Aph

Question 1

What is the difference in how the uterus feels for placenta Praevia and abruptio placenta

Answer 1

Abruptio: hard- woody
Praevia: soft

Question 2

What type of pain does abruptio cause?

Answer 2

Sudden abdominal pain and cramps

Question 3

What are the clinical features of placenta Praevia ?

Answer 3

• unstable lie
• fetal heart present
• soft uterus with abdominal presenting part (breech or very high head)

Question 4

What are indications for delivery for placenta Praevia

Answer 4

• electively at 37 weeks
• bleeding
• labour or rupture of the membranes
• fetal compromise
• other conditions eg GPH or IUGR

Question 5

What investigations are necessary for abruptio placenta?

Answer 5

• haemoglobin and haematocrit
• clotting time and platelet count
• full haemtological investigations of clotting time delayed
• blood urea, creatinine, irate
• serum electrolytes
• blood gases
• CTG

Question 6

What necessary resuscitation is necessary for women suffering from abruptio placenta?

Answer 6

• adequate blood transfusion
• 1 unit of fresh frozen plasma for every 2 units of blood
• cryoprecipitate, if fibrogen less than 1 g according to DIC screen

Other supportive measures:

• morphine
• specific blood clotting components or drugs

Question 7

What causes DIC in patients suffering from abruptio?

Answer 7

Release of thromboplastin, causes DIC, depletion of fibrinogen

Question 8

Why is epidural analgesia contra indicated in abruptio?

Answer 8

Contra indicated due to potential coagulopathy and resultant danger of spinal cord compression by blood

Question 9

What are the causes of antepartum haemorrhage?

Answer 9

1. Placenta Praevia
2. Abruptio placenta
3. Show
4. Local lesion of the genital tract
5. Vasa Praevia
6. Ruptured uterus
7. Idiopathic
8. Other source: haematuria, bleeding from a haemorrhoid