Obstetrics Flashcards
Define antepartum haemorrhage
A vaginal bleed that occurs after 24 weeks gestation
What is abruptio placenta?
- It is when the normally positioned placenta has separated from the uterus before delivery
- There is continuous severe abdominal pain
- Blood is dark with red clots
- Absence of fetal movement following bleeding
What are the risk factors for Abruptio placenta?
- Previous abruptio placenta (10%; 25%)
- Pre-eclampsia / Hypertensive disorder of pregnancy
- Smoking
- IUGR
- Poor socio-economic circumstances
- History of abdominal trauma
What are the clinical findings in abruptio placenta?
- Patient is shocked out of proportion to blood loss
- Severe abdominal pain
- Tonically contracted hard and tender uterus
- Rigid abdomen
- Fetal parts not palpable
- Uterus big for dates
- Low Hb
What is the classification of abruptio placenta?
- Grade 1 - Small amount of vaginal bleeding and some uterine contractions, no signs of fetal distress or low blood pressure in the mother.
- Grade 2 - Mild to moderate amount of bleeding, uterine contractions, the fetal heart rate may shows signs of distress.
- Grade 3 - Moderate to severe bleeding or concealed (hidden) bleeding, uterine contractions that do not relax (called tetany), abdominal pain, low blood pressure, fetal death.
What is the management of abruptio placenta?
- If in doubt DO NOT PV!
- Certain signs and symptoms of abruptio - PV
- If cervix >9cm - ROM and NVD or emergency C/S
- If fetus not viable - NVD
- While preparing for delivery - resus and intrauterine resus
- If fetal distress + viable fetus - C/S
What is Placenta preavia?
When the placenta is implanted completely or partially in the lower segment of the uterus
What are the risk factors for placenta preavia?
- Grande multiparity (>5)
- Previous C/S
- Multiple pregnancy
- Threatened abortion
- Abnormal presentation
What are the clincal finding of placenta preavia?
- Patient shocked in proportion to blood loss
- Painless bleeding and bright red in colour
- Uterus soft and non-tender
- Fetal parts easily palpated and FH present
- Abnormal presentation
- Fetal head high in cephalic presentation
What is the classification of placenta preavia?
- Minor
Type I - Low-lying placenta - placenta implanted in the lower uterine segment >2cm from the os
Type II - Marginal placenta previa - placental edge at margin <2cm from the internal os - Major
Type III - Partial placenta previa - internal os partly covered by placenta.
Type IV - Complete placenta previa - internal os completely covered by placenta.
What is the management of placenta preavia that is not bleeding?
- <38 weeks and not bleeding
- U/S to localize placentae
- Hospitalized, bed rest, conservative management till 38 weeks / active bleeding
- steroids for lung maturity if >28 and <34
- > 38 weeks
- U/S to localize placentae
- PV in theater if no U/S and C/S
What is the management of placenta preavia that is bleeding?
- > =38 weeks + bleeding
- If actively bleeding - C/S
- Grade 1 - ROM, NVD
- Grade 2 - C/S
- 36 weeks + grade 4 - Emergency C/S
What are the types of Antepartum haemorrhage?
- Abruptio placentae
- Placenta preavia
- Ruptured uterus
- Decidual bleeding
- Vasa Placentae
- Cervical cancer
- Local lesions
- APHUO
What are the causes of Postpartum haemorrhage?
- Primary
- Uterine atony
- Contracted uterus
- Uterine inversion
- Lower genital tract laceration
- Coagulopathy
- Haematoma
- Secondary
- Endometriosis
- Haematoma
- Gestational trophoblastic neoplasm
What is the management of postpartum haemorrhage?
- Prevention
- Refer to higher level of care
- Antepartum correction of anaemia
- Consent for possible hysterectomy
- Counselling regarding sterilization
- Medical
- Uterine atony
- Fundal massage
- Empty bladder
- Oxytocin infusion
- No retained products of conception
- Misoprostol PR
- Prostin
- Surgical
- Local suturing
- Uterine packing
- Subtotal abdominal hysterectomy
- B-lynch suture