PROM, Prem labour and antepartum haemorrhage Flashcards
Within what time period must a mother be given anti-D prophylaxis following a placental abruption (if they are found to be rhesus -)
72 hours
When can CTG be carried out on a baby?
What is the alternative?
When they are >26 weeks old
Auscultation of the fetal heart
INVESTIGATIONS IN ANTEPARTUM HAEMORRHAGE
a) what bloods?
b) what biochemistry?
a) FBC, G&S, Cross match if you suspect the patient may require a transfusion, Clotting, Kleihauer test
b) Biochem is to rule out pre-eclampsia or HELLP syndrome, LFTs and U&Es
What is Kleihauer test
It is a test to assess the amount of blood that has entered the fetal circulation and calculates the amount of anti-D that should be given
What are the 3 main types of management of placental abruption?
Conservative, emergency delivery and induction of labout
When is emergency delivery considered to be required for the management of placental abruption?
When there is fetal or maternal compromise
May be indicated if there has been fetal death but there is maternal compromise
Unless spontaneous delivery is imminent
When is induction of labour considered for the management of placental abruption?
When there is no fetal or maternal compromise and haemorrhage has occurred at term
When is conservative management considered for the management of placental abruption?
When the abruption is partial or marginal and there is not maternal or fetal compromise (this is dependent on the gestation and amount of bleeding)
Transvaginal ultrasound can be used to assess placental abruption but is should NOT be used to EXCLUDE abruption - why not?
Because it had a poor negative predictive value
The reason why it is useful is because it has a good positive predictive value
What is the definition of an antepartum haemorrhage?
A vaginal bleed from week 24 until delivery
What is placenta praevia?
What are the 2 types? Describe them
Where the placenta is fully or partially attached to the lower uterine segment
Minor or major
Minor - placenta is low but doesn’t lie over the internal cervical os
Major lies over the internal cervical os
What can trigger bleeding in a placenta praevia?
Mild trauma e.g vaginal examination
What is the main risk factor for placenta praevia?
C section
What are other risk factors for placenta praevia?
High parity
Multiple pregnancy
Maternal age >40
Previous placenta praevia
History of uterine infection (endometritis)
Curettage to the endometrium after miscarriage or termination
What is the difference between the terms gravidity and parity?
Gravity is the number of pregnancies, regardless of their outcome
Parity is the number of liveborn children the woman has delivered