Antepartum hemorrhage

Question 1

placenta adheres to uterine wall

Answer 1

placenta accreta

Question 2

placenta invades into myometrium

Answer 2

increta

Question 3

placenta penetrates through to uterine serosa

Answer 3

percreta

Question 4

membranes form dense ring around placenta

Answer 4

circumvallate placenta

Question 5

fetal vessels develop over internal os

Answer 5

vasa previa

Question 6

fetal vessels insert between amnion and chorion

Answer 6

velamentous placenta

Question 7

extra lobe of placenta ± blood fetal vessels between two lobes

Answer 7

succenturiate placenta

Question 8

4 causes of third trimester hemorrhage

Answer 8

Obstetric causes: placenta previa (20%), abruptio placentae (30%), fetal vessel rupture, uterine rupture

Non-obstetric causes: cervical/vaginal lacerations, hemorrhoids, infx, neoplasms
**non-obstetric present as spotting, no ctx, no abd pain

Question 9

3 subtypes of previa

Answer 9

complete, partial, marginal

Question 10

previa painful or painless?

Answer 10

painless

Question 11

suspect placenta previa, next step?

labs to get?

Answer 11

transabd or vag US (if <34 wks, give tocolytics and beta)

H&H, Type and cross

Question 12

usually asx during pregnancy, presents as vaginal bleed + inability to separate placenta after delivery

Answer 12

accreata, increta, percreta

Question 13

3rd trimester vaginal bleeding + severe abd pain, strong ctx

Answer 13

placental abruption

Question 14

risk factors for abruption

Answer 14

HTN > trauma, previous abruption, smoking, cocaine

Question 15

vaginal bleeding + sinusoidal pattern on FHR [tachy → brady → sinusoidal

Answer 15

fetal vessel rupture

Question 16

how is fetal vessel rupture diagnosed

Answer 16

Apt test (examine blood for fetal/nucleated RBCs, pink indicates fetal blood)

Question 17

what are the 3 common causes of fetal vessel rupture

Answer 17

Vasa previa: fetal vessels develop over internal os

Velamentous placenta: fetal vessels insert between amnion and chorion

Succenturiate placenta: extra lobe of placenta ± blood fetal vessels between two lobes