8.2 Late Pregnancy Bleeding Flashcards Preview

Woman's Health > 8.2 Late Pregnancy Bleeding > Flashcards

Flashcards in 8.2 Late Pregnancy Bleeding Deck (22)
Loading flashcards...
1
Q

What are the causes of late pregnancy bleeding?

A
  • Pregnancy specific: Placenta praevia, placental abruption, vasa praevia, uterine rupture, morbidly adherent placenta, excessive show (non-pathological)
  • Unrelated: Cervical lesions (polyps/ectropion), trauma to genital tract (e.g. lacerations), lower genital tract infections, genital tract malignancies
2
Q

what is the definition of late pregnancy bleeding?

A

Late pregnancy bleeding is defined as bleeding from the genital tract > 24 weeks gestation until delivery (antepartum haemorrhage/APH)

3
Q

what are maternal complications of late pregnancy bleeding?

A

PPH, anaemia, infection, maternal shock, renal tubular necrosis, consumptive coagulopathy, prolonged hospital stay, psychological sequelae, complications of blood transfusion

4
Q

what are foetal complications of late foetal bleeding?

A

Foetal anaemia & hypoxia, SGA/IUGR, prematurity (iatrogenic/spontaneous), hypoxic ischaemic encephalopathy, foetal death

5
Q

What is the definition of placenta praevia>

A

Placenta praevia is defined as partial or full insertion of the placenta into the lower uterine segment (LUS)

6
Q

what is considered Grade I placenta praevia minor?

A

Placenta encroaches LUS but does not reach cervical os

7
Q

what is considered Grade II placenta praevia minor?

A

Placenta reaches cervical os but does not cover it

8
Q

what is considered Grade III placenta praevia major?

A

Placenta covers part of the cervical os

9
Q

what is considered Grade IV placenta praevia major?

A

Placenta completely covers cervical os

10
Q

which part of the uterus is considered the lower uterine segment?

A

part of the uterus below the vesicouterine fold of peritoneum (need to open it and push down the bladder to visualise LUS in C-sections)

11
Q

what is the clinical presentation of placenta praevia?

A

Placenta praevia presents with bright red, painless, recurrent vaginal bleeding occurring usually near the end of the 2nd trimester (or later):
• Sentinel bleed (first bleeding) is rarely so profuse as to cause death (ceases → recurs)
• Foetal movements and condition are normal
• Other clinical features (eluding to PP): high presenting part, abnormal foetal lie

12
Q

what is the gold standard for diagnosis of placenta praevia?

A

The gold standard for diagnosis is transvaginal ultrasound (TVUS), which is safer and more accurate than transabdominal ultrasound in locating the placenta.

13
Q

what is placenta accreta?

A

Penetrates through

decidua basalis

14
Q

what is placenta increta?

A

Penetrates through myometrium

15
Q

what is placenta percreta?

A

Penetrates through serosa (surrounding uterus)

16
Q

Placental abruption refers to premature separation of a normally sited placenta from the uterine wall → clinical diagnosis:
• Usually associated with constant severe abdominal pain (whereas placenta praevia tends to be painless) → due to infiltration of blood into the ____________
o Features: vaginal bleeding, pain, uterine tenderness & irritability, foetal distress/death, evidence of DIC
• Ultrasound is usually requested to confirm ____________ and exclude ___________

A

myometrium;

foetal viability;

praevia

17
Q

Vasa praevia occurs when the foetal vessels traverse the foetal membranes over the ____________ (below the foetal presenting part) → affects ~1 in 1000 pregnancies:
• Associated with _____________ (vessels run between the main lobe and accessory placental lobe → may rupture when membranes rupture)
• No risk to the mother; significant risk to foetus (50% mortality risk) → unprotected foetal vessels are disrupted when membranes rupture → foetal/APH → foetal distress

A

internal os;

velamentous cord insertion

18
Q

Uterine rupture is a rare but very dangerous condition for both mother and baby, where the uterine wall spontaneously tears and may expel the foetus into the peritoneal cavity:
• Associated with previous uterine surgery (C-sections, myomectomy, D & C if cavity has been breached)
o May occur with no previous uterine surgery when _____________ (to increase intensity and frequency of contractions) is used inappropriately
• Other risk factors: trauma, grand multiparity (> 5 pregnancies before), excessive oxytocin use, ___________ (obstruction in labour), high forceps delivery

A

oxytocin infusion;

shoulder dystocia

19
Q

what is the clinical presentation of uterine rupture?

A
  • Pain over site of uterine scar, vaginal bleeding
  • Disruption of labour: Abnormal cardiotocograph (CTG) → abnormal foetal heartbeat and/or uterine contractions, cessation of uterine contractions, inability to feel the foetal presenting part in the pelvis
  • Hypovolaemic shock: Hypotension, tachycardia, pallor
  • Haematuria (if rupture involves bladder → bleeding into urine)
20
Q

Show is a sign of the early stage of labour where the ________________ (which seals off the cervix and uterus during pregnancy) is expelled due to cervical dilatation:
• May be associated with bleeding (bloody show) → ________________ mucus
• Common harmless cause of bleeding in late pregnancy → careful evaluation is required to exclude other pathological causes of APH (e.g. placental abruption)

A

cervical mucus plug;

blood-tinged

21
Q

Cervical ectropion (ectopy/erosion) occurs when the ____________ exposes the ________________ to the vaginal milieu:
• Common normal finding in pregnancy → exposed columnar epithelium is prone to light bleeding when touched (e.g. coitus, speculum insertion, bimanual examination, cervical specimen obtained for cytology/culture)
• Therapy is usually unnecessary

A

eversion of the endocervix;

columnar epithelium

22
Q

what are cervical causes of bleeding?

A
  • cervical ectropion
  • cervical polyp
  • cervicitis
  • cervical cancer