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25 Cards in this Set
- Front
- Back
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def: antepartum hemorrhage
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any bleeding from the genital tract after 20w gestation
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causes of APH
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placenta previa (31%)
abruptio placentae (22%) others: marginal, show, cervicitis, trauma, ectropion, endocervical polyps, vulvovaginal varicosities, genital tumors, genital infections, hematuria, vasa previa |
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def: placenta previa
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placenta inserted into lower uterine segment
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classifications and grades of placenta previa
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minor: grades 1 & 2
- in the lower segment of uterus but doesn't cover internal cervical os major: grades 3 & 4 - covering the internal cervical os |
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Why does low lying placenta incidence drop with increased gestational age?
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Change in placental position is due to enlargement of the upper segment and formation of the lower uterine segment.
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causes and associations of placenta previa
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etiology unknown
assoc'd with: age parity previous LUSCS (more increases risk) cigarette smoking previous previa (4-8% recurrence risk) |
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placenta previa: maternal risks
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hemorrhage (ante, intra, or postpartum)
anesthetic/surgical risk post-partum sepsis (PPH and post-partum sepsis due to inadequate occlusion of sinuses in LUS) |
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placenta previa: fetal risks
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preterm delivery
IUGR congenital malformations malpresentation fetal death in utero (FDIU) fetal anemia umbilical cord Cx (prolapse, compression) |
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def: abruptio placentae
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placental separation prior to delivery
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abruptio placentae: types of presentation
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revealed - PV bleeding
concealed - bleeding w/o evidence of PV bleeding (abdo pain or stiff uterus only) |
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abruptio placentae: associations
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parity
smoking blunt trauma to abdo (eg. seatbelt) spontaneous ROM in the setting of polyhydramnios & multiple pregnancy ECV (external cephalic version) placental abnormalities (esp. circumvallate placenta) pre-eclampsia |
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abruptio placentae: maternal risks
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mortality
recurrence hypovolemia acute renal failure PPH hemorrhagic shock DIC fetomaternal hemorrhage --> Rh sensitization |
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abruptio placentae: fetal risks
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perinatal mortality
IUGR congenital abnormalities fetal anemia transient coagulopathies |
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def: vasa previa
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where vessels of umbilical cord course through membranes in front of presenting part of fetus before insertion into the placenta
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APH Hx questions
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initiating and associated factors
amt and character (eg. intermittent or profuse) of bleeding assoc'd w/abdo pain or regular painful uterine tightening? hx of ruptured membranes hx of previous vag bleeding known gestational age placental site fetal mvmts |
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APH examination
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vitals
evidence of shock (restlessness, cold clammy extremities, poor skin perfusion, goosebumps/pilo-erector response) abdo exam speculum/vag exam (only if placental site is known) |
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Apt test
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qualitative test to determine if bleeding is fetal or maternal
(supernatant treated w/NaOH; pink = fetus, yellow-brown = adult) |
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APH Ix
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CTG (only if of viable gestation)
if non-viable age, use Doppler for fetal heart FBE coag studies X-match Kleihauer-Betke US (to check for placental site) |
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APH immediate Mx
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use team approach (eg. pediatrician, hematologist)
IV access with wide bore cannula (14-16G preferably) blood tests IV fluid resus IDC consider CVC anti-D (if Rh negative) |
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APH: When to immediately deliver fetus?
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once initial resus has occurred, but there is ongoing life-threatening maternal bleeding
non-reassuring fetal state at viable gestation |
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APH: When to perform immediate delivery for preterm fetus?
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evidence of fetal compromise, even if bleeding has settled
recurrent life-threatening bleeding pre-term APH which results in FDIU where bleeding has settled (give corticosteroids to mom to prevent RDS) |
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APH: When to delay delivery until term?
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if placenta previa and bleeding is non-threatening or settles and fetal state is reassuring
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what to do for a stable fetus with placenta previa
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admit to hospital and monitor with regular FBE and x-match
avoid coitus supplemental Fe if necessary corticosteroids to prevent RDS deliver by C-section with CURRENT x-match ready |
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what to do for stable fetus with mild abruptio placentae
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induction of labor at 38w gestation
monitor mother during labor: IV access, FBE, x-match, and continuous CTG monitoring |
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what to do for stable mother and fetus with unexplained APH
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regular fetal monitoring
FBE Fe supplements as necessary avoid coitus induce labor if no contraindications with x-match monitor during labor with continuous CTG |
