3rd trimester and post-partum bleeding Flashcards

1
Q

What is placenta previa?

A

Implantation of the placenta either partially or completely over the cervical os.

  1. Complete
  2. Partial
  3. Marginal
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2
Q

Which placenta previa types need C-section delivery?

A

Complete and most partials

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3
Q

What is placenta abruption?

A

Premature separation of the placenta from the uterine wall.

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4
Q

Illicit drug that can cause placenta abruption.

A

Cocaine

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5
Q

Main risk factor for a uterine rupture.

A

Previous C-section

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6
Q

What is the definition of post-partum hemorrhage?

A

Excess of 500mL blood loss after vaginal delivery

Excess 1000mL blood loss after C-section

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7
Q

Name and describe the 3 types of abnormal placenta attachments.

A

Accreta: attachment to the myometrium
Increta: invasion of the myometrium
Percreta: penetration thru the serosa or beyond

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8
Q

How much does maternal blood volume increase in pregnancy?

A

40%

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9
Q

What happens to maternal blood pressure and HR in pregnancy?

A

BP decreases

HR increases

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10
Q

Top 3 causes of maternal death in the U.S.

A
  1. Embolism
  2. Hypertensive Disease
  3. Obstetrical Hemorrhage
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11
Q

How much blood loss can occur in obstetrical hemorrhage before symptoms arise?

A

1000mL

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12
Q

2 most common causes of antepartum bleeding.

A
  1. Placenta Abruptio

2. Placenta Previa

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13
Q

What is important to remember before examining a patient with antepartum hemorrhage?

A

DO NOT check the cervix until placenta previa has been ruled out.

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14
Q

Most accurate means of determining cause of antepartum bleeding.

A

Ultrasound, very good at detecting placenta previa but not abruption

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15
Q

What should a physician considered if a patient had painful vagina bleeding antepartum that was temporarily relieved?

A

Uterine Rupture

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16
Q

What should a physician consider if a patient has painless bright red antepartum vaginal bleeding?

A

Placenta Previa

17
Q

What should a physician consider if a patient has painful red antepartum vaginal bleeding?

A

Placenta Abruptio

18
Q

How is a placenta previa case handled with a preterm infant and a stable mother?

A

Amniocentesis to test for lung maturity

Deliver by C-section (unless lungs immature, then bed rest for mother with possible transfusion)

Rhogam if mother is Rh(-)

19
Q

What is the Kleihauer-Betke test?

A

Test to see what dose of Rhogam is needed to cover the amount of blood mixing that occurs between the mother and fetus in an Rh(-) mother

20
Q

How is a placenta previa case handled in an unstable mother or baby?

A

Immediate C-section

21
Q

2 biggest risk factors for placenta abruptio.

A
  1. Maternal HTN

2. Cocaine abuse

22
Q

What is Couvelaire Uterus?

A

Bluish purple discoloration of the uterus caused by blood dissecting the myometrium after placenta abruptio.

23
Q

How is placenta abruptio managed?

A

Primary goal is to stabilize the mother. Keep blood products on hand in case of DIC. Vaginal delivery preferred.

24
Q

What is the treatment of choice for a Uterine Rupture?

A

Total Abdominal Hysterectomy

uterus and cervix removed

25
Main cause of post-partum hemorrhage.
Uterine Atony | -failure of uterine contraction preventing myometrium blood vessels that were supplying the placenta from closing off.
26
How is postpartum hemorrhage diagnosed?
Insepction/palpation for all causes except coagulation defects.
27
Best 3 medications to treat postpartum bleeding caused by uterine atony.
Pitocin (IV) Methergine (ergonovine) PG F2-alpha
28
Second most common cause of postpartum bleeding.
Genital Tract Trauma | uterus will be hypertonic on palpation, as opposed to atony where it will be soft
29
What is the management strategy for postpartum bleeding due to a "retained placenta"?
Manual removal or D&C. -often caused by accreta, increta, or percreta in which case evaluation may be necessary to determine if a hysterectomy is needed.
30
Main cause of a uterine inversion.
Delivering placenta too early, leads to vasovagal shock.
31
Treatment for a uterine inversion.
OMT
32
Medications used in management of uterine inversion.
Halothan or terbutaline for anesthesia | Pitocin after uterus is put back in place
33
Most lethal form of a coagulation disorder leading to postpartum bleeding.
Amniotic Fluid Embolism | -leads to DIC (80% mortality)