Obstetrics: Ectopic Pregnancy and Complications

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Questions and Answers

What is classified as Ante-partum Haemorrhage (APH)?

Bleeding of any amount during pregnancy until delivery

Bleeding amounting to 100ml or more during pregnancy

Bleeding occurring only after the onset of labor

Bleeding of 50ml or more during pregnancy (correct)

What should be done if there is fresh bleeding after 20 weeks of gestation?

Monitor until the next routine checkup

Pre-alert to the nearest obstetric unit (correct)

Investigate the source of bleeding immediately

Contact a midwife for advice

When should a woman be conveyed to a maternity unit based on the flags system?

If she has a history of previous bleeding incidents

If she shows no signs of instability

If she is between 15 and 20 weeks gestation

If she presents with one red flag or two amber flags (correct)

What is an indicator that a woman is unstable and should be sent to the emergency department?

Recent seizure and ongoing life-threatening hemorrhage Signup and view all the answers

In the provided case review, at what time was the blue call (pre-alert) to the nearest obstetric unit made?

18.27 Signup and view all the answers

What immediate action was taken upon the arrival at the obstetric unit?

The maternity team prepared for transfer to the surgical theater Signup and view all the answers

What is a key diagnostic criterion for post-partum hemorrhage (PPH)?

Total blood loss exceeding 500ml after vaginal delivery Signup and view all the answers

What procedure was performed following the mother's admission to the obstetric unit?

Emergency caesarean section Signup and view all the answers

What is a significant risk associated with ectopic pregnancy?

Maternal death Signup and view all the answers

What symptom is NOT typically associated with placental abruption?

Fainting spells Signup and view all the answers

Which factor is known to significantly increase the risk of placental abruption?

Smoking Signup and view all the answers

In which scenario might a woman with a positive pregnancy test be sent home without immediate intervention?

If a baby is not located on scan Signup and view all the answers

What is a common symptom of placenta praevia?

Silent vaginal bleeding Signup and view all the answers

At what gestation period is an ectopic pregnancy most commonly diagnosed?

6-8 weeks Signup and view all the answers

Which of the following is an appropriate way to manage remains after a miscarriage?

Discuss with the woman her preferences Signup and view all the answers

What symptom would likely NOT indicate an ectopic pregnancy?

Increased appetite Signup and view all the answers

What is the primary action to take when a woman shows signs of clinical deterioration after 500mls of blood loss postpartum?

Administer oxygen and fluids based on observations. Signup and view all the answers

Which of the following actions is NOT recommended during the management of postpartum hemorrhage?

Self-administer tranexamic acid without medical advice. Signup and view all the answers

When should a pre-alert to the obstetric unit be required according to the red-amber flag system?

When there are two amber flags or one red flag. Signup and view all the answers

What should be done with any pads or clothing contaminated with blood?

Bring them in for further examination. Signup and view all the answers

Which statement best describes the physiological response of women to blood loss postpartum?

Women compensate well until they reach a critical point of deterioration. Signup and view all the answers

What can cause pregnant women to appear well despite significant blood loss?

Up to 50% additional circulating blood volume Signup and view all the answers

Which of the following is NOT a form of haemorrhage?

Controlled Signup and view all the answers

What is a common cause of late ante-partum bleeding beyond 20 weeks of gestation?

Placental abruption Signup and view all the answers

Which symptom is commonly associated with a miscarriage?

Central, crampy pain or backache Signup and view all the answers

What is NOT a management consideration during a suspected miscarriage?

Providing immediate intravenous fluids Signup and view all the answers

Which medical condition may increase the risk of miscarriage?

Obesity Signup and view all the answers

What is the most critical observation to make in assessing maternal hypotension during a miscarriage?

Evidence of bradycardia Signup and view all the answers

Which of the following is considered a cause of post-partum bleeding?

Retained products of conception Signup and view all the answers

Which factor does NOT contribute to the risk of ante-partum bleeding?

Regular prenatal care Signup and view all the answers

What kind of bleeding can occur within the abdomen or uterus, remaining hidden from view?

Concealed bleeding Signup and view all the answers

Study Notes

Communication and Care Approach

Discuss management of remains sensitively with the woman.
Wrap discernibly formed babies in a maternity towel.
Treat both family and baby with utmost respect and honesty.
Avoid providing false hope if uncertain about medical information.

Ectopic Pregnancy

Occurs when an egg implants outside the uterine wall.
Affects 1-2% of pregnancies, most commonly diagnosed between 6-8 weeks.
Possible late presentation up to 20 weeks.
Can lead to maternal death if untreated.

Signs and Symptoms of Ectopic Pregnancy

Symptoms may include vaginal bleeding, nausea, and lower abdominal pain.
Sharp, one-sided pain and cramping may occur.
Risk increases for women of childbearing age with missed periods and related symptoms.
Fainting or collapsing may indicate severe complications.

Placental Abruption

Refers to partial or complete detachment of the placenta from the uterine wall.
Smoking doubles the risk, along with high blood pressure, substance use, and trauma.
Symptoms include vaginal bleeding (sometimes not externally visible), constant abdominal pain, and a rigid abdomen.

Placenta Praevia

Occurs when the placenta embeds near or over the cervix.
Can cause silent vaginal bleeding that is not associated with pain.

Ante-partum Haemorrhage (APH)

Defined as bleeding during pregnancy (≥ 50ml), regardless of gestational age.
Fresh bleeding after 20 weeks is a red flag requiring immediate attention.

Management of Bleeding Over 20 Weeks

Determine the cause of bleeding, often requires hospital examinations.
Pre-alert nearest obstetric unit if the pregnant woman is unstable.
Initiate intravenous cannulation if paramedics are already present on scene.

Emergency Transport Protocols

One red flag or two amber flags necessitates immediate transport to an obstetric unit.
Stable women ≥ 20 weeks gestation should go to maternity units.
Unstable women or those < 20 weeks gestation should be taken to the emergency department.

Case Review Scenario

A 40-year-old woman with confirmed Vasa Praevia experiences vaginal bleeding on 30+4 weeks.
Rapid response from emergency services leads to timely transfer to obstetric unit and emergency caesarean section.
The infant required NICU care and both mother and baby subsequently discharged home.

Post-partum Haemorrhage (PPH)

Diagnosis involves assessing maternal bleeding following childbirth.
Common causes include uterine atony, trauma, retained tissue, and clotting disorders.

Maternal Physiology in Pregnancy

Physiological changes increase circulating blood volume by 50%, affecting signs of blood loss.
Pregnant and postpartum women may appear stable despite significant blood loss.

Recognition of Haemorrhage

Bleeding may be revealed (visible) or concealed (internal).

Signs of Miscarriage

Commonly involves bleeding (light to heavy) and abdominal pain.
Symptoms can mimic labor pains, with potential for hypotension and bradycardia.

Care During Suspected Miscarriage

Transport pregnancy tissue to hospital if visualized blood loss is significant (≥ 500ml).
Monitor for signs of clinical deterioration regardless of visualized blood loss.

Management of Post-partum Haemorrhage

Fundal massage and IV access should be prioritized.
Administer drugs like tranexamic acid early for severe cases.
Apply gauze to control bleeding from tears, and provide oxygen and fluids per observation.

Learning Points from Incidents

Patients may initially compensate well for blood loss, requiring vigilance in assessment.
Accurate estimation and documentation of blood loss are critical.
Prioritize rapid transfer to obstetric theatre for at-risk patients.
Separate teams should manage both mother and newborn when applicable.

Summary Guidelines

Utilize the Maternal Assessment Card from conception through 4 weeks postpartum.
Any indication of hemorrhage warrants pre-alert to the nearest obstetric unit.
Document all instances of pregnancy and post-partum bleeding for further review.

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Description

This quiz covers critical aspects of ectopic pregnancy, including its management, signs, symptoms, and the associated risks. It also discusses the sensitive communication approach needed when addressing such complications with patients and their families. Test your understanding of these important obstetric conditions.