OBSTETRICS AND GYNECOLOGY
OBSTETRICS AND GYNECOLOGY
Exercise 1.0
a. Define Genital tract bleeding in late pregnancy also known as Antepartum haemorrhage.
b. Outline both the maternal and fetal causes of genital tract bleeding in late pregnancy also known as antepartum haemorrhage
c. Outline the types of antepartum haemorrhage
d. What is the effect of antepartum haemorrhage on the fetus and the mother
Answer:
a. Definition of antepartum haemorrhage
Antepartum haemorrhage is defined as bleeding from the genital tract after the 24th-28th week of pregnancy, before the onset of labour and till the end of second stage of labour
b. Causes of antepartum haemorrhage
Maternal causes
• Placenta praevia: 30%.
• Abruptio placentae: 35%.
• Local cause in the vagina and cervix: 5%.
• Blood dyscrasias: <1%.
• Cause never found: 30%.
Fetal causes
• Vasa praevia: <1%.
c. Types of antepartum haemorrhage
Placenta bleeding in late pregnancy is confined to placenta separation due to
• Placenta praevia
• Placental abruption
d. Effect of antepartum haemorrhage on fetus and mother
• Effect on fetus
o Fetal mortality and morbidity are increased as a result of severe vaginal bleeding in pregnancy
o Still birth or perinatal or neonatal death may occur
o Premature placenta separation and consequent hypoxia may result in the birth of a child who is mentally and physically handicapped.
• Effect on mother
o If bleeding is severe, mother may experience shock
o If bleeding is severe, mother may also experience disseminated intravascular coagulation
o If bleeding is severe, mother may experience renal failure
o If bleeding is severe, the mother may die or be left with permanent ill-health
Exercise 1.1
a. Define the term placenta praevia
b. Outline the causes of placenta praevia
Answer:
a. Definition of placenta praevia
In placenta praevia the placenta encroaches on the lower segment of the uterus. Which
• Does not contract in labour but is stretched in response to contractions.
• Used to be the isthmus before pregnancy.
• Underlies the loose fold of peritoneum that reflects from the bladder.
• Is covered by a full bladder anteriorly.
• Is within 8 cm of the internal cervical os at term.
b. Causes of placenta praevia
Placenta praevia follows the low implantation of the embryo. Associated factors are:
• Multiparty.
• Multiple pregnancy.
• Embryos are more likely to implant on a lower segment scar from previous caesarean section. This increases the risk of placenta accreta/increta/percreta
Exercise 1.0
a. Define Genital tract bleeding in late pregnancy also known as Antepartum haemorrhage.
b. Outline both the maternal and fetal causes of genital tract bleeding in late pregnancy also known as antepartum haemorrhage
c. Outline the types of antepartum haemorrhage
d. What is the effect of antepartum haemorrhage on the fetus and the mother
Answer:
a. Definition of antepartum haemorrhage
Antepartum haemorrhage is defined as bleeding from the genital tract after the 24th-28th week of pregnancy, before the onset of labour and till the end of second stage of labour
b. Causes of antepartum haemorrhage
Maternal causes
• Placenta praevia: 30%.
• Abruptio placentae: 35%.
• Local cause in the vagina and cervix: 5%.
• Blood dyscrasias: <1%.
• Cause never found: 30%.
Fetal causes
• Vasa praevia: <1%.
c. Types of antepartum haemorrhage
Placenta bleeding in late pregnancy is confined to placenta separation due to
• Placenta praevia
• Placental abruption
d. Effect of antepartum haemorrhage on fetus and mother
• Effect on fetus
o Fetal mortality and morbidity are increased as a result of severe vaginal bleeding in pregnancy
o Still birth or perinatal or neonatal death may occur
o Premature placenta separation and consequent hypoxia may result in the birth of a child who is mentally and physically handicapped.
• Effect on mother
o If bleeding is severe, mother may experience shock
o If bleeding is severe, mother may also experience disseminated intravascular coagulation
o If bleeding is severe, mother may experience renal failure
o If bleeding is severe, the mother may die or be left with permanent ill-health
Exercise 1.1
a. Define the term placenta praevia
b. Outline the causes of placenta praevia
Answer:
a. Definition of placenta praevia
In placenta praevia the placenta encroaches on the lower segment of the uterus. Which
• Does not contract in labour but is stretched in response to contractions.
• Used to be the isthmus before pregnancy.
• Underlies the loose fold of peritoneum that reflects from the bladder.
• Is covered by a full bladder anteriorly.
• Is within 8 cm of the internal cervical os at term.
b. Causes of placenta praevia
Placenta praevia follows the low implantation of the embryo. Associated factors are:
• Multiparty.
• Multiple pregnancy.
• Embryos are more likely to implant on a lower segment scar from previous caesarean section. This increases the risk of placenta accreta/increta/percreta
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