Blue Prints 5: Antepartum Hemorrhage

Question 1

Define placenta previa?

3 types of previa?

Answer 1

Placenta implants over the internal cervical os.

Complete, partial and marginal

Question 2

3 placental causes of antepartum bleeding?

1 maternal and 1 fetal cause of antepartum bleeding?

Answer 2

Placenta previa, placenta abruption, vasa previa
Uterine rupture
Fetal vessel rupture

Question 3

Patient presentation of placenta previa and when does it usually happen?

Answer 3

Painless vaginal bleeding after 28 weeks

Question 4

When do 50% of abruptions occur?

Answer 4

Before labor and after 30 weeks

Question 5

What is classic presentation of abruption?

Answer 5

Third trimester vaginal bleeding with severe abdominal pain

Question 6

What is the difference between cervical insufficiency and preterm labor?

Answer 6

Painful and painless cervical dilation and effacement

Question 7

What is considered low birth weight?

Answer 7

Less than 2500 grams

Question 8

Infants who have not grown appropriately for their gestational age have what or are what?

Answer 8

Intrauterine growth restriction or are small for gestational age

Question 9

4 big time conditions that baby is at risk for if born premature?

Answer 9

RDS, intra ventricular hemorrhage, sepsis, and necrotizing enterocolitis

Question 10

What is the only FDA approved tocolytic?

Answer 10

Ritodrine

Question 11

Studies have shown that tocolytics only prolong gestation for how long, which means what is the primary purpose and what med is used for this primary purpose?

Answer 11

48 hours
Allow lungs to mature
Betamethasone

Question 12

What is the goal of tocolytics?

Answer 12

Decrease cervical change for contractions

Question 13

Besides tocolytics, what else is used to decrease contractions and why?

Answer 13

Hydration. It decreases the level of ADH which can bind to oxytocin receptors and halt contractions.

Question 14

Explain big picture what regulates uterine contractions on a molecular level and what turns it on and off?

Answer 14

Myosin light chain kinase.

Calcium + calmodulin turns it on and cAMP turns it off.

Question 15

How can we increase levels of cAMP and what is the actual effect of cAMP to turn off MLK?

Answer 15

Beta agonists that activate b2 receptors, convert ATP to cAMP. The cAMP causes calcium to go inside the SR which lowers available calcium for contractions.

Question 16

What are the two beta agonists historically used to prolong pregnancy?

Answer 16

Ritodrine and terbutaline

Question 17

What effect does magnesium have on contractions and how does it work?

Answer 17

Decreases by being anti calicum

Question 18

What is the calcium channel blocker mentioned in the book?

Answer 18

Nifedipine

Question 19

What is the prostaglandin inhibitor mentioned to decrease contractions?

Answer 19

Indomethacin, blocks cyclo oxygenase

Question 20

How to best make the diagnosis of ROM?

Answer 20

History of leaking vaginal fluid
Pooling, nitrazine test positive and ferning
US shows less fluid
Tampon test via amniocentesis

Question 21

What drives the management of preterm premature ROM?

Answer 21

At some gestational age, the risk of prematurity and the risk of infection becomes equal between 32 and 36 weeks. Up to 32 weeks, the risk of prematurity is the driving factor in management and after 36 weeks it is infection. Most would say they deliver at 34 weeks.

Question 22

What two meds are recommended in the setting of preterm premature ROM?

Answer 22

Antibiotics, so ampicillin (+- erythromycin)

And steroids for lungs.

Question 23

What is the most common concern of premature ROM?

How do we treat?

Answer 23

Chorioamnionitis

Abx and deliver at 34 weeks

Question 24

How do we define prolonged deceleration and bradycardia in baby?

Answer 24

HR below 100 for over 2 minutes

Longer than 10 minutes is bradycardia

Question 25

What is the Mc Roberts maneuver for shoulder dystocia, what does it accomplish and what needs to be done along with it?

Answer 25

Sharply flex moms hips to increase AP diameter
Suprapubic pressure above symphysis to get anterior shoulder out
If there is a shoulder out, try to push it toward anterior chest to decrease diameter of baby’s