Abnormal pregnancy II Flashcards
Placenta location over/close to cervical os
Placenta previa
pt presentation for placenta previa
Painless vaginal bleeding in 3rd trimester
Degrees of placenta previa
- Complete: os completely covered
- Partial: os partially covered
- Marginal: edge of placenta at margin of os
- Low lying placenta: lower uterine segment w/ edge any 2cm from os
diagnostic test for placenta previa
*Transabd -> TVU/S
How early can placenta previa be recognized
2nd trimester U/S
Which types of placenta previa could potentially spontaneously resolve
Partial, marginal and low lying at 33-35 wks
What should you never do in a pt w/ placenta previa
Bimanual exam
Placenta previa mgt w/out active bleed
Hospitalize, corticosteroids if
Placenta previa mgt w/ active bleed/spontaneous labor
Immediate C-section
Placenta accreta
Growing into uterine wall
Placenta increta
Invasion of myometrium
Placenta percreta
Perforate uterus into bladder and rectum
Abn. premature separation of membranes in
Placenta abruptio
pt presentation of placenta abruptio
+/- painful hemorrhage w/ fetal distress
Risk factors of placental abruption
preeclampsia/chronic HTN, cocaine/amphetamine use, abdominal trauma
Types of abruption
Complete
Partial
marginal
What coagulopathy do you watch for in placental abrution
DIC
placenta abruptia mgt
- marginal: watch and tx hemodynamic instability
* Fetal distress: C-section + corticosteroids if
Fetal blood vessels running unsupported through the membranes over cervix and under presenting fetal part
Vasa previa
pathophys of vasa previa
- Velamentous insertion of cord
* cord insertion btn 2 lobes of accessory lobed placenta
Pt presentation of vasa previa
Painless vaginal bleeding at ROM w/ fetal distress (∆ in fetal heart tracing)
Diagnostics for vasa previa
U/S w/ color doppler Apt test (if risk factors)
Mgt of vasa previa
Hospitalization in 3rd trimester, corticosteroids, pelvic rest
C-section at 35wks
Risk factors for vasa previa
Multiple gestation
Low lying placenta
bilobed/accessory lobed placenta
IVF pregnancy
Spontaneous ROM before onset of labor
PROM
How long after PROM should labor start
within 24hrs
What could happen if labor doesnt start within 24hrs following PROM
Chrorioamonitis
Risks due to PROM
Prolapse of cord (biggest risk)
preterm labor
intrauterine infection
PROM before 37 wks
PPROM
potential pathophys for PROM
STIs
BV
