Placental Issues

Question 1

What is placenta praevia?

Answer 1

Placenta lies over internal cervical os

Question 2

What is a “low-lying placenta”?

Answer 2

Placenta low in uterus but does not cover the internal os

Question 3

What is the most important risk factor for placenta praevia?

Answer 3

Previous C sec

Question 4

Give other risk factors for placenta praevia

Answer 4

High parity
>40 years
Multiple preg
Prev PP
Uterine inferion

Question 5

How does placenta praevia classically present?

Answer 5

Painless vaginal bleeding after week 24

Question 6

What is placental abruption?

Answer 6

Some/all of placenta separates from the uterine wall

Question 7

What is vasa praevia?

Answer 7

Foetal blood vessels run near the internal cervical os

Question 8

What is the triad of symptoms in vasa praevia?

Answer 8

vaginal bleeding
membrane rupture
foetal compromise

Question 9

What is uterine rupture?

Answer 9

Full thickness disruption of the uterine muscle and overlying serosa

Question 10

What are the major risk factors for uterine rupture?

Answer 10

Prev C sec
Uterine surgery (eg myomectomy)

Question 11

Which infections may predispose to placenta praevia?

Answer 11

Candida
BV
Chlamydia

Question 12

Which local problems may predispose to placenta praevia?

Answer 12

Polyps
Cervical ectropion
Carcinoma

Question 13

Which test can be performed to determine req’d dose of anti-D?

Answer 13

Kleihauer test

Question 14

What is HELLP syndrome characterised by?

Answer 14

Haemolysis
Elevated Liver enzymes
Low Platelet count

Question 15

What is HELLP syndrome?

Answer 15

Variant of pre-eclampsia

Question 16

What is the main investigation of placenta praevia?

Answer 16

USS

Question 17

What extra investigation should be performed in women >26 weeks gestation with placenta praevia?

Answer 17

CTG

Question 18

How is should a low lying placenta discovered at 24 weeks be managed?

Answer 18

Repeat scan at 36 weeks (as is likely it will sort itself)

Question 19

How should placenta praevia discovered at 24 weeks be managed?

Answer 19

Repeat scan at 32 weeks

Question 20

How should placenta praevia present at 32 weeks be managed?

Answer 20

Delivery by C sec at 38 weeks

Question 21

Within how long of bleeding is anti-D given?

Answer 21

72 hours

Question 22

Which examination should not be performed with placenta praevia?

Answer 22

Digital vaginal

Speculum

Question 23

Outline the pathophysiology of placental abruption

Answer 23

Rupture of maternal vessels at basal layer of endometrium

Bleeds and splits placenta form basal layer

Question 24

What are the two main types of placental abruption?

Answer 24

Revealed

Concealed

Question 25

Describe a revealed placental abruption?

Answer 25

Bleeds down the side of the placental separation and drains through the cervix

Question 26

Describe a concealed placental abruption

Answer 26

Bleed remains in uterus and forms a retroplacental clot

May causes systemic shock

Question 27

What are the main risk factors for placental abruption?

Answer 27

Prev PA
Pre-eclampsia
Abnormal lie
Polyhydramnios
Abdo trauma
Drug use/smoking

Question 28

How does placental abruption present classically?

Answer 28

Sudden onset extreme pain and bleedign

Question 29

How does the uterus feel on examination of placental abruption?

Answer 29

Painful

“Woody” (tense)

Question 30

USS can be used to rule in or out placental abruption true/false

Answer 30

False

Good for ruling in but poor for ruling out

Question 31

How is placental abruption managed?

Answer 31

Induction of labour/emergency delivery

Question 32

When in emergency delivery by C-sec offered in placental abruption?

Answer 32

Maternal or foetal compromise

Question 33

When would induction of labour be offered in placental abruption

Answer 33

No foetal or maternal compromise