abruption

Question 1

what is abruption?

Answer 1

separation of placenta from endometrial wall causes bleeding

Question 2

what are the risk factors for abruption?

Answer 2

Previous placental abruption
Pre-eclampsia
Bleeding early in pregnancy
Trauma (consider domestic violence)
Multiple pregnancy
Fetal growth restriction
Multigravida
Increased maternal age
Smoking
Cocaine or amphetamine use

Question 3

what is Polyhydramnios?

Answer 3

excess of amniotic fluid surrounding the fetus, often found during routine scans

Question 4

what are the symptoms of abruption?

Answer 4

• 3/3 very painful and continous pain
• Pv dark red bleed
• hard woody uterus ( suggesting large haemmorage)
• often pain is not proportional to apparent blood loss ( due to occult blood)

Question 5

how is abruption diagnosed

Answer 5

USS- to rule out vasa previa
but the ultrasound for abruption is likely normal
more of a clinic diagnosis

Question 6

what is the treatment for abruption

Answer 6

if stable- observe
if mother or fetus in distress- CAT 1 c- section

Question 7

what are the complications of aruption?

Answer 7

• DIC - blood clots form throughout the body, blocking small blood vessels.
• prematurity
• M-F distress- CAT 1- C section
• increased risk of pph

Question 8

what is vasa previa

Answer 8

the vessels ( 2 umb arteries and 1 umb vein) are placed over internal cervical os, before the fetus.- these vessels are unprotected- prone to bleeding

Question 9

what are the two types of vasa previa

Answer 9

Type I vasa praevia – the fetal vessels are exposed as a velamentous umbilical cord
Type II vasa praevia – the fetal vessels are exposed as they travel to an accessory placental lobe

Question 10

what is type 1 vasa previa

Answer 10

Velamentous umbilical cord is where the umbilical cord inserts into the chorioamniotic membranes, and the fetal vessels travel unprotected through the membranes before joining the placenta.

Question 11

risk factors for vasa previa?

Answer 11

in IVF, placenta previa, multi preg

Question 11

what is type 2 vasa pevia

Answer 11

An accessory lobe of the placenta connected by fetal vessels that travel through the chorioamniotic membranes between the placental lobes.

Question 12

what are the symtpoms of vasa previa

Answer 12

bright painless heavy PV bleed 3/3 simultaneously to rupture of membranes

Question 13

how is vasa previa diagnosed?

Answer 13

USS- shows the arteries presenting ( not reliable)

Question 14

what is the treatment for vasa previa?

Answer 14

• Corticosteroids, given from 32 weeks gestation to mature the fetal lungs
• Elective caesarean section, planned for 34 – 36 weeks gestation