Bleeding disorders in pregnancy Flashcards
What are the maternal risk factors for placental abruption (3) ? NOT OBSTETRIC ONES
Advanced maternal age
Cocaine use
Smoking during pregnancy
(Remember things that affect vasculature and placental perfusion)
What are obstetric risk factors for Placental Abruption (8)?
- Chorioamnionitis
- Fetal growth restriction
- History of placental abruption
- Hypertensive disorders
- Multifetal gestation
- Premature rupture of membranes
- Polyhydramnios
- Thrombophilias (inherited blood clotting disorders)
What are acute cause of placental abruption
- Trauma (i.e car accident
2. External Cephalic version for Breech
What is the MOST COMMON risk factor for placental abruption?
Hypertensive disorders - the placental insufficiency. Especially chronic hypetension with superimposed preeclampsia
What kind of abruption is associated with only a low backache?
a concealed abruption with a posterior placenta
How can ultrasound aid in the diagnosis of placental abruption?
Sometimes bleeding can be seem on ultrasound. A placenta previa can almost always been see, presence a a previa generally helps rule out abruption in a differential diagnosis.
What kind of monitoring should be done following a trauma
after 24 weeks, 4 hours continuous monitoring. If more than 6 contraction in any given hour 24 hours of monitoring.
What are the maternal s/s of placental abruption (8). They are variable and non specific
- generalized back discomfort
- abdominal cramping
- severe abdominal pain,
- Can mimic early labor, look like contractions and bloody show.
- Either decreased OR Increased fetal movement
- Distress out of proportion of objective clinical signs
- Abdomen can be rigid if blood is in peritoneal cavity, but can also be only mildly tender.
- Usually frequent low amplitude contractions.
Placenta previa and placental abruption are main suspected diagnosis with bleeding. What is the most common differential patient symptom between the two?
bleeding from a previa is usually painless. Pain, in varying degrees is usually associated with an abruption.
What FHR tracing may be associated with an abruption (5)?
- Recurrent lates
- recurrent variable
- minimal or absent variability
- bradycardia
- Sinusoidal pattern
In summation all of the bad catagory three tracings
What factor most impacts quality of information from ultrasound when attempting to diagnosis possible placental abruption?
The time elapsed since bleeding event. After more time bleeding may no longer be visasble.
What assessment should be done when suspecting a placental abruption (5)?
- monitoring for hemodynamic stability
- Fetal monitoring
- ROS/ History (Pain, bleeding, cardiac and respiratory)
- Physical exam (abdominal tenderness, no digital exams
- ultrasound
What are the step in assessing bleeding disorders for hemodynamic instability (4)?
Vital signs
mental status
skins color (pallor) - don’t froget mucus membranes in people of color
visual evaluation of blood loss
Blood loss should be determined both visually and by evaluation of hemodynamic compromise. If the is significant blood What management actions actions should be taken (8)?
- get consulting physician
- Establish two large bore intravenous lines
- Give oxygen
- Place on continuous fetal monitoring
- Labs ( CBC, coagulation studies, blood type, anitbody screen
- cross match minimum of 4 units of blood.
- for Rh negative women get assessment of fetomaternal blood transfer (Kleinhaure-Betke test)
- Perform ultrasounds (and review/ obtain any previous ultrasound results)
How does placenta previa initially present?
Initially as painless bleeding that is self limiting in the first episode. Fetus remains stable
Can also be diagnosed without symptoms during ultrasound.
