Please enable JavaScript.

Coggle requires JavaScript to display documents.

CRS 2 : Abdominal pain in early pregnancy, CRS 2 : Obs Per Vaginal…

- - - - -Recurrent painless per vaginal bleed
        
        associated sx : abdominal pain, uterine contractions, leaking liquor
        
        symptoms of anaemia
        
        any trigger ? after sexual intercourse, vaginal discharge
        
        fatal movement
      - VE is contraindicated
    - - Multiparity
        
        increased maternal age
        
        prior placenta previa
        
        multiple gestation
        
        caesarian delivery
    - - Attachment site
        
        Placenta Accrete : attachment superficial
        
        placental Increte : extends into myometrium partially
        
        placenta percreta : through myometrium trying to the serous surface
      - Grading
        
        low lying placenta
        
        Marginal
        
        Partial
        
        Complete PP ( major )
    - - Diagnostic
        
        Ultrasound to confirm placenta site
  - - - Abrupt onset of vaginal bleeding
        
        Painful vaginal bleeding
        
        Constant abdominal/back pain
        
        Reduced foetal movement
        
        Uterine tenderness
    - - MATERNAL
        
        Previous history of placenta abruptio
        
        Hypertension or pre-eclampsia
        
        Abdominal trauma (MVA)
        
        Smoking
      - FETAL
        
        Multiple pregnancy
        
        Polyhydramnios
        
        Premature rupture of membrane
    - - Diagnosed clinically
        
        Class 0: Asymptomatic
        
        Diagnosis is made retrospectively
        
        Discovery of a blood clot on the maternal side of a delivered placenta
        
        Class 1: Mild
        
        No sign of vaginal bleeding or a small amount of vaginal bleeding.
        
        Slight uterine tenderness
        
        Maternal blood pressure and heart rate within normal limits
        
        No signs of fetal distress
        
        Class 2: Moderate
        
        No sign of vaginal bleeding to a moderate amount of vaginal bleeding
        
        Significant uterine tenderness with tetanic contractions
        
        Change in vital signs: maternal tachycardia, changes in blood pressure.
        
        Evidence of fetal distress
        
        Clotting profile alteration: hypofibrinogenemia
        
        Class 3: Severe
        
        Tetanic uterus/ board-like consistency on palpation
        
        Maternal shock
        
        Clotting profile alteration: hypofibrinogenemia and coagulopathy
        
        Fetal death
      - FBC (anaemia)
        
        Coagulation profile (TRO bleeding disorder)
    - - Maternal hemodynamics are unstable and fetal heart present
        
        Emergency LSCS
      - Maternal hemodynamics are stable and fetal heart present or absent (IUD)
        
        Induction of labor with amniotomy
      - Supplemental oxygen if needed
        
        Assess maternal haemodynamic status and fetal well-being
        
        Resuscitation of fluid and blood if required
    - - Premature separation of normally sited placenta from the uterus
- - - - usually asymptomatic
        
        HMB, intermestrual bleed , post- menopausal, post-coital bleed
        
        vagina discharge ( white/ yellow )
    - - premenopausal
        multiparous
        
        previous history of UTI
        
        history of cervical polyps
    - - diagnostic :
        
        Vaginal Speculum Examination
        
        cervical cytology
    - - narrow-based
        
        removed by twisting the polyp off base ( polypectomy)
      - broader-based
        
        removed with cautery or other modalities that can control bleeding after removal
    - - types :
        
        ectocervical : in outermost layer of cervix
        
        endocervical : growth in cervical canal ( common )
  - - - *emergency caesarean section + exploratory laparotomy (diagnosis)
        
        large bore of IV saline + blood transfusion
        
        uterine repair
        
        hysterectomy (if significant injury)
    - - Trauma
        
        Overstretching
        
        Uterine abnormality
        
        Previous surgical procedure
        
        Multiparity
        
        VBAC
        
        Prolonged IOL
    - - Triad of:
        
        Sudden constant abdominal pain
        
        Cessation of uterine contraction
        
        Fetal distress
      - Signs of major obstetric haemorrhage:
        
        tachypnoiec
        
        tachycardic
        
        hypotension
      - vaginal bleeding
    - - Palpation:
        
        abdominal tenderness
        
        fetal part easily palpable
        
        change of uterus shape
      - CTG:
        
        fetal bradycardia
        
        abnormal/cessation of contraction
      - VE:
        
        os closed
        
        fetal part may not be palpable
    - - FBC (Hb & HCT): assess blood loss
        
        Imaging (USS)
- - - - maternal
        
        vital signs, contraction chart, labor progress chart, pad chart
      - fetal
        
        CTG, fetal kick chart
    - - fetal lung maturation (IM dexamethasone 12mg BD 12 hours apart)
    - - indications = allow course of steroid to be given to mother, facilitate transfer of undelivered mother to a unit for proper care
        
        oral CCB nifedipine OR IV atosiban
      - contraindication
        
        gestation > 34 weeks
        
        labor is too advanced (>4cm dilated)
        
        antepartum hemorrhage
        
        chorioamnionitis
        
        fetal death/ lethal abnormalities
        
        maternal / fetal condition requiring immediate delivery (severe preeclampsia, abruptio, IUGR)
    - - only if labor is confirmed, IV ampicillin 2g stat & 1g 4 hourly
- - - - Type 1 (vasa previa with velamentous cord insertion)
      - Type 2 (vasa previa with a bilobed placenta)
    - - Placenta previa/low-lying placenta
        
        Previous caesarean section
        
        IVF
        
        Multiple pregnancies
        
        Previous surgeries on uterus
    - - Painless vaginal bleeding
        
        Rupture of membranes
        
        Fetal bradycardia
    - - Transvaginal ultrasonography:
        
        fetal vessels can be seen within the membranes passing directly over or near the internal cervical os. Doppler color flow mapping can be used as adjunct
    - - Non-stress test: assess fetal heart rate
        
        Corticosteroids: accelerate fetal lungs maturity for c-section delivery
        
        Inpatient management: early admission for close monitoring leading up to delivery
        
        Scheduled c-section (34-37weeks): reduce risk of pregnancy complications