Womens Health Flashcards
What is an antepartum haemorrhage
•Bleeding from anywhere within the genital tract after the 24th week of pregnancy
Causes of Antepartum haemorrhage (4)
-low lying placenta/ placenta praevia
-vasa praevia
-minor/major abruption
-infection
What is low lying placenta
Any part of the placenta that has implanted into the lower segment of the uterus
What classes as a major and minor low lying placenta
Major - covering the Os
Minor - in lower segment not covering os
How to diagnose low lying placenta
20 week Ultrasound scan
Repeated at 32 weeks + 36 weeks
Mx of low lying placenta
•Advise to present if pain / bleeding
•Advise to avoid sexual intercourse
•If recurrent bleeds may require admission until delivery and ensuring has cross-match in date
•Remember to give anti-D if Rh negative
•Elective Caesarean section around 37/40
Signs and symtoms of placenta praevia
-painless vaginal bleeding
-light contractions
-lie and presentation of baby maybe abnormal
What is placental abruption
the complete or partial detachment of the placenta before delivery.
Cause of placental abruption
Unknown
Maybe trauma or injury
Risk factors of placental abruption
-maternal aged 35+
-Multiparity (e.g twins)
-pre eclampsia
-smoking during pregnancy
-use of cocaine during pregnancy
-trauma
-Hx of HTN
-Hx of anti phospholipid syndrome
Clinical presentation of placental abruption (5)
-Abdominal pain (most common) – posterior
-placental abruptions may present with back pain
-Vaginal bleeding
-Uterine contractions
-Dizziness and/or loss of consciousness
Clinal findings upon examination for placental abruption
-woody, tense uterus
-fetal heart may be absent or distressed
Investigations for placental abruption
Diagnostic - ultrasound scan to locate the bleed
Other
-vital signs
-FBC
-Clotting profile
-kelihauer test - fetal haemoglobin transferred from fetus to mother
Mx of placental abruption
Foetus alive
-fetal distress - immediate C-section
-no fetal distress - observe closely
Foetus dead - induce signal delivery unless mother heamodynamically unstable - then do C-section
Complications of placental abruption in:
Mother
Foetus
Complications in mother:
-Major haemorrhage
-Shock: can result in Sheehan syndrome - pituitary gland necrosis
-Compression of uterine muscles prevents good contraction of muscles during labour
-disseminated intravascular coagulation (DIC)
-Post-partum haemorrhage
Complications for the fetus:
Placental insufficiency: results in hypoxia and intrauterine growth restriction (IUGR) due to lack of nutrients
-Premature birth
-Stillbirth
What is vasa praevia
Fetal blood vessels (the two umbilical arteries and single umbilical vein) are within the fetal membranes and run across the internal cervical os.
Risk factors for vasa praevia (3)
IVF pregnancy
Multiple pregnancy
Low lying placenta
Sx of vasa praevia
-Painless vaginal bleeding
-Rupture of membranes
-Fetal bradycardia
Investigations for vasa praevia
Diagnostic - ultrasound scan
Others:
Vital signs
FBC
Clotting profile
Kleihauer test
Mx of vasa Praevia (3)
-if found on US then elective casearean section at 34-36 weeks
-corticosteroids given to promote fetal lung maturity
If Antepartum haemorrhage then emergency caesarean
What is pre eclampsia
New high blood pressure in pregnancy with end organ dysfunction usually with proteinuria
Triad of pre eclampsia
Oedema
Proteinuria
Hypertension
Whats the pathology of pre eclampsia
after 20 weeks gestation, when the spiral arteries of the placenta form abnormally (more tangled), leading to a high vascular resistance in these vessels and poor perfusion of placenta.
Leads to oxidative stress in the placenta
Release of inflammatory chemicals into systemic circulation and impaired endothelial function of blood vessels
What is eclampsia
When seizures occur as a result of pre-eclampsia.
What is gestational HTN
Hypertension occurring after 20 weeks gestation, without proteinuria.
High Risk factors for pre eclampsia (5)
Pre existing HTN
HTN before in pregnancy
Existing autoimmune conditions e.g lupus
Diabetes
CKD
