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OB/GYN > Antepartum hemorrhage > Flashcards

Antepartum hemorrhage Flashcards

1
Q

what are 3 common causes of bleeding during 1st tri?

A

SAB
ectopic
normal spotting

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2
Q

what are major causes of antepartum hemorrhage?

A 
placenta previa
placental abruption
vasa previa
uterine rupture
fetal vessel rupture
cervicitis
cervical polyps
cervical ca.
cervical, vaginal, or vulvar lacs
hemorrhoids
congenital bleeding disorder
pelvic trauma
hematuria
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3
Q

what is a placenta previa?

A

abnormal implantation of placenta over internal cervical os

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4
Q

diff types of placenta previa

A

complete
partial
marginal - edge of placenta reaches margin of os

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5
Q

what is vasa previa

A

a fetal vessel lies over cervical os

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6
Q

what is placenta accreta

A

abnl invasion of placenta into uterine wall => inability to separate from uterine wall after delivery

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7
Q

placenta increta

A

invasion of placenta into myometrium

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8
Q

placenta percreta

A

invasion of placenta into uterine serosa

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9
Q

most women w/both a placenta previa & a placenta accreta require what? Why?

A

hysterectomy

b/c inability of placenta to separate => profuse hemorrhage

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10
Q

what is the incidence of placenta previa

A

1 in 200

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11
Q

women with placenta previa are at increased risk of placenta accreta if they have a hx of what?

A

prior c/s

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12
Q

what are predisposing factors for placenta previa

A 
prior c/s
prior uterine surgery (ex: myomectomy)
multiparity
multiple gestation
erythrobastosis
smoking
hx of placenta previa
AMA
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13
Q

what usually happens to marginal previa or low-lying placenta?

A

they migrate upwards as uterus grows

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14
Q

what is velamentous placenta?

A

umb bv’s insert at the edge of placenta instead of middle => fetal bv’s pass over internal os (vasa previa)

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15
Q

what is succenturiate placenta?

A

an extra lobe of placenta is implanted at some distance away from the rest, w/bv’s coursing b/w them which c/=> vasa previa

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16
Q

what is a sentinel bleed?

A

the first bleeding 2/2 a placenta previa. Usually after 28 weeks

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17
Q

CP of placenta percreta?

A

usually asx’c, but c/h hematuria or hematochezia if invasion into bladder or rectum

18
Q

what must you NOT do if a pt has a placenta previa?

A

place a speculum!

19
Q

how do you dx placenta previa?

A

transabdominal or translabial u/s (not transvaginal)

20
Q

what m/you make sure to do before doing u/s to look for placenta previa? why?

A

empty bladder. B/c full bladder can give illusion of placenta previa.

21
Q

mgt of placenta previa pts who are antepartum:

A

strict pelvic rest
modified bed rest
some ppl do this right away, some wait till sentinel bleed.

22
Q

mgt of placenta previa pts who make it to 36 weeks without a bleed:

A

Amnio to dtm fetal lung maturity, then delivery by c/s b/w weeks 36 and 37

23
Q

mgt of a bleeding pt with a placenta previa:

A

1) stabilize pt. Need continuous FHR monitoring and 2 large-bore IVs
2) obtain Hct, type & cross, maybe d-dimer, fibrinogen, PT and PTT.
3) if mom is Rh-, perform Kleihauer-Betke test. (dtm extent of fetomaternal transfusion so you know how much RhoGam to give)
4) prepare for disaster. Have 2U of blood ready.
5) Transfuse to maintain Hct 25% or more.
6) Prepare for preterm delivery - give betamethasone if before 34 weeks. Give tocolytics if not up to 34 weeks.

24
Q

what is placental abruption?

A

premature separation of implanted placenta from uterine wall

25
Q

what are complc’ns of placental abruption?

A

PTD
uterine tetany
DIC
shock

26
Q

what factors are ass’d w/placental abruption?

A 
maternal HTN
hx of placental abruption
maternal cocaine use
maternal trauma
rapid decompression of uterus (MVA, trauma)
27
Q

what is concealed hemorrhage? what % of cases?

A

placental abruption in which bleeding is confined w/in uterine cavity
20% of cases

28
Q

CP of placental abruption:

A

vaginal bleeding
frequent ctr’ns
ab’l pain
maybe shock

29
Q

what is a couvelaire uterus?

A

blood penetrating into myometrium, only seen at time of c/s

30
Q

mgt of suspected placental abruption:

A

1) stabilize pt, order labs, give RhoGam if Rh-
2) Prepare for possibility of future hemorrhage (place 2 large-bore IVs, order blood)
3) prepare for PTD - give betamethasone or tocolytics
4) Immediate c/s if bleeding is life-threatening or fetal testing is non-reassuring

31
Q

T or F: vaginal delivery is CI’d if placental abruption is present.

A

F. Most abruptions are small. Vaginal delivery is possible of pt is stable.

32
Q

what’s the risk of uterine rupture in pts w/previous c/s?

A

0.5%

33
Q

CP of uterine rupture:

A 
severe ab'l pain
vag bleeding - spotting or profuse
nonreassuring FHTs
cessation of uterine ctr'ns
regression of presenting part
34
Q

mgt of uterine rupture

A

immediate laparotomy & delivery.

Can try to repair rupture site, but hysterectomy may be indicated.

35
Q

what advice is given regarding future pg’ies

A

avoid. If they do get pg, cannot do a VBAC. Need repeat c/s at week 36 after confirming lung maturity.

36
Q

where are umb bv’s supposed to insert? Where do they insert in velamentous cord insertion?

A

supposed to insert at chorionic plate of placenta

in velamentous cord, they insert b/w amnion and chorion => exposed

37
Q

what increases the likelihood of velamentous cord insertion?

A

multiple gestation

38
Q

CP of fetal vessel rupture:

A

seen thru dilated cervix, or vag bleeding

sinusoidal variation of FHR

39
Q

what does sinusoidal variation of FHR indicate

A

fetal anemia

40
Q

what is the Apt test?

A

test used to examine vaginal blood to dtm if its maternal or fetal. If it turns pink after addition of NaOH, its fetal.

41
Q

mgt of ruptured fetal vessel:

A

immediate c/s. Or AROM if pt elects a TOL

OB/GYN (29 decks)

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