maternal bleeding

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Questions and Answers

What is a common symptom of an ectopic pregnancy?

Chest pains

Vaginal bleeding (correct)

Severe headaches

Frequent urination

Which of the following factors doubles the risk of placental abruption?

Smoking (correct)

Multiple pregnancies

Advanced maternal age

Obesity

What can pregnancy of unknown location (PUL) lead to if not properly monitored?

Preterm labor

Increased chance of a healthy pregnancy

Enhanced fetal growth

Maternal death (correct)

Which symptom is NOT typically associated with placenta praevia?

Painful vaginal bleeding Signup and view all the answers

At what gestational weeks is an ectopic pregnancy most commonly identified?

6-8 weeks Signup and view all the answers

What might a woman with placental abruption experience besides vaginal bleeding?

Abdominal pain Signup and view all the answers

Which of the following is a sign of ectopic pregnancy that may aid in diagnosis?

Pain in the shoulder Signup and view all the answers

How should a family be treated when faced with the loss of a baby?

With respect and sensitivity Signup and view all the answers

What is considered Ante-partum Haemorrhage (APH)?

Bleeding during pregnancy amounting to 50ml or more regardless of gestation Signup and view all the answers

What is the first action to take when heavy bleeding is observed post-birth?

Call for immediate help Signup and view all the answers

Which drug is specifically mentioned for managing postpartum hemorrhage?

Tranexamic acid Signup and view all the answers

Which of the following is a red flag during pregnancy?

Fresh bleeding after 20 weeks of gestation Signup and view all the answers

What procedures should be avoided during the management of postpartum hemorrhage?

Delaying on-scene treatment Signup and view all the answers

When is it appropriate to convey a patient to the maternity unit?

If the woman is stable and at least 20 weeks gestation Signup and view all the answers

What immediate action should be taken if a paramedic is already on the scene and the woman is bleeding?

Cannulation Signup and view all the answers

What should be done with any clothing contaminated with blood during a hemorrhage incident?

Bring them in for documentation Signup and view all the answers

What was the confirmed diagnosis for the 40-year-old patient in the case review?

Vasa previa Signup and view all the answers

When should a pre-alert be initiated for a patient experiencing significant bleeding?

Upon any red flag or two amber flags Signup and view all the answers

What procedure was performed on the patient upon arrival at the obstetric unit?

Emergency caesarean section Signup and view all the answers

What signs indicated that the patient required immediate transport to the ED?

Ongoing life-threatening hemorrhage Signup and view all the answers

What is the significance of the 'blue call' mentioned in the management for bleeding over 20 weeks?

It alerts healthcare facilities about a potential emergency Signup and view all the answers

What physiological change allows maternity patients to appear well even with significant blood loss?

Increased blood volume Signup and view all the answers

Which of the following is NOT a sign or symptom of miscarriage?

Severe hyperventilation Signup and view all the answers

Which type of bleeding involves blood loss that is concealed within the abdomen or uterus?

Concealed bleeding Signup and view all the answers

What form of management is appropriate for a woman experiencing suspected miscarriage?

Transporting pregnancy tissue to the hospital Signup and view all the answers

Which of the following is a cause of late ante-partum bleeding after 20 weeks of gestation?

Placental abruption Signup and view all the answers

What is considered postpartum hemorrhage?

Blood loss occurring from birth to 4 weeks post-partum Signup and view all the answers

Which condition can lead to tissue retention as a cause of postpartum hemorrhage?

Atonic uterus Signup and view all the answers

What proportion of confirmed pregnancies results in miscarriage within the first trimester?

15% Signup and view all the answers

Which of the following factors does NOT influence risk in pregnancy bleeding?

Gender of the child Signup and view all the answers

Which statement about revealed hemorrhage is true?

It usually entails blood loss that is evident. Signup and view all the answers

Study Notes

Ectopic Pregnancy

Occurs when a fertilized egg implants outside of the uterus, typically within the fallopian tubes.
Affects 1-2% of pregnancies.
Most common between 6-8 weeks gestation but can occur as late as 20 weeks.
Can be life-threatening for the mother.

Signs and Symptoms of Ectopic Pregnancy

Vaginal bleeding
Lower abdominal pain
Sharp cramps, often one-sided
Pain in the neck, rectum, or shoulder
Feeling faint or collapsing

Placental Abruption

Partial or complete detachment of the placenta from the uterine wall.
Doubled risk with smoking.
Also more likely in pregnancies with high blood pressure, drug use, trauma, and infections.
Symptoms include vaginal bleeding (may not be visible externally), constant abdominal pain, and a hard, rigid abdomen.

Placenta Praevia

Placenta is embedded near to or over the opening of the womb (cervix).
Can cause "silent" bleeds, meaning vaginal bleeding without pain.

Ante-Partum Haemorrhage (APH)

Defined as vaginal bleeding 50ml or greater during any gestation.
Any fresh bleeding after 20 weeks, regardless of amount, is a red flag.

Management of Bleeding During Pregnancy Greater than 20 Weeks and APH

Determining the cause of bleeding may not be possible in the field.
Pre-alert the nearest obstetric unit.
If the patient is unstable, transport directly to the emergency department.
Cannulate the patient if a paramedic is already on scene.

Red Flags and Amber Flags for Determining Transport Destination

One red flag or two amber flags indicate a time-critical situation.
Transport to a maternity unit with obstetrics on site if the gestational age is 20 weeks or more and the woman is stable.
Transport to an emergency department with obstetrics on site if the gestational age is less than 20 weeks, or if the woman is unstable (e.g., life-threatening hemorrhage, recent seizure, decreased GCS).

Maternal Physiology and Observation in Pregnant and Postpartum Patients

Pregnant and postpartum women have up to 50% additional circulating blood volume.
This means they may appear well, despite having significant blood loss.

Haemorrhage

Haemorrhage can be revealed (evident blood loss) or concealed (within the abdomen or uterus).

Causes of Bleeding During Pregnancy

Early Ante-partum Bleeding (before 20 weeks):
- Miscarriage
- Ruptured ectopic pregnancy
**Late Ante-partum Bleeding (20 weeks to birth): **
- Low-lying placenta
- Placental abruption
- Uterine rupture
- Ruptured vasa praevia
Post-partum Bleeding (from birth to four weeks postpartum):
- Tone (atonic uterus)
- Tear (trauma to the vulva from birth)
- Tissue (retained products)
- Thrombin (clotting disorders)

Miscarriage

Loss of a pregnancy before 24 completed weeks gestation.
The majority of miscarriages occur in the first 12 weeks of pregnancy (1st trimester).
Around 15% of confirmed pregnancies result in miscarriage.

Factors Associated with Increased Miscarriage Risk

Previous miscarriages
Smoking
Obesity
Substance abuse
Maternal Age (over 35)

Signs and Symptoms of Miscarriage

Bleeding; light or heavy, often with clots or jelly-like tissue.
Pain; central, crampy, suprapubic, or dull backache; can be as intense as labor pains.
Hypotension and bradycardia; can indicate cervical shock due to retained tissue in the cervix.

Care During Suspected Miscarriage

Ensure any baby or pregnancy tissue is conveyed to the hospital.

Post-partum Haemorrhage (PPH)

Significant blood loss after childbirth.
It is a common, but potentially life-threatening complication.
Requires prompt diagnosis and management.

Causes of Post-partum Haemorrhage

Uterine atony (the uterus does not contract properly after delivery).
Trauma (tears in the birth canal).
Retained placental tissue.
Clotting disorders.

Recognizing PPH

Visualized blood loss of 500mls or more.
Heavy bleeding post birth that doesn't stop (e.g., saturated inco sheet with 500mls).
Signs of clinical deterioration after birth, regardless of the amount of blood loss observed.

PPH Management

Fundal massage (under direction).
Medications (seek help early).
IV access.
Tranexamic acid.
Use gauze to apply pressure to any tears.
Oxygen and fluids as per observations.
Rapid extrication and conveyance.

Key Learning Points

Maternal Assessment Card should be used from conception to 4 weeks post-partum because physiological changes may alter observation parameters..
One red flag or two amber flags require a pre-alert to the nearest obstetric unit.
Haemorrhage may be revealed or concealed.
Document all pregnancy and post-partum bleeding in a Datix report..

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Description

Test your knowledge about common symptoms of ectopic pregnancy. This quiz will cover typical signs and the implications of this medical condition. Understand better the importance of early detection and management.