Placental Insufficiency, APH, and IUGR Lecture Notes

30 question-and-answer flashcards covering links between chronic hypertension, IUGR, and APH; definitions, risk factors, assessments, and communication strategies.

What common underlying problem links chronic hypertension, IUGR, and APH?

Placental insufficiency.

How does chronic hypertension affect the placenta?

It reduces placental blood flow, limiting oxygen and nutrient transfer.

What fetal complication can arise from poor placental perfusion in hypertension?

Intrauterine Growth Restriction (IUGR).

How can IUGR raise the chance of ante-partum haemorrhage?

Placental damage or mal-attachment in IUGR can precipitate placental abruption, causing APH.

Outline the risk cascade beginning with chronic hypertension.

Chronic hypertension → ↑ IUGR risk → ↑ placental abruption/APH, stillbirth, and intervention risk.

Name four overlapping surveillance measures for hypertension, IUGR, and APH.

Blood-pressure checks, fundal-height or growth scans, CTG/fetal-movement assessment, and obstetric/ultrasound reviews.

Which specialties form the shared care approach for these conditions?

Obstetrics, radiology, and neonatology.

Define ante-partum haemorrhage (APH).

Bleeding from the genital tract after 20 weeks’ gestation and before birth.

List four common causes of APH.

Placenta previa, placental abruption, vasa previa, and local cervical/infective bleeding.

Why is APH dangerous for the mother?

It may cause maternal haemorrhage, shock, and the need for emergency caesarean section.

Why is APH dangerous for the fetus?

It can lead to fetal hypoxia, death, or prematurity.

State two key communication points when supporting a woman with APH.

Stay calm/reassuring and explain the need for prompt hospital assessment with a support person.

What examination must be avoided until placental site is known in APH?

Vaginal examination, to prevent provoked bleeding in placenta previa.

List five items you should document when a woman presents with APH.

Amount/colour of bleeding, pain or contractions, fetal movements, maternal observations, and time of presentation.

Who should you liaise with for APH management and why?

Obstetric doctor (management), radiology (placental site), ambulance (if bleeding heavy/unstable).

Give an example of supportive language to explain the plan for APH.

“Once you’re at the hospital, they’ll check your baby and placenta so we can keep you both safe.”

Name four risk factors for placental abruption.

Chronic hypertension, previous C-section/uterine surgery, smoking, and trauma (also advanced age, drugs, multiples).

Briefly describe the pathophysiology of placental abruption.

Decidual vessels rupture → bleeding into decidua → placenta separates → fetal hypoxia and maternal bleeding.

Why does placenta previa bleed in late pregnancy?

Placenta in the lower segment cannot stretch; cervical dilation/contracts shear its edges causing bleeding.

Define Small for Gestational Age (SGA).

Estimated fetal weight below the 10th percentile for gestational age.

How is IUGR distinguished from SGA?

IUGR is pathological restricted growth due to placental insufficiency, often with abnormal Dopplers or low liquor.

List four fetal risks associated with IUGR.

Stillbirth, birth hypoxia, preterm delivery, and neonatal or long-term developmental complications.

Give a supportive statement you might use when explaining IUGR to parents.

“Your baby is measuring smaller than expected, so we’ll do extra tests to check their wellbeing.”

Which routine measurement helps detect IUGR at every visit?

Fundal height plotted on a customised growth chart.

What ultrasound features are assessed when investigating IUGR?

Estimated fetal weight, amniotic fluid volume, and Doppler studies (umbilical, MCA, ductus).

Name three maternal causes of IUGR.

Chronic hypertension, pre-eclampsia, and malnutrition (also smoking, drugs, low BMI, infections, vascular diabetes).

Name three placental causes of IUGR.

Placental insufficiency, abnormal implantation, and placental abruption.

Name two fetal causes of IUGR.

Chromosomal abnormalities and congenital anomalies (also multiple pregnancy).

Summarise the pathophysiology of IUGR.

Poor placental blood flow or maternal ill-health limits oxygen/nutrient delivery, restricting fetal growth and liquor volume.

What key reassurance can you give families about increased IUGR monitoring?

Close surveillance is protective and collaborative, aiming for the safest timing and mode of birth.