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1. How is antepartum haemorrhage defined?
Bleeding from the genital tract after 24 weeks gestation.
2. What are the common causes of antepartum haemorrhage?
undetermined, placental abruption, placenta praevia
3. What are the risk factors for placenta praevia?
previous caesarian section, high parity, twins.
4. On examination what might you expect in placenta praevia?
breech presentation, transverse lie. NEVER perform a vaginal examination in someone with vaginal bleed unless placenta praevia is excluded.
5. you suspect placenta praevia. How do you investigate?
ultrasound. Then perform ctg, full blood count, clotting studies and cross match in case of maternal pph.
6. what is management of placenta praevia?
admission keep blood available, administer steroids til 34 weeks. Deliver at 39 weeks.
7. how is placental abruption defined?
part or all of the placenta separates before delivery.
8. what are the complications of placental abruption
fetal death is common (30%), maternal haemorrhage, DIC, renal failure.
9. what are risk factors of placental abruption?
IUGR, pre-eclampsia, smoking, hypertension, previous abruption
10. what is the most likely cause of painless APH?
11. what is the most likely cause of painful APH?
placental abruption. Often there is pain and no blood.
12. A 24 week pregnant woman presents with painful abdomen. She is tachycardic. Uterus is tender. No vaginal bleeding. What are you concerned about?
Concealed placental abruption
13. What is management for placental abruption?
Maternal: Admission, access with IV fluid, steroids if gestation is under 34 weeks. Blood prepared. Analgesia. Fetal: CTG. Early delivery.
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