Placental Complications Flashcards
define placenta praevia
a placenta overlying the cervical os:
major = covers internal os minor = leading edge in lower segment but not covering os
classifications of placenta praevia
Type I: placenta in lower 1/3rd uterus
Type II: placenta reached edge of cervial os
Type III: placenta partially covers cervical os
Type IV: placenta totally covers cervical os
risk factors of placenta praevia
previous history previous C-section advanced maternal age increased parity smoking/cocaine use in pregnancy
clinical features of placenta praevia
bright red vaginal bleed
soft and non-tender uterus
mal-presentation of foetus
investigations of placenta praevia
trans-vaginal US
bloods (FBC + crossmatch)
management of placenta praevia (unknown position)
admit patient to hospital
ABC approach
urgent US
if uncontrolled bleeding:
immediate C-section + blood transfusion
management of placenta praevia (known position)
ABC approach
stabilise
if cannot stabilise:
corticosteroids between 24-34wk gestation
immediate C-section
management of placenta praevia (if in labour/term reached)
C-section
management of placenta praevia (no bleeding or labour)
monitor with US
advise pelvic rest
advise hospital if vaginal bleeding occurs
management of placenta praevia (no bleeding or labour but term reached)
elective C-section
if placental edge >20mm:
offer trial labour and if foetal distress or haemorrhage, immediate C-section
define placental abruption
the premature separation of the placenta from the uterine wall during pregnancy - causing maternal haemorrhage
types of placental haemorrhage
concealed: haemorrhage confined to uterine cavity
revealed: blood drained through cervix
risk factors of placental abruption
maternal trauma pre-eclampsia multiparity increased maternal age PMH of placental abruption MH of coagulation disorder
clinical features of placental abruption
severe abdominal pain 'woody' and tense uterus contractions vaginal bleeding ⬇️ foetal movements hypovolaemic shock
investigations of placental abruption
clinical base but do:
US
bloods (FBC, group, cross-match + coagulants)
management of placental abruption (maternal/foetal compromise)
ABCD approach
emergency C-section
management of placental abruption (no compromise)
labour induction but ONLY if mother at full-term
management of placental abruption (partial or marginal and no compromise)
conservative management
define postpartum haemorrhage
a major obstetric haemorrhage causing the loss of >500ml of blood within initial 24hrs post-birth
causes of postpartum haemorrhage
poor uterine TONE
TRAUMA during birth
retained TISSUE
THROMBIN issues
risk factor of postpartum haemorrhage
previous PPH BMI >35 multiple pregnancy parity >4 pre-eclampsia gestational hypertension prolonged labour (>12hrs) increased maternal age
clinical features of postpartum haemorrhage
uncontrolled continuous PV bleeding after delivery
swelling and pain in vaginal/perianal tissue
if major PPH:
hypovolaemic shock
investigations of PPH
bloods (FBC, cross-match, coagulation)
pelvic US
initial management of minor PPH
IV crystalloid infusion
initial management of major PPH
resus and ABCD approach
mechanical measures in PPH
rubbing uterus to stimulate contraction
catheter of bladder
medical management in PPH
5 units IV oxytocin (slow)
0.5mg ergomterine IM or slow IV
0.25mg carboprost IM
1000mcg misoprostol
surgical management in PPH
intrauterine balloon tamponade
b-lynch suture
uterine artery ligation
hysterectomy
