Placenta Preavia

Question 1

Define antepartum haemorrhage?

Answer 1

Any bleed from the genital tract occurring after 20+0 weeks gestation and before the birth of the baby

Question 2

State five differentials for APH presentation?

Answer 2

Placenta praevia
Placental abruption
Cervical carcinoma
Cervical polyp
Cervical ectropian

Question 3

Clinically how would you differentiate between placental abruption vs placenta praevia?

Answer 3

Presence/absence of constant pain - Abruption = pain as myometrium is infiltrated with blood causing irritation and possible contractions
O/E - Abdo palpation with abruption = uterine tenderness and contractions. With praevia uterus is SNT

Question 4

State four essential points needed from a presentation of APH history?

Answer 4

1. Amount of bleeding
2. Pain?
3. Mucoid discharge?
4. Trigger event - i.e sexual intercourse (?ectropian)

Question 5

What examinations should be carried out in a presentation of APH?

Answer 5

Abdominal palpation
Speculum examination - confirm the source of bleeding
NO digital examination

Question 6

Which 8 investigations should be carried out?

Answer 6

FBC (coag screen)
U&E
LFT
TFT
Group+save
X-match
CTG
U/S - check position of placenta

Question 7

Define placenta praevia?

Answer 7

Placenta is implanted (partially/fully) within the lower uterine segment and lies below the presenting part of the foetus
Minor = 3cm next to cervical os
Major = covering the cervical os

Question 8

Why is a low-lying placenta not clinically worrying within early/mid pregnancy?

Answer 8

The lower uterine segment grows within the 3rd trimester and often the placenta shifts upwards - An U/S scan should be conducted at 28 weeks to confirm

Question 9

Name four risk factors associated with placenta praevia?

Answer 9

Multiparous
Previous C-section
Smoking
Multiple pregnancy

Question 10

Describe the symptoms and signs commonly seen with placenta praevia?

Answer 10

Unprovoked PV bleeding WITHOUT pain often occurring within the 3rd trimester and in the absence of labour
O/E - on palpation the uterus is soft non-tender

Question 11

Name three maternal complications from APH?

Answer 11

Shock
Anaemia
DIC

Question 12

Name two foetal complications from APH?

Answer 12

Hypoxia

IUD

Question 13

Define placental abruption?

Answer 13

When part/all the placenta separates before the delivery of the foetus

Question 14

Describe the signs and symptoms experienced with placental abruption?

Answer 14

Unprovoked PV bleeding WITH abdominal pain
Degree of PV bleeding may not reflect the extent of haemorrhage due to a possible concealed haemorrhage (presentation may be shock)
O/E - Tachycardia/hypertension. Uterus is tender and hard
Contractions may be felt

Question 15

Name four risk factors associated with placental abruption?

Answer 15

IUGR
Pre-eclampsia
Smoking
Previous abruption