Placental Complications

Question 1

define placenta praevia

Answer 1

a placenta overlying the cervical os:

major = covers internal os
minor = leading edge in lower segment but not covering os

Question 2

classifications of placenta praevia

Answer 2

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

Question 3

risk factors of placenta praevia

Answer 3

previous history 
previous C-section
advanced maternal age
increased parity 
smoking/cocaine use in pregnancy

Question 4

clinical features of placenta praevia

Answer 4

bright red vaginal bleed
soft and non-tender uterus
mal-presentation of foetus

Question 5

investigations of placenta praevia

Answer 5

trans-vaginal US

bloods (FBC + crossmatch)

Question 6

management of placenta praevia (unknown position)

Answer 6

admit patient to hospital
ABC approach
urgent US

if uncontrolled bleeding:
immediate C-section + blood transfusion

Question 7

management of placenta praevia (known position)

Answer 7

ABC approach
stabilise

if cannot stabilise:
corticosteroids between 24-34wk gestation
immediate C-section

Question 8

management of placenta praevia (if in labour/term reached)

Answer 8

C-section

Question 9

management of placenta praevia (no bleeding or labour)

Answer 9

monitor with US
advise pelvic rest
advise hospital if vaginal bleeding occurs

Question 10

management of placenta praevia (no bleeding or labour but term reached)

Answer 10

elective C-section

if placental edge >20mm:
offer trial labour and if foetal distress or haemorrhage, immediate C-section

Question 11

define placental abruption

Answer 11

the premature separation of the placenta from the uterine wall during pregnancy - causing maternal haemorrhage

Question 12

types of placental haemorrhage

Answer 12

concealed: haemorrhage confined to uterine cavity
revealed: blood drained through cervix

Question 13

risk factors of placental abruption

Answer 13

maternal trauma 
pre-eclampsia 
multiparity 
increased maternal age 
PMH of placental abruption
MH of coagulation disorder

Question 14

clinical features of placental abruption

Answer 14

severe abdominal pain
'woody' and tense uterus
contractions
vaginal bleeding 
⬇️ foetal movements 
hypovolaemic shock

Question 15

investigations of placental abruption

Answer 15

clinical base but do:
US
bloods (FBC, group, cross-match + coagulants)

Question 16

management of placental abruption (maternal/foetal compromise)

Answer 16

ABCD approach

emergency C-section

Question 17

management of placental abruption (no compromise)

Answer 17

labour induction but ONLY if mother at full-term

Question 18

management of placental abruption (partial or marginal and no compromise)

Answer 18

conservative management

Question 19

define postpartum haemorrhage

Answer 19

a major obstetric haemorrhage causing the loss of >500ml of blood within initial 24hrs post-birth

Question 20

causes of postpartum haemorrhage

Answer 20

poor uterine TONE
TRAUMA during birth
retained TISSUE
THROMBIN issues

Question 21

risk factor of postpartum haemorrhage

Answer 21

previous PPH
BMI >35
multiple pregnancy 
parity >4 
pre-eclampsia 
gestational hypertension
prolonged labour (>12hrs)
increased maternal age

Question 22

clinical features of postpartum haemorrhage

Answer 22

uncontrolled continuous PV bleeding after delivery
swelling and pain in vaginal/perianal tissue

if major PPH:
hypovolaemic shock

Question 23

investigations of PPH

Answer 23

bloods (FBC, cross-match, coagulation)

pelvic US

Question 24

initial management of minor PPH

Answer 24

IV crystalloid infusion

Question 25

initial management of major PPH

Answer 25

resus and ABCD approach

Question 26

mechanical measures in PPH

Answer 26

rubbing uterus to stimulate contraction

catheter of bladder

Question 27

medical management in PPH

Answer 27

5 units IV oxytocin (slow)
0.5mg ergomterine IM or slow IV
0.25mg carboprost IM
1000mcg misoprostol

Question 28

surgical management in PPH

Answer 28

intrauterine balloon tamponade
b-lynch suture
uterine artery ligation
hysterectomy