perinatal complications
TRANSCRIPT
Perinatal Complications
Amy HuxtableYear 3
Learning outcomes• Overview of Antepartum Haemorrhage (APH)• Pre-eclampsia and it’s sequelae• Tears during labour• When do we c-section?• Postpartum Haemorrhage (PPH)
APHDefinition;“Any vaginal bleed after 24 weeks gestation”
Management
1. ABC2. Cannulate3. Take Blood4. Maternal BP & HR5. Fetal HR
A lady who is 7 months pregnant presents to ED with abdominal pain and vaginal bleeding. She is
brought in by her partner who says she is becoming less responsive very quickly. You
estimate she has lost around 300ml of blood. What is the most likely diagnosis?
A.Normal for pregnancyB.Menstrual periodC. Placental abruptionD.Placenta praveiaE. Post-coital bleeding
Placental Abruption• MEDICAL EMERGENCY• Patient presents with pain• Placenta has detached from uterine wall
Risk factors• Smoking• Clotting disorders• Cocaine use• Previous placental
abruption• Etc..
“Level of shock does not correlate with volume of blood loss”
Placenta Praevia• When the placenta lies close to the internal Os• Usually expectant management
Patient presents with..Painless, bright red bleeding
Investigations• Ultrasound
Bedrest and ‘watchful waiting’In uncomplicated pregnancies
Debate as to whether C-section or Vaginal delivery is best
Causes of Maternal Mortality (MEDCs)
1. Pre-eclampsia2. Thrombosis3. Haemorrhage4. Infection
Pre-eclampsia• Hypertension; 140/90+• Proteinuria 300mg (+++)
• ..can also have oedema of hands and face
Occurs after 20 weeks gestation
Pre-eclampsia Risk Factors
• Nulliparity (or new partner)• Previous pre-eclampsia• Chronic conditions• Family history• Multiple pregnancy• Obesity
Smoking seems to have a protective effect
Investigations• FBC - why?• Urinalysis – PCR• BP• U&Es & LFTS• CTG (every two days)
Symptoms & Management
• Asymptomatic• Headaches, nausea, flu-like symptoms, irritability
Labetalol for BP
However…
Delivery is the only cure
Sequelae of Pre-eclampsia
• Eclampsia• HELLP Syndrome• Renal failure• Liver failure• DIC• Cerebral haemorrhage
Tears during labour• Labial tears• 1st degree tears• 2nd degree tears• 3rd degree tears• 4th degree tears
• Episiotomy
Indications for C-Section
• Malpresentation• Cephalopelvic disproportion• Multiple pregnancy• Failure to progress (failed induction)• Previous c-section• Fetal distress/VLBW• Maternal infection
PPH
• Uterine atony• Genital tract trauma
• Retained placenta
Definition;“Any vaginal bleed of more than 500 ml”
ManagementABCCannulateSend BloodsRub up uterine contractionsGive IV oxytocin
MCQWhich of the following is true of pre-eclampsia?
a) A woman with diabetes prior to pregnancy is more at risk
b) The presence of proteinuria alone makes this diagnosis
c) Pre-eclampsia can be cured with anti-hypertensives
d) Eclampsia is the most common complication of pre-eclampsia
Any Questions?