Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

OB > Antepartum hemorrhage > Flashcards

Antepartum hemorrhage Flashcards

1
Q

Placenta previa

A

Complete, partial, marginal

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Most common reasons for peripartum hysterectomy?

A

Uterine atony FORMERLY, now it’s placenta previa w/ associated accreta (2/3 of them need hysterectomy)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Placenta increta

A

Placenta invades myometrium

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Placenta percreta

A

Placenta invades thru myometrium INTO the serosa…or even beyond!

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Differential of antepartum bleeding?

A
  • Placenta previa, placental abruption, vasa previa
  • Uterine rupture
  • Fetal vessel rupture

BLEEDING USUALLY FRANK

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Placenta accreta

A

Adheres to the UTERINE WALL.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Velamentous placenta

A

When blood vessels insert between the amnion and chorion. Vessels largely unprotected and vulnerable to compression or injury.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Placenta previa epidemiology

A

0.5% of pregnancies

20% of all antepartum hemorrhage

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Placenta previa w/ accreta incidence?

A

5% of placenta pre via cases

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Rules about placenta previa?

A

1) The later in pregnancy its diagnosed, the higher the likelihood of persistence to delivery
2) Low-lying placenta in 2nd trimester is a risk factor for developing VASA PREVIA…use u/s to check later in pregnancy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Predisposing factors for placenta previa?

A

1) History of placenta previa
2) Prior uterine scar (eg. prior c/s), prior uterine surgery eg. myometctomy
- Multiparity
- Multiple gestation
- Erythroblastosis
- Smoking
- Increasing maternal age
- Uterine anomaly

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Diagnosis of placenta previa?

A

ULTRASOUND

Transvaginal is better bc of fewer false positives. It’s not dangerous with its placement.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Treatment of placenta previa?

A

Strict pelvic rest (no sex) and modified bed rest.

Some hospitalize right away.
Others, no hospitalized bed rest until large bleed, or drop in Hct of > 3 points.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

When should you DELIVER NO MATTER GESTATIONAL AGE?

A
  • Unstoppable labor
  • Fetal distress
  • Life-threatening hemorrhage
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Which placenta abnormality patients should get c/s? Vaginal considered for which?

A

C/S= PLACENTA 2 cm from os)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Recent decision regarding planning delivery in placenta previa?

A

34 up until 37 at the latest is probably optimal AND amnio isn’t that useful for determining fetal lung maturity

17
Q

What do you need to do with ACUTE SETTING of vaginal bleeding and suspected previa or accreta?

A

1) Stabilize patient- IV catheters, labs of HCT, type cross, RhoGAM after a Kleihaur-Betke test
2) Prepare for catastrophic hemorrhage- transfusions are usually given to maintain Hct of 25% or more
3) Prepare for preterm delivery- give steroids; be cautious with tocolytics

18
Q

Plan when you’re dealing with known placenta previa or accreta?

A

1) Plan for TAH at the time of cesarean (esp with accreta)
2) Schedule delivery for 34-37 wks
3) Plan ahead and have backup available like blood products

19
Q

Placental abruption definition

A

Premature separation of normally implanted placenta from the uterine wall. Hemorrhage between wall and placenta.

20
Q

Concealed vs. external hemorrhage?

A

20% concealed

80% frank bleeding on outside of body

21
Q

Predisposing factors to placental abruption?

A

-Hypertension #1 (whether chronic, preeclampsia, or cocaine/methamphetamine induced)

  • Previous one
  • Advanced maternal age
  • Multiparity
  • Uterine distension
  • Multiple pregancy
  • Polyhydramnios
  • Vascular deficiency
  • Diabetes
  • Collagen vascular disease
  • Cocaine or methamphetamine use
  • Cigarette smoking
  • Alcohol use
  • Circumvallate placenta
  • Short umbilical cord
22
Q

Precipitating factors for placental abruption?

A
  • Trauma
  • External/internal version
  • MVA, abdominal trauma
  • Sudden uterine volume loss (eg. delivery of first twin)
  • Rupture of membranes with polyhydraminos
  • PPROM
23
Q

Epidemiology of placental abruption

A

0.5-1.5% of pregnancies

Incidence increases with number of gestations but the MORTALITY is greatest among SINGLETONS!

24
Q

Classic presentation of placental abruption?

A

Third trimester vaginal bleeding associated with severe abdominal pain and/or frequent strong contractions

THOUGH MANY HAVE FEW OR NO SYMPTOMS and are id’d after seeing the placenta after delivery

25
Q

Classic sign of placental abruption that can only be seen during c/s?

A

Couvelaire uterus- LIFE THREATENING.

When the myometrium turns bluish due to having so much bleeding

26
Q

Diagnosis of placental abruption?

A

Mostly clinical. Negative u/s DOES NOT exclude placental abruption.

Retroplacental clot with overlying placental destruction confirms.

27
Q

Additional findings with placental abruption?

A
  • Hypovolemic shock (with oliguria which can be corrected with rigorous IV infusion)
  • Consumptive coagulopathy (elevated D-dimer aka fibrin degradation products). MORE LIKELY WITH A CONCEALED ABRUPTION. Plasminogen–> plasmin.
28
Q

Treatment of placental abruption?

Vaginal or c/s?

A

1) Stabilize patient
2) Prepare for future hemorrhage (Large bore IVs, infusion of lactated Ringer’s, 2 units packed RBCs: 1 unit fresh frozen plasma)
3) Prepare for preterm delivery
4) Deliver if bleeding is life threatening or fetal testing is nonreassuring

VAGINAL DELIVERY PREFERRED AS LONG AS BLEEDING IS CONTROLLED AND THERE ARE NO SIGNS OF FETAL DISTRESS.

29
Q

Uterine rupture risk?

A

More than 90% are associated with prior uterine scar from either c/s or other uterine surgery

For example, TRAUMA, L&D issues like improper oxytocin use or excessive fundal pressure

Spontaneous causes: placenta percreta, multpile gestation, grand multiparity, invasive mole, choriocarcinoma, large fetus, external version

30
Q

Presentation of uterine rupture?

A

HIGHLY VARIABLE

Regression of the presenting fetal part
Nonreassuring fetal testing
Abnormal abdominal contour
Cessation of contractions
Disappearance of fetal heart tones
31
Q

How do you treat uterine rupture?

A
  • Immediate laparotomy
  • Delivery of fetus

Discouraged to attempt future pregnancies given high risk of recurrence or told they would need a c/s.

32
Q

Fetal vessel rupture cause? Incidence? Clinical manifestations?

A

Velamentous cord insertion- cords inserting between amnion and chorion instead of directly into the chorionic plate

Only 0.1-0.8% of pregnancies

Singletons 1%, Twins 4-12%

Vaginal bleeding assoc with sinusoidal FHR (fetal anemia).

DELIVER THE FETUS IMMEDIATELY

33
Q

Diagnosis of fetal vessel rupture?

A

Apt test- examines blood for nucleated (FETAL) RBCs.

Pink is fetal meaning positive test, yellow-brown is maternal and negative.

34
Q

Nonobstetric causes of antepartum hemorrhage? Outcomes following treatment?

A

Cervical and vaginal lacerations, hemorrhoids, infections, neoplasms

Simple treatment and good outcomes.

OB (8 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions