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1. How is antepartum haemorrhage defined?
Bleeding from the genital tract after 24 weeks gestation.
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2. What are the common causes of antepartum haemorrhage?
undetermined, placental abruption, placenta praevia
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3. What are the risk factors for placenta praevia?
previous caesarian section, high parity, twins.
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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.
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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.
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6. what is management of placenta praevia?
admission keep blood available, administer steroids til 34 weeks. Deliver at 39 weeks.
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7. how is placental abruption defined?
part or all of the placenta separates before delivery.
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8. what are the complications of placental abruption
fetal death is common (30%), maternal haemorrhage, DIC, renal failure.
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9. what are risk factors of placental abruption?
IUGR, pre-eclampsia, smoking, hypertension, previous abruption
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10. what is the most likely cause of painless APH?
placenta praevia
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11. what is the most likely cause of painful APH?
placental abruption. Often there is pain and no blood.
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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
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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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