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Reproduction SOH > Problems in late pregnancy > Flashcards

Problems in late pregnancy Flashcards

1
Q

Bleeding in LATE pregnancy occurs any time after __ weeks gestation?

A

24

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2
Q

Ante partum haemorrhage (APH) - definition

A

Bleeding from the genital tract occurring from 24+0 weeks gestation and prior to the birth of the baby

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3
Q

Name 5 potential causes of APH

A 
Placenta praevia
Placental abruption
Placenta accreata
Uterine rupture
Vasa praevia
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4
Q

Spotting

A

Staining, streaking or blood spotting noted on underwear/when wiping

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5
Q

Minor haemorrhage - APH

A

Blood loss less than 50ml which has now settled

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6
Q

Major haemorrhage - APH

A

Blood loss of 50-1000ml

No signs of clinical shock

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7
Q

Massive haemorrhage - APH

A

Blood loss greater than 1000ml and/or signs of clinical shock

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8
Q

What is heavy show?

A

Mixture of blood and mucous which comes from a woman during labour

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9
Q

Placental abruption - definition

A

Premature separation (either partially or totally) of a normally implanted placenta before the baby is born

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10
Q

Placental abruption - pathogenesis

A

Vasospasm followed by arteriole rupture.
The blood escapes into the amniotic sac or further under the placenta and into the myometrium.
This causes continuous contraction and interrupts placental circulation, causing hypoxia

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11
Q

Placental abruption - clinical features

A

Continuous, severe, abdo pain
Bleeding
Pre-term labour (with heavy show)
Maternal collapse

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12
Q

Placental abruption - signs

A

Uterus

  • Uterine tenderness
  • Woody hard uterus

Foetal parts are difficult to identify
- as the sac is engorged with blood

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13
Q

Placental abruption - investigations

A

Assess foetal heart

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14
Q

What do you use to assess foetal heart?

A

CTG

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15
Q

Investigations are needed to confirm the diagnosis of placental abruption. True or false?

A

False

- clinical diagnosis

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16
Q

Placental abruption - risk factors

A 
Pre-eclampsia 
Hypertension
Trauma - RTA, domestic abuse
Smoking 
Poly-hydramnios 
Multiple pregnancy 
Abnormal placenta 
Previous abruption
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17
Q

Placental abruption - management

A

Resuscitate mother

Rapidly assess and deliver baby

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18
Q

What do you do if no foetal heart is found on CTG?

A

Urgent US

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19
Q

Placental abruption - how do you delivery baby?

A

If baby is alive and seems well –> induction of labour

If baby is alive and seems poorly –> urgent C-section

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20
Q

If a baby has died, you should deliver them by C-section. True or false?

A

False

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21
Q

Placental abruption - maternal complications

A

Hypovolaemic shock
Anaemia
PPH
Renal failure

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22
Q

Placental abruption - foetal complications

A

Intra uterine death
Hypoxia
Prematiurity
SGA

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23
Q

Placenta praevia - definition

A

When the placenta is partially or totally implanted in the LOWER uterine segment (low lying placenta which covers all/part of the entrance aka internal cervical os)

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24
Q

Placenta praevia - what is the lower segment of the uterus?

A

The part of the uterus below the utero-vesical peritoneal pouch superiorly and the internal os inferiorly

25
Q

Lower segment of the uterus contracts during labour. True or false ?

A

False

- passively dilates

26
Q

Major praevia - definition

A

If the placenta lies over the internal cervical os

27
Q

Minor/partial praevia - definition

A

If the leading edge of the placenta is in the lower uterine segment but not covering the internal cervical os

28
Q

Placenta praevia - clinical features

A

Painless bleeding

- this is usually unprovoked but sex can trigger it

29
Q

Placenta praevia - signs

A

Uterus is soft, non tender

Mal-presentations (breech, transverse, oblique)

30
Q

If you suspect someone has placenta praevia, you should do a vaginal exam. True or false?

A

False

- do NOT do a vaginal exam on these patients

31
Q

If an US scan around 20 weeks shows that the placenta extends over the cervix, what should be done?

A

Re-scan patients at 32 weeks

32
Q

Placenta praevia - investigations

A

Transvaginal US scan

MRI (to exclude placenta accreta)

33
Q

Investigations must be done to make a final diagnosis of Placenta praevia. True or false?

A

True

- requires a transvaginal US

34
Q

Placenta praevia - risk factors

A 
Previous caesarean section 
Smoking 
Assisted conception 
Previous placenta praevia 
Asian
Previous TOP 
Advanced maternal age
35
Q

Placenta praevia - management of foetal well being

A

Monitor foetal heart (CTG)
Steroids (24+34+36 weeks)
Magnesium sulphate (24-32 weeks)

36
Q

Placenta praevia - delivery plan if placenta is >2cm from cervical os

A

Aim for vaginal delivery

37
Q

Placenta praevia - delivery plan if placenta is <2cm from cervical os

A

Aim for caesarian section

38
Q

Placenta Accreata - definition

A

Placenta is normally adherent to uterine wall

39
Q

Placenta Accreata - clinical features

A

Severe bleeding

40
Q

Placenta Accreata - risk factors

A

Previous caesarean sections

Placenta praevia

41
Q

Placenta Accreata - management

A

Prophylactic internal iliac artery balloon

42
Q

Uterine rupture - clinical features

A

Severe abdominal pain
Maternal collapse
PV bleeding
Shoulder tip pain (due to blood spreading in the peritoneal cavity and irritating the diaphragm)

43
Q

Uterine rupture - signs

A 
Loss of uterine contractions 
Acute abdomen 
Presenting part of the placenta rises 
Peritonism 
Foetal distress
44
Q

Uterine rupture - risk factors

A

Previous caesarean section
Previous uterine surgery
Multiparity
Use of prostaglandins

45
Q

Uterine rupture - management

A

Surgical management

46
Q

Vas praevia - definition

A

Unprotected foetal vessels traverse the foetal membranes over the internal cervical os

47
Q

Vas praevia - management

A

Steroids from 32 weeks

Delivery baby

48
Q

PPH - definition

A

Post Partum Haemorrhage

Blood loss equal to or exceeding 500ml after the birth of the baby

49
Q

PPH - classification

A

Minor

Major

50
Q

Minor PPH - definition

A

500ml-1000ml blood loss

No clinical shock

51
Q

Major PPH - definition

A

Over 1000ml blood loss or

Signs of CV collapse

52
Q

PPH - types

A

Primary

Secondary

53
Q

Primary PPH - definition

A

Occurs within 24 hours of delivery

54
Q

Secondary PPH - definition

A

Occurs over 24 hours -> 6 weeks post delivery

55
Q

PPH causes

A 
4 T's 
Tone 
Trauma - vaginal tears etc 
Tissue - is there any membrane left inside? 
Thrombin - is there a coagulopathy?
56
Q

PPH - management for stopping the bleeding

A 
Uterine massage 
5 units IV syntocinon stat 40 units 
Foley's catheter 
Ergometrine IV 
Misoprostol 
Tranexamic acid
57
Q

Avoid giving ergometrine to which patients ?

A

Cardiac disease

Hypertension

58
Q

PPH - management of minor PPH

A

IV access

IV warmed crystalloid infusion

59
Q

Active management of the third stage of labour

A

Syntometrine
- combo of oxytocin and ergometrine

Syntocinon

Reproduction SOH (50 decks)

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