Antepartum Hemorrhage MCQs

Alveolar hypoventilation (as evidenced by the higher than normal value of Paco2) is a type of hypoxic hypoxia or hypoxemia (as evidenced by the decreased PaO2). Anemic hypoxia is characterized by a decreased concentration of hemoglobin (anemia) or a reduction in the saturation of hemoglobin with oxygen (SaO2) expected for a given Pao2, as would occur in carbon monoxide poisoning or methemoglobinemia. Stagnant hypoxia is characterized by a decreased cardiac output; in this patient, cardiac output, calculated as (VO2/CaO2 - CvO2), is 5 L/min, which is normal. In histotoxic hypoxia, oxygen extraction is impaired, and thus CaO2 - CvO2 would be less than normal and Svo2 would be greater than normal. Reference: Ganong, pp 683-691. Levitzky, pp 180-183.

Pelvic floor exercises Sling operation Colposuspension (Burch) is all done for management of SUI. As far as anterior colporrhaphy is concerned - Kelly’s application is anterior colporrhaphy along with bladder neck repair, so I have included it in the correct option also. Reference: Shaw 14 th /ed p 174; Dutta gynae 5 th /ed p 387-9

Expectant treatment had been advocated by Mcafee and Johnson, in an attempt to improve the fetal salvage without increasing undue maternal hazards. The aim is to continue pregnancy for fetal maturity without compromising the maternal health. Reference:-D C Dutta’s textbook of obstetrics 8 th edition, chapter 19

The patient in the question: Has gestational age = 37 weeks i.e. fetus has attained maturity so immediate termination of pregnancy is recommended. Has central placenta previa Type IV i.e. vaginal delivery is contraindicated, cesarean section has to be done. Patient is having heavy bleeding. According to Fernando Arias 3/e, p 337 "In patients with heavy bleeding an efficient management plan including life support measures and immediate operative intervention is the only way to avoid a maternal death." It further says – on p 339 "Patients with placenta previa and severe bleeding should be delivered by cesarean section irrespective of the type of placenta previa." Reference: Dutta Obs 7/e, p 249, 250; Fernando Arias 3/e, p 337, 339

Abruptio placenta is premature separation of normally situated placenta resulting in hemorrhage Risk factors: Increased maternal age Pre-eclampsia Preterm ruptured membranes pregnancy Cigarette smoking Cocaine abuse External trauma Uterine leiomyoma Increased parity Chronic hypertension Sudden uterine decompression as in hydramnios and twin Thrombophilia Previous abruption Folic acid deficiency Reference: Dutta Obs. 7/e, p 252, 253; Williams Obs. 22/e, p 813, 814, 23/e, p 763-765

About one-third cases of antepartum hemorrhage belong to placenta previa. The incidence of placenta previa is 1 in 200 pregnancies (0.5%). In 80% cases, it is found in multiparous women. The incidence is increased beyond the age of 35 years, with high birth order pregnancies and in multiple pregnancy Reference: D C Dutta's textbook of obstetrics 8 th edition, chapter 19

Risk factors for placenta previa Multiparity Advanced age (>35 years) Smoking Prior caesarean delivery Multifetal gestation Placental abnormality Prior curettage History of ART (assisted reproductive technology) Reference:-Williams obstetrics 26 th edition, chapter 43

There are four types of placenta previa depending upon the degree of extension of placenta to the lower segment. For clinical purpose, the types are graded into mild degree (Type-I and II anterior) and major degree (Type-II posterior, III and IV). Reference:-D C Dutta’s textbook of obstetrics 8 th edition, chapter 19