Vaginal Bleeding

Question 1

Maternal bleeding

Answer 1

Early 0-20 weeks - suspected miscarriage/ ectopic pregnancy
Late gestation 20-40 weeks

Question 2

Miscarriage

Answer 2

Spontaneous loss of pregnancy before baby reaches 24 weeks gestation
Confirmed with ultrasound
Clinicle of hypovalemaic shock
Maternal pad soaked wi in 30 minutes
Total blood loss 500ml+
Hypotension/ tachycardia
Ss of ectopic pregnancy

Question 3

Ectopic pregnancy

Answer 3

Pregnancy implanted outside the uterus
Ss:
Abdo pain
Vaginal bleeding
Nausea
Appetite loss

Question 4

Late gestation bleeding

Answer 4

Vaginal bleeding during pregnancy after 20 weeks gestation
Time critical
Shock may present late

Question 5

Placenta praevia

Answer 5

Can lead to haemorrhage during pregnancy/ labour- placenta implanted near/ covering cervix
Bleeding is usually painless
Bright red
Can be heavy
Tearing of blood vessels close to cervical canal

Question 7

Placenta abruption

Answer 7

Placenta detaches from uterine wall
Can e a result of hypertensive disease / direct trauma
Bleeding accompanied by:
Constant pain/ contractions
Rarely painless

Ss
Aches/ agony
Smoking
Increase by
Substance use
Trauma
Infection

Question 8

Haemorrhage

Answer 8

Revealed - Evident blood loss
Concealed - occurs with in the abdominal/ uterus

Question 9

Postpartum haemorrhage (PPH)
Primary

Answer 9

Blood loss of 500ml or more
Blood less due to hypovalemic shock

Question 10

PPH
Secondary

Answer 10

Excessive bleeding from the birth canal between 24 hours and 6 weeks post birth
Maternal sanitary pad is soaked with in 30 minutes Total blood

Question 11

PPH
4 Ts

Answer 11

Tone
Tissue
Trauma
Thrombosis

Question 12

Management of PPH
EMOTIVE

Answer 12

Early recognition of PPH
Massage the uterus
Oxytocin’s
Txa (drug)
IV access/ fluids as per JRCALC
Extricate and pre alert