Antepartum Haemorrhage (APH) Flashcards Preview

Midwifery Emergencies > Antepartum Haemorrhage (APH) > Flashcards

Flashcards in Antepartum Haemorrhage (APH) Deck (41)
Loading flashcards...
1

What is the definition of APH?

Bleeding from/into the genital tract from 24+0 to the birth of the baby

2

What percentage of women have APH's?

3-5%

3

What percentage of global maternal deaths does it cause?

50%

4

Name 4 causes of APH

Placenta praevia
placental abruption
ruptured vasa praevia
uterine scar rupture

5

What minor things can cause an APH? (6)

Show
Cervicitis
Cervical Polyp
Cervical cancer
Cervical ectropion
Vaginal Trauma

6

What is the definition of placental abruption?

When the placenta detaches from the uterus wall before delivery

7

What are the signs of placental abruption? (8)

Vaginal bleeding (in a revealed) +/- clots
Abdo pain
Hypertonic uterus
Couvelaire uterus (concealed)
Backache
Fetal distress
Maternal shock

8

Name some risk factors for placental abruption (11)

- Pre existing condition
- Previous placental abruption
-Pre-eclampsia
- Fetal growth restriction
- non vertex presentation
-polyhydramnios
-high mat age
-multiparity
-low bmi
-drug misuse
-domestic abuse

9

What percentage of pregnancies have an abruption?

1%

10

What is the recurrence rate of placental abruption?

19-25%

11

What should you never do until placental site is confirmed?

vaginal examination

12

Management of placental abruption (10 steps)

-prioritise mother
-call for help (bell/2222)
-left lateral
-ABC (oxygen, sats, BP, RR, pulse, temp)
-IV access + bloods
-indwelling catheter
-3 Ps - pres part, position, progress
-stabilize mother
-then consider baby

13

What additional blood tests should you do for an abruption?

Blood tests - fbc, clotting, group and save, cross match, kleihauer if RH -

14

What other tests should you do for an abruption? (minus bloods)

MSU + urine
Speculum
USS - placental site

15

What is the definition of placenta praevia?

Placenta praevia is when the placenta is inserted wholly or in part of the lower segment of the uterus

16

How is placenta praevia diagnosed?

USS at 20 weeks, repeat follow ups

17

What percentage of pregnancies does placenta praevia occur in?

0.5-1%

18

What are the two classifications of placenta praevia?

Major- <2cm from or covering cervical os
Minor- >2cm from cervical os

19

What are the 8 signs of placenta praevia?

-Painless bright red vaginal bleeding (may be precipitated by intercourse)
-hx of smaller pv bleeds
-uterus may or may not be contracting
-maternal shock/collapse
-fetal distress
-malpresentation/unstable lie (placenta in the way)
-high head
-check the scan

20

What are the risk factors for placenta praevia? (10)

- prev CS
-prev uterine intrumentation
-high parity
-high mat age
-smoking
-multiple pregnancy
-maternal haemorrhage
-transfusion
-prematurity
-Placenta acreta, increta and percreta

21

What is placenta accreta, increta and percreta?

Placenta attaches too deeply into the uterus so remains after birth
Locations
Accreta - low side
Increta - Side
Percreta- top

22

Causes of placenta praevia (3 sections)

Endometrial scarring, increased placental mass, impeded endometrial circulation

23

What causes endometrial scarring? (3)

-prev lscs or myomectomy (fibroids)
-prev placenta praevia
-Multiparity - placenta likes to change site each pregnancy

24

What causes placental mass? (2)

-placental anomolies (succenturiate lobe or bipartite)
-multiple pregnancy - usually join into one big mass and stay in lower segment

25

What causes impeded endometrial circulation? (5)

Medical conditions (hypertension, diabetes)
Increased maternal age
Uterine tumours
Smoking
Drugs

26

Management of placenta praevia (11 steps)

-prioritise mother
-call for help (bell/2222)
-left lateral
-ABC (oxygen, sats, BP, RR, pulse, temp)
-IV access and bloods- x matched should be available
-Fluid resus
-indwelling catheter
-3 P's- pres part, position, progress
-USS
-stabilise mother
-then baby

27

What percentage of 20/40 scans show low lying placenta?

50%

28

How many placentas stay low after 20/40?

10%

29

What are the 12 potential complications of a severe APH?

- severe anaemia
-infection
-pph
-blood coagulation disorders
-acute renal failure
-sheehans syndrome
-psychological distress/ptsd
-hysterectomy
-fetal hypoxia
-neonatal anaemia/hypovolaemia
-preterm delivery
-intrauterine death

30

Management of severe APH (7)

-catheterise (urometer)
-strict fluid balance
-involve haemotologist
-may need blood products
-EMCS
-may need central line
-uterine rupture - possible hysterectomy