23: Obstetric Hemorrhage Flashcards
Process of examination when antepartum hemorrhage is suspected?
Speculum exam; NO DIGITAL exam until placenta previa is ruled out via US
MOST COMMON abnormal placentation
Presents as PAINLESS vaginal bleeding
Placenta previa
Types of placenta previa
Marginal - encroaches on cervical os
Partial - partially covers cervical os
Complete - completely covers cervical os
Considerations with COMPLETE placenta previa
Pelvic rest, NO digital exams, must be delivered via C-section
Abnormal attachment to the myometrium
Placenta accreta
Placenta invades myometrium
Placenta increta
Placenta invades through myometrium into uterine serosa
Placenta percreta
Most common cause of 3rd trimester bleeding
Presents as PAINFUL vaginal bleeding
Placental abruption
Most common risk factor for placental abruption
Maternal HTN
Most common cause of DIC in pregnancy
Placental abruption
Complete separation of uterine musculature through all three layers
Uterine rupture
Most common risk factor for uterine rupture
Previous uterine scar (especially vertical/classical C-section incision)
Causes of 3rd trimester fetal bleeding
Velamentous cord insertion, vasa previa
PPH occuring within first 24 hours, usually secondary to uterine atony
Primary postpartum hemorrhage
Bleeding secondary to inability of the uterus to maintain a contraction and involute normally around a placental tissue mass
Retained placenta
