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Obstetrics > Bleeding in Pregnancy (2/3 Trimester) > Flashcards

Bleeding in Pregnancy (2/3 Trimester) Flashcards

1
Q

Painless dilation often in the second trimester between 16 and 24 weeks is consistent with this diagnosis.

a. cervical insufficiency
b. placenta previa
c. abruption
d. uterine rupture
e. vasa previa

A

a. cervical insufficiency

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2
Q

What are the 4 primary risk factors for cervical insufficiency?

A
  • history of cervical surgery
  • history of cervical lacerations
  • uterine anomalies
  • history of DES
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3
Q

If a patient had a prior loss, at what week can a cerclage be placed?

A

13 weeks

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4
Q

If cervical insufficiency is diagnosed in the current pregnancy, a cerclage placement can be done up until what week?

A

up until 24 weeks

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5
Q

What are the 5 major causes for second and third trimester bleeding?

A
  • cervical insufficiency, preterm/term labor
  • placenta previa
  • abruption
  • uterine rupture
  • vasa previa
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6
Q

Presence of light bleeding, pressure and intermittent pain or no pain in the second trimester may suggest what?

a. cervical insufficiency
b. placenta previa
c. abruption
d. uterine rupture
e. vasa previa

A

a. cervical insufficiency

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7
Q

When examining for second and third trimester bleeding what physical exam should you start with?

A

sterile speculum

*do not do a digital exam first because you do not know what is presenting

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8
Q

This is defined as a separation of the placenta from site of implantation before delivery of the fetus that results in abdominal tenderness and vaginal bleeding.

a. cervical insufficiency
b. placenta previa
c. abruption
d. uterine rupture
e. vasa previa

A

c. abruption

remember this is PAINFUL

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9
Q

What are the 3 most common risk factors for placental abruption (per Dr. Marino)?

A
  • hypertension
  • PPROM
  • Cigarette smoking
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10
Q

T/F: Negative findings on ultrasound evaluation rules out placental abruption.

A

FALSE

DOES NOT RULE OUT

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11
Q

How is placental abruption diagnosed?

A

diagnosis of exclusion

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12
Q

This is defined as abnormal implantation of the placenta over or near the internal cervical os.

a. cervical insufficiency
b. placenta previa
c. abruption
d. uterine rupture
e. vasa previa

A

b. placenta previa

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13
Q

What is the gold standard diagnostic exam for placenta previa?

A

transvaginal ultrasound

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14
Q

What is the greatest risk with placenta previa?

A

bleeding

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15
Q

Delivery in a patient with placenta previa is always by this method.

A

cesarean section

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16
Q

This condition refers to a placenta that is abnormally adherent.

A

placenta accreta spectrum

17
Q

What is the greatest risk factor for placenta accreta spectrum?

A

previous cesarean section

18
Q

What is the difference between placenta attachment in accreta, increta, and percreta?

A
  • accreta = through the endometrium
  • increta = into myometrium
  • percreta = through the serosa to adjacent organs
19
Q

How is placenta accreta spectrum diagnosed?

A

ultrasound

20
Q

Placenta accreta spectrum (abnormal placentation) is the second leading cause of this procedure.

A
  • cesarean hysterectomy
21
Q

Mrs. S is currently 37 weeks pregnant and present to labor and delivery with painless vaginal bleeding. Her antenatal course has been uncomplicated however she only had 3 prenatal visits. You perform a transabdominal ultrasound and the placenta appears low. Her most likely diagnosis is?

A

Placenta previa

22
Q

In this condition fetal vessels course through the membranes and present at the internal os.

a. cervical insufficiency
b. placenta previa
c. abruption
d. uterine rupture
e. vasa previa

A

e. vasa previa

23
Q

A low lying placenta and/or velamentous cord insertion is consistent with what condition?

a. cervical insufficiency
b. placenta previa
c. abruption
d. uterine rupture
e. vasa previa

A

e. vasa previa

24
Q

What diagnostic test do you want to use for vasa previa?

A

pulse color doppler

to differentiate maternal v.s fetal vessels

Obstetrics (12 decks)

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