Antepartum and Postpartum Haemorrhage Practise Flashcards

Comprehensive practice questions covering types, symptoms, diagnosis, and management of antepartum and postpartum haemorrhage based on lecture notes.

How is Antepartum haemorrhage (APH) defined?

Vaginal bleeding occurring after $20$ weeks' gestation ($MSD = 24$ weeks).

Why are placental causes of antepartum haemorrhage considered the most worrying?

They potentially endanger the lives of both the mother and the fetus and often involve more severe bleeding.

What must be documented to make extrauterine pregnancy an unlikely cause of bleeding?

An intrauterine pregnancy.

What uterine size is expected at $20$ to $22$ weeks of gestation during abdominal examination?

The uterus should be palpable at the level of the umbilicus.

What do uterine firmness, rigidity, and tenderness suggest in a bleeding patient?

Placental abruption.

What is the crucial rule regarding digital cervical examination in cases of APH?

Avoid digital cervical examination until placenta previa has been excluded by imaging.

What test is used for Rh(D) negative mothers to determine the dose of anti-D Ig needed?

Kleihauer-Betke test.

Which medications are used for expectant management of stable preterm patients to improve neonatal outcomes?

Corticosteroids (e.g., betamethasone) for fetal lung maturity and Magnesium sulfate for fetal neuroprotection.

What is the clinical triad for Vasa previa?

Painless vaginal bleeding, fetal distress (especially after rupture of membranes), and fetal blood present in the vaginal bleeding.

What defines Placental abruption?

The separation of a normally situated placenta (upper segment of the uterus) before delivery.

What is a 'Couvelaire uterus'?

A condition found in $70\%$ of placental abruption cases where blood intravasates through the myometrium to the serosal surface, giving the uterus a bluish or purple appearance.

How does the uterus typically feel in a concealed placental abruption?

Hard or "wooden" in consistency.

What are the three types of Placenta previa?

Partial Previa (partially covers os), Complete/Total Previa (fully covers os), and Low-Lying Placenta (implanted in the lower uterine segment but does not reach the os).

What is the gold standard for diagnosing placenta previa?

Ultrasound (Transabdominal for initial screening, and Transvaginal for more accurate measurement).

What test distinguishes fetal hemoglobin from maternal blood in cases of suspected vasa previa?

The Apt test (fetal hemoglobin is resistant to alkali denaturation).

What is the primary difference between Primary and Secondary Postpartum haemorrhage (PPH)?

Primary PPH is blood loss $> 500\,ml$ within the first $24$ hours; Secondary PPH is excessive bleeding from $24$ hours up to $6$ weeks postpartum.

What is the most common cause ($90\%$) of Postpartum haemorrhage?

Uterine atony.

Which PPH medication is contraindicated in patients with asthma?

$PGF2\alpha$ (Hemabate) due to the risk of bronchospasm.

Which PPH medication should be avoided in patients with hypertension or cardiac disease?

Ergometrine.

What is the pathophysiology of Sheehan Syndrome?

Severe PPH leads to hypovolemic shock, causing ischemia and necrosis of the enlarged pituitary gland, resulting in panhypopituitarism.

What are the three types of Placenta Accreta Spectrum (PAS)?

Placenta Accreta (attaches to myometrium), Placenta Increta (invades myometrium), and Placenta Percreta (penetrates through myometrium into serosa or adjacent organs).

What is the strongest risk factor for Placenta Accreta Spectrum?

Previous Cesarean sections.