Bleeding And Sepsis Flashcards
When a lady presents with antepartum bleeding, what am I avoiding until something is confirmed? Also how much does a packed red blood cell unit bring up HCT and HgB?
Avoid digital exam until confirmed it is not placenta previa
3% and 1 gram
5 causes of vaginal bleeding before 20 weeks?
Abortions, ectopic, cervical/vaginal etiology, subchorionic hemorrhage, cervical insufficiency
4 causes of upper genital tract bleeding after 20 weeks?
Placental abruption, placental previa, uterine rupture, vasa previa.
6 causes of lower genital tract bleeding after 20 weeks?
Bloody show labor, cervical polyps, infections, trauma, cancer, and vulvar varicosities
Most common symptom of placenta previa?
Painless vaginal bleeding
3 types of placenta previa, how to diagnose, when is peak time to diagnose and how do we diagnose, how do they get resolved most of the time?
Marginal, partial and complete
US
30 weeks
90% resolve on own by migrating
How do we treat/manage placenta previa?
Goal is to deliver via c section 36-37 weeks with fetal lung maturation
If things are going bad, c section and be prepared.
What are the three abnormal placental implantations and which one is most common?
Accreta, increta, and percreta
Accreta is most common
What two conditions increase risk for accreta?
Multiple c sections and previa
What is the most common cause of third trimester bleeding? What are the 4 signs and symptoms of this condition?
Placental abruption
Painful bleeding, tender uterus, hyperactive uterus and fetal distress
What is the most common risk factor or placental abruption?
Maternal HTN
How is diagnosis made of abruption?
Some can be seen on US
Manage/treat abruption?
Abruption is the most common cause of what in pregnancy?
If mom and baby are good, the vaginal delivery. If baby ain’t having it, the c section?
DIC
What is couvelaire uterus?
Placenta abruption causes bleeding into the uterus and can penetrate into myometrium and into peritoneal cavity
What is the most common risk factor for uterine rupture?
Prior uterine incision
2 big signs and symptoms of uterine rupture?
Sudden severe pain with/without bleeding
Abnormal fetal HR or complete absence of it
How do we manage uterine rupture?
Immediate laparotomy and c section
If rupture is very large, hysterectomy while in there
What is mom presents with acute vaginal bleeding and baby’s HR goes tachycardia then bradycardia, what are we taking and what do we do?
Rupture of fetal vessel due to vasa previa
Delivery right away
How do we define Post partum hemorrhage? What are the two classifications of PPH?
Lose over 500 mls after vaginal delivery
Lose over 1000 mls after c section
Primary is within first 24 hours
Secondary is 24 hours to 12 weeks
Most of the time, primary PPH is secondary to what condition?
Uterine Atony
What is uterine atony and why does it lead to PPH?
It’s when the uterus fails to contract after delivering the placenta. It’s important for the uterus to be able to contract/compress/VC the severed vessels from the placenta being released.
4 things we can do to treat uterine atony?
Massage uterus, give meds to help contract (oxytocin, prostaglandins), uterine packing or large volume balloon, surgery (hysterectomy or ligate uterine arteries)
What confirms the diagnosis of uterine atony and what will we feel?
Bimanual massage of uterus
Uterus is boggy
Which patients do we avoid methergine, prostaglandin f2 alpha, and dinoprostone?
HTN
Asthmatics
And hypotensive
What is the second most common cause of PPH?
Trauma during delivery
How do we treat bleeding because of retained placenta?
Manually remove the placenta fragment
What do we not do with an inverted uterus and how do we treat it?
Do not remove placenta until the inversion is corrected
Manually stick the uterus back up in there
Amniotic fluid embolism is characterized by what 6 things?
RD, cyanosis, CV collapse, coma, consumptive coagulopathy and bleeding
How do we treat amniotic fluid embolism?
Respiratory support, correct shock and replace coagulation factors
What is Von Willa brand disease, what is the effect and what two things to treat?
Deficiency in factor 8, prolonged bleeding times, give factor 8 or cryoprecitpaite
What is the problem with idiopathic thrombocytopenia and how do we treat it?
Abnormally function platelets leading to low palettes and bleeding, give platelets
