Bleeding in Pregnancy (2/3 Trimester) Flashcards
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. cervical insufficiency
What are the 4 primary risk factors for cervical insufficiency?
- history of cervical surgery
- history of cervical lacerations
- uterine anomalies
- history of DES
If a patient had a prior loss, at what week can a cerclage be placed?
13 weeks
If cervical insufficiency is diagnosed in the current pregnancy, a cerclage placement can be done up until what week?
up until 24 weeks
What are the 5 major causes for second and third trimester bleeding?
- cervical insufficiency, preterm/term labor
- placenta previa
- abruption
- uterine rupture
- vasa previa
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. cervical insufficiency
When examining for second and third trimester bleeding what physical exam should you start with?
sterile speculum
*do not do a digital exam first because you do not know what is presenting
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
c. abruption
remember this is PAINFUL
What are the 3 most common risk factors for placental abruption (per Dr. Marino)?
- hypertension
- PPROM
- Cigarette smoking
T/F: Negative findings on ultrasound evaluation rules out placental abruption.
FALSE
DOES NOT RULE OUT
How is placental abruption diagnosed?
diagnosis of exclusion
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
b. placenta previa
What is the gold standard diagnostic exam for placenta previa?
transvaginal ultrasound
What is the greatest risk with placenta previa?
bleeding
Delivery in a patient with placenta previa is always by this method.
cesarean section
This condition refers to a placenta that is abnormally adherent.
placenta accreta spectrum
What is the greatest risk factor for placenta accreta spectrum?
previous cesarean section
What is the difference between placenta attachment in accreta, increta, and percreta?
- accreta = through the endometrium
- increta = into myometrium
- percreta = through the serosa to adjacent organs
How is placenta accreta spectrum diagnosed?
ultrasound
Placenta accreta spectrum (abnormal placentation) is the second leading cause of this procedure.
- cesarean hysterectomy
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?
Placenta previa
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
e. vasa previa
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
e. vasa previa
What diagnostic test do you want to use for vasa previa?
pulse color doppler
to differentiate maternal v.s fetal vessels
