OSCE OBGYN > APH > Flashcards

APH Flashcards

(18 cards)

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1
Q

What is APH?

A

PV bleeding from 24 weeks to onset of labour

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2
Q

What are the causes/ddx of APH?

A

Placental Causes:
Previa 30%, Abruption 20%, Morbidly adherent

Fetal Causes:
Vasa Previa

Local Causes 5%
e.g. lesions, trauma etc

Unclassified (45%)

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3
Q

What is the clinical presentation of Placenta previa?

A
  1. often asymptomatic/ found incidentally on US
  2. If PV bleeding - painless, bright red
  3. Uterus is non tender & Smooth
  4. Might have a high fetal presentation
  5. Normal foetal heart sounds
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4
Q

What is the clinical presentation of placental abruption?

A
  1. can be revealed or concealed - if revealed blood tends to be dark red
  2. Painful - abdomen and back pain
  3. Hard wood like uterus and abdomen
  4. Difficult to palpate and difficult to auscultate fetal heart sounds
  5. Tends to be haemodynamically unstable - emergency situation
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5
Q

What are the risk factors for Placenta previa?

A
  1. multi-parity
  2. advanced maternal age

Other:
smoking, prior uterine surgery, prior CS, multiple pregnancy

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6
Q

What are the risk factors of placental abruption?

A
  1. Chronic HTN/ PET
  2. Drugs - cocaine
  3. MVA/ deceleration accident/ trauma
  4. PPROM
  5. chronic chorioamniotitis
  6. multiparity
  7. smoking
  8. past uterine surgery
  9. past hx abruption
  10. maternal thrombophilia
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7
Q

What is the diagnosis of placenta previa?

A

TVUS to locate placenta

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8
Q

how do you diagnose placental abruption?

A

clinical diagnosis
confirmed by delivery of retroplacental clot

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9
Q

What are the complications of placenta previa?

A

maternal:
1. haemorrhage
2. accreta
3. abruption
4. hysterectomy
5. death

fetal:
1. Preterm delivery
2. IUGR
3. Death

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10
Q

What are the complications of placental abruption?

A

coagulopathy
DIC
PPH

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11
Q

Management of APH?

A
  • Immediate:
  • History ans examination
  • IMEWS/ABCD
  • IV line
  • FBC/Coag/X-match 4 units
  • IV Fluids
  • Prepare O negative blood
  • Continuous CTG
  • Call for senior help
  • Delivery:
  • Elective CS 34 weeks if severe placenta previa
  • Emergency CS –severe bleeding abruption
  • Vaginal delivery –fetus already dead
  • Expectant:
  • Antenatal Corticosteroids <36 weeks
  • Admission from viability or as outpatient
  • US at 36 weeks
  • Aim for elective CS at 37 weeks
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12
Q

Examination in APH

A
  • IMEWS –specifically pulse and BP
  • Signs of anemia
  • CS scar –must rule out morbidly adherent placenta previa
  • SFH -<dates? IUGR due to recurrent abruption
  • Uterine tenderness –abruption (wood-like)
  • Lie/presentation –unstable, breech (placenta previa)
  • Vaginal exam is contraindicated in APH unless prior scan excluded placenta previa
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13
Q

Investigations in APH?

A
  • Transvaginal ultrasound + empty bladder to locate placenta (TVUS>TAUS in diagnosis of placenta previa)
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14
Q

Points of note in an APH history?

A
  • Nature of bleeding
  • Amount, more than a period?
  • Flooding
  • Clots
  • Color (bright or dark red, pink/watery, show)
  • Pain (abruption)
  • Abdominal trauma
  • Post coital
  • Setting
  • Recurrent

Smoking, blood pressure (abruption), previous CS (placenta previa)
cervical smear?
* Rhesus status, anti-D
* Position of placenta in anatomy
scan
* Presentation of baby
* Speculum done?
* Antenatal corticosteroids given?
* On iron tablets?
* CTG? Reactive? Location of FH
* Management plan?

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15
Q

What are the indications for immediate delivery in placenta previa?

A
  1. life threatening maternal haemorrhage
  2. non reassuring fetal testing
  3. if at advanced gestational age 34-36 weeks

Ok to hold off till 36-37 if only minor bleed, not recurrent and steroids had not been given

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16
Q

What is morbidly adherent placenta?

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A

abnormal attachment of the placenta to the uterine wall (decidua) such that the chorionic villi invade beyond the endometrium and directly into the myometrium

17
Q

What are the grades of morbidly adherent placenta?

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A
  1. accreta 80% - CV in contact with myometrium
  2. Increta 15% - CV invade myometrium
  3. Percreta 5%- CV invade through myometrium to serosa & beyond
18
Q

What should you warn the patient about before placenta acreta CS?

Study These Flashcards
A

possible need for Caesarean hysterectomy, massive intrapartum haemorrhage, possible need for blood transfusion

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