Bleeding And Sepsis

Question 1

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?

Answer 1

Avoid digital exam until confirmed it is not placenta previa

3% and 1 gram

Question 2

5 causes of vaginal bleeding before 20 weeks?

Answer 2

Abortions, ectopic, cervical/vaginal etiology, subchorionic hemorrhage, cervical insufficiency

Question 3

4 causes of upper genital tract bleeding after 20 weeks?

Answer 3

Placental abruption, placental previa, uterine rupture, vasa previa.

Question 4

6 causes of lower genital tract bleeding after 20 weeks?

Answer 4

Bloody show labor, cervical polyps, infections, trauma, cancer, and vulvar varicosities

Question 5

Most common symptom of placenta previa?

Answer 5

Painless vaginal bleeding

Question 6

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?

Answer 6

Marginal, partial and complete
US
30 weeks
90% resolve on own by migrating

Question 7

How do we treat/manage placenta previa?

Answer 7

Goal is to deliver via c section 36-37 weeks with fetal lung maturation
If things are going bad, c section and be prepared.

Question 8

What are the three abnormal placental implantations and which one is most common?

Answer 8

Accreta, increta, and percreta

Accreta is most common

Question 9

What two conditions increase risk for accreta?

Answer 9

Multiple c sections and previa

Question 10

What is the most common cause of third trimester bleeding? What are the 4 signs and symptoms of this condition?

Answer 10

Placental abruption

Painful bleeding, tender uterus, hyperactive uterus and fetal distress

Question 11

What is the most common risk factor or placental abruption?

Answer 11

Maternal HTN

Question 12

How is diagnosis made of abruption?

Answer 12

Some can be seen on US

Question 13

Manage/treat abruption?

Abruption is the most common cause of what in pregnancy?

Answer 13

If mom and baby are good, the vaginal delivery. If baby ain’t having it, the c section?

DIC

Question 14

What is couvelaire uterus?

Answer 14

Placenta abruption causes bleeding into the uterus and can penetrate into myometrium and into peritoneal cavity

Question 15

What is the most common risk factor for uterine rupture?

Answer 15

Prior uterine incision

Question 16

2 big signs and symptoms of uterine rupture?

Answer 16

Sudden severe pain with/without bleeding

Abnormal fetal HR or complete absence of it

Question 17

How do we manage uterine rupture?

Answer 17

Immediate laparotomy and c section

If rupture is very large, hysterectomy while in there

Question 18

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?

Answer 18

Rupture of fetal vessel due to vasa previa

Delivery right away

Question 19

How do we define Post partum hemorrhage? What are the two classifications of PPH?

Answer 19

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

Question 20

Most of the time, primary PPH is secondary to what condition?

Answer 20

Uterine Atony

Question 21

What is uterine atony and why does it lead to PPH?

Answer 21

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.

Question 22

4 things we can do to treat uterine atony?

Answer 22

Massage uterus, give meds to help contract (oxytocin, prostaglandins), uterine packing or large volume balloon, surgery (hysterectomy or ligate uterine arteries)

Question 23

What confirms the diagnosis of uterine atony and what will we feel?

Answer 23

Bimanual massage of uterus

Uterus is boggy

Question 24

Which patients do we avoid methergine, prostaglandin f2 alpha, and dinoprostone?

Answer 24

HTN
Asthmatics
And hypotensive

Question 25

What is the second most common cause of PPH?

Answer 25

Trauma during delivery

Question 26

How do we treat bleeding because of retained placenta?

Answer 26

Manually remove the placenta fragment

Question 27

What do we not do with an inverted uterus and how do we treat it?

Answer 27

Do not remove placenta until the inversion is corrected

Manually stick the uterus back up in there

Question 28

Amniotic fluid embolism is characterized by what 6 things?

Answer 28

RD, cyanosis, CV collapse, coma, consumptive coagulopathy and bleeding

Question 29

How do we treat amniotic fluid embolism?

Answer 29

Respiratory support, correct shock and replace coagulation factors

Question 30

What is Von Willa brand disease, what is the effect and what two things to treat?

Answer 30

Deficiency in factor 8, prolonged bleeding times, give factor 8 or cryoprecitpaite

Question 31

What is the problem with idiopathic thrombocytopenia and how do we treat it?

Answer 31

Abnormally function platelets leading to low palettes and bleeding, give platelets