3rd trimester and post-partum bleeding Flashcards
What is placenta previa?
Implantation of the placenta either partially or completely over the cervical os.
- Complete
- Partial
- Marginal
Which placenta previa types need C-section delivery?
Complete and most partials
What is placenta abruption?
Premature separation of the placenta from the uterine wall.
Illicit drug that can cause placenta abruption.
Cocaine
Main risk factor for a uterine rupture.
Previous C-section
What is the definition of post-partum hemorrhage?
Excess of 500mL blood loss after vaginal delivery
Excess 1000mL blood loss after C-section
Name and describe the 3 types of abnormal placenta attachments.
Accreta: attachment to the myometrium
Increta: invasion of the myometrium
Percreta: penetration thru the serosa or beyond
How much does maternal blood volume increase in pregnancy?
40%
What happens to maternal blood pressure and HR in pregnancy?
BP decreases
HR increases
Top 3 causes of maternal death in the U.S.
- Embolism
- Hypertensive Disease
- Obstetrical Hemorrhage
How much blood loss can occur in obstetrical hemorrhage before symptoms arise?
1000mL
2 most common causes of antepartum bleeding.
- Placenta Abruptio
2. Placenta Previa
What is important to remember before examining a patient with antepartum hemorrhage?
DO NOT check the cervix until placenta previa has been ruled out.
Most accurate means of determining cause of antepartum bleeding.
Ultrasound, very good at detecting placenta previa but not abruption
What should a physician considered if a patient had painful vagina bleeding antepartum that was temporarily relieved?
Uterine Rupture
What should a physician consider if a patient has painless bright red antepartum vaginal bleeding?
Placenta Previa
What should a physician consider if a patient has painful red antepartum vaginal bleeding?
Placenta Abruptio
How is a placenta previa case handled with a preterm infant and a stable mother?
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(-)
What is the Kleihauer-Betke test?
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
How is a placenta previa case handled in an unstable mother or baby?
Immediate C-section
2 biggest risk factors for placenta abruptio.
- Maternal HTN
2. Cocaine abuse
What is Couvelaire Uterus?
Bluish purple discoloration of the uterus caused by blood dissecting the myometrium after placenta abruptio.
How is placenta abruptio managed?
Primary goal is to stabilize the mother. Keep blood products on hand in case of DIC. Vaginal delivery preferred.
What is the treatment of choice for a Uterine Rupture?
Total Abdominal Hysterectomy
uterus and cervix removed