

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9
Q

What can placenta previa complicate to and how is it related to caesarian section?

A

-It may complicate into placenta accreta, increta and percreta

-In presence of placenta previa, risk of acreta increases with increase in number of previous c/s
1C + PP= 3%
2C + PP =10%
3C +PP= 40%
4C + PP = 60%

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10
Q

Describe the classification of placenta previa?

A

MINOR -
1-(Low-lying Placenta)Placenta encroaches lower uterine segment, but does not reach the internal Os.
2-(Marginal)-Placenta reaches the internal Os but does not cover it.
MAJOR -
3-(Partial) -Placenta partially covers the internal Os.
4-(Complete) -Placenta completely covers the internal Os.

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11
Q

What are the history/physical exam findings in Placenta Previa?

A

-Painless par vaginum bleed
-Relaxed uterus
-Abnormal Lie, or high presenting part
-Present fetal heart sounds

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12
Q

What investigations to do in Placental Previa?

A

FBS and Vital signs?

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13
Q

What is the management of placenta previa?

A
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14
Q

Define Placenta Abruption?

A

When the placenta separates partly or completely from the uterus before delivery of foetus. Hence blood accumulates behind placenta or is lost via cervix.

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15
Q

What are the types of placenta Abruption?

A

Concealed and Revealed.

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16
Q

What are the risk factors for placental abruption?.

A

previous placental abruption
advanced maternal age
multiparity
diabetes mellitus + HTN
cocaine use + Smoking
Pre-eclampsia

16
Q

What is the most common cause of abruptio placenta? And explain it.

A

Couvelaire -is when the collection of blood from the abruption infiltrates the myometrium up to the serosa especially the cornua. Giving the myometrium a bluish purple tone.

17
Q

What are the the history/physical exam findings in placenta abruption?

A
18
Q

What is the classification of Placenta Abruption ?

A
  1. Asymptomatic patient with a small retroplacental clot.
    1.Vaginal bleeding =/- Uterine tetany and tenderness (No signs of maternal shock + No fetal distress)
  2. External vaginal bleeding possible
    (No signs of maternal shock and signs of fetal distress)
  3. External bleeding possible; marked uterine tetany and persistent abdominal pain (+maternal shock, fetal demise (3a) and coagulopathy defect (3b) )
19
Q

What is the first clinical sign of placenta abruption.

A

Fetal distress

20
Q

What are the history/physical findings of placenta abruption?

A

-Vaginal Bleed
-Tense/tender uterus
-Decreased/absent fetal movements
-Fetal distress/absent fetal heart
-Possible shock

21
Q

Investigations in placenta abruptio?

A

FBC
G&M

22
Q

Management of Placenta Abruptio?

A
23
Q

Define Uterine Rupture?

A

Involves a full thickness disruption of the uterine wall.
Can be present in antenatal period, but is more common during labor.
Often during 3rd trimester of pregnancy.

24
Q

What are the risk factors of uterine rupture?

A

-A prior caesarean section
-Injudicious use of oxytocin
-Overdistended uterus- (macrosomia, polyhydraminos ,multiple fetus)
-Grand Multiparity
-Abnormal fetal lie
-Trauma

25
Q

What are the history/physical findings of Uterine Rupture?

A

-Tenderness over previous uterine scar sites
- Abnormal contour
-Tender abdomen
-Easily palpable fetal parts
- +/- Absent fetal movements/heart sounds
-Possible shock from hypovolemia/APH

26
Q

What are the investigations of Uterine Rupture?

A

FBC &G &M

27
Q

Define Vasa Previa?

A

Vasa previa is a rare but serious pregnancy complication characterized by fetal blood vessels that run across or very close to the internal opening of the cervix

28
Q

Management of Uterine Rupture?

A

-Emergency Laparotomy, to repair the uterine rupture. If not possible then hysterectomy.
- In cases of uterine repair counsel the patient that all subsequent deliveries are to be C/S
-Patient should also seek early antenatal care at Central Hospital
-Document operative findings in health passport.

29
Q

What are the risk factors for vasa Previa?

A

Velamentous Cord Insertion
Bilobed or Succenturiate Lobed Placenta
In Vitro Fertilization (IVF): Pregnancies achieved through IVF have a higher incidence of vasa previa compared to natural conception.
Multiple Pregnancies: Due to the potential for abnormal placental arrangements.
Low-Lying Placenta
Previous History of Vasa Previa

30
Q

What are the types of vasa previa?

A

Type I Vasa Previa:The umbilical cord is inserted into the membranes instead of directly into the placenta. The fetal blood vessels then run within the amniotic membranes, directly over or close to the cervix.
Type II Vasa Previa: This type involves a placenta that has two or more lobes, with fetal blood vesselsconnecting these lobes. These vessels flow over or near the cervix, posing a risk during delivery
Type III Vasa Previa: In this less common form, one or more large vessels run through the membranesalong the margin of the placenta and are located at the internal cervical opening. This type can often be seen in cases where a placenta previa has resolved

31
Q

What are the signs seen in Vasa Previa?

A
  1. Painless Vaginal Bleeding: The bleeding may be dark red(fetal blood)
  2. Fetal Distress: Abnormal fetal heart rate(continuous fetal monitoring).
32
Q

What tests done in Vasa Previa and what do thy indicate?

A
  1. Speculum: Presence of fetal blood vessels crossing over or near the cervical opening(confirms diagnosis)
  2. Ultrasound Findings: Ultrasound critical in diagnosing vasa previa. A transvaginal ultrasound may show blood vessels running across the cervix(Definitive sign of the condition)
33
Q

What is the goal in management of Vasa Previa?

A

Goal is to prolong the pregnancy while planning for an early delivery to minimize risks

34
Q

How do you manage Vasa Previa?

A

Scheduled Cesarean Delivery(34 and 37 weeks of gestation, to prevent the rupture of blood vessels during labor)
Corticosteroids: Mature baby’s lungs if early delivery is anticipated.
Increased Monitoring: Hospitalize for close monitoring If there are additional risk factors or symptoms like vaginal bleeding or contractions.
Pelvic Rest: Avoiding sexual intercourse and inserting anything into the vagina to reduce the risk of complications.

Obs/Gynae (16 decks)

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