Obstetrics

Question 1

Antepartum Haemorrhage definition?

Answer 1

Antepartum haemorrhage (APH) is usually defined as bleeding from the birth canal after the 24th week of pregnancy. It can occur at any time until the second stage of labour is complete; bleeding following the birth of the baby is postpartum haemorrhage.
(patient.info)

Question 2

Antepartum Haemorrhage Causes

Answer 2

Placental Abruption

• Tender, tense uterus
• Maternal shock out of keeping with visible blood loss
• Pain
• Distressed fetal heartbeat
• RF’s include HTN, trauma, Vasoconstrictor drugs e.g. cocaine/crack, infection

Placenta Praevia

• No pain
• Fetal lie may be abnormal

Vasa Praevia (Foetal blood vessels crossing the os)

• Bleeding following rupture of membranes
• Fetal bradycardia common
• Small risk to mother but high foetal mortality

Women with suspected APH should not undergo vaginal examination in primary care- if it is Placenta Praevia this may cause a bleed.

Question 3

Placenta Accreta

• definition?
• risks?
• RF’s?

Answer 3

Placenta penetrates through decidua basalis and through the myometrium

Risks of postpartum haemorrhage

RF’s:

• previous caesarean section
• placenta praevia

Question 4

Eclampsia

Answer 4

Eclampsia may be defined as the development of seizures in association pre-eclampsia. To recap, pre-eclampsia is defined as:
condition seen after 20 weeks gestation
pregnancy-induced hypertension
proteinuria

Magnesium sulphate is used to both prevent seizures in patients with severe pre-eclampsia and treat seizures once they develop. Guidelines on its use suggest the following:
should be given once a decision to deliver has been made
in eclampsia an IV bolus of 4g over 5-10 minutes should be given followed by an infusion of 1g / hour
urine output, reflexes, respiratory rate and oxygen saturations should be monitored during treatment
treatment should continue for 24 hours after last seizure or delivery (around 40% of seizures occur post-partum)