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?