placental abruption, placenta praevia + placenta accreata

Question 1

what- placental abruption?

Answer 1

Separation of a normally implanted placenta from the wall of the uterus - partially or totally before the birth of the fetus

Question 2

risk factors- placental abruption?

Answer 2

-cocaine use
-trauma
-pre eclampsia
-multiple pregnancies
-increasing maternal age
-smoking
-abnormal placenta

Question 3

presentation- placental abruption?

Answer 3

-sudden onset of continuous abdominal pain + bleeding (bleeding may be concealed)
-Woody hard uterus (suggests a large haemorrhage)
-abnormal CTG indicating fetal abnormalities

Question 4

management of placental abruption?

Answer 4

Fetus alive and < 36 weeks:
-Fetal distress: immediate caesarean
-No fetal distress: observe closely, steroids, no tocolysis, threshold to deliver depends on gestation

Fetus alive and > 36 weeks:
-Fetal distress: immediate caesarean
-No fetal distress: deliver vaginally

Fetus dead:
-induce vaginal delivery

Question 5

what is placenta praevia?

Answer 5

when the placenta lies directly over the internal os

Question 6

what is a low lying placenta?

Answer 6

when the placenta is within 20mm of the internal cervical os

Question 7

what are the top 3 causes of antepartum haemorrhage?

Answer 7

-placental abruption
-placenta praevia
-vasa praevia

Question 8

when should placenta praevia be picked up?

Answer 8

it should be picked up at 20 weeks at mid trimester scan

-if low lying placenta or PP detected then it should be rescanned at 32 and 36 weeks

Question 9

risk factors for placenta praevia?

Answer 9

-Previous C section
-Termination of pregnancy
-Advanced maternal age
-smoking
-assisted conception

Question 10

Presentation of placenta praevia?

Answer 10

usually picked up at 20 week anomaly scan

-painless bleeding usually in third trimester

Question 11

investigations- placenta praevia?

Answer 11

usually picked up at routine 20 weeks scan

if low lying placenta or pp found- rescan at 32 and 36 weeks

-transvaginal USS

Question 12

what exam should NOT be performed until placenta pravia is ruled out?

Answer 12

vaginal exam should NOT be performed until pp has been ruled out- it may cause a severe haemorrhage

Question 13

management- placenta praevia?

Answer 13

C section if placenta covers os or <2cm from os

Vaginal delivery if placenta >2cm from os and no malpresentation

Question 14

what- vasa praevia?

Answer 14

Where the fetal vessels are within the fetal membranes (chorioamniotic membranes) and travel across the internal cervical os.

Question 15

what are the fetal vessels?

Answer 15

2 umbilical arteries and 1 umbilical vein

Question 16

what protects the fetal vessels ?

Answer 16

-the fetal vessels (2 umbilical arteries and single umbilical vein) are found within the umbilical cord which inserts directly into the placenta

-the umbilical cord contains Wharton’s jelly (soft connective tissue) which protects the vessels

-so they are either protected by the placenta or umbilical cord

Question 17

what is Velamentous umbilical cord ?

Answer 17

-where the umbilical cord inserts into the chorioamniotic membranes, and the fetal vessels travel unprotected before joining the placenta

Question 18

what is an accessory lobe of the placenta?

Answer 18

An accessory lobe of the placenta (also known as a succenturiate lobe) is connected by fetal vessels that travel through the chorioamniotic membranes between the placental lobes.

Question 19

type 1 vasa praevia?

Answer 19

the fetal vessels are exposed as a velamentous umbilical cord

Question 20

type 2 vasa praevia?

Answer 20

the fetal vessels are exposed as they travel to an accessory placental lobe

Question 21

risk factors for vasa pravia?

Answer 21

-low lying placenta
-IVF pregnancy
-multiple pregnancy

Question 22

investigations vasa praevia?

Answer 22

can be picked up on US at 20 weeks

Question 23

presentation vasa praevia?

Answer 23

Will rupture during labour or at amniotomy - sudden dark red bleeding

Question 24

management of vasa praevia?

Answer 24

steroids from 32 weeks
emergency C section