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OB exam 3 > Ch 28, hemorrhagic disorders > Flashcards

Ch 28, hemorrhagic disorders Flashcards

1
Q

Maternal blood loss decreases oxygen-carrying capacity and increases risk for what 5 things?

A

-Hypovolemia (low plasma volume)
-Anemia (Low RBC/Blood loss)
-Infection
-Preterm labor
-Insufficient O2 to the fetus

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2
Q

Fetal risks from maternal hemorrhage are what 5 things?

A

-Blood loss/Anemia
-Hypoxemia (Low blood O2)
-Hypoxia (Low O2 to tissues)
-Anoxia (complete lack of O2)
-Preterm birth

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3
Q

Hemorrhagic disorders are classified as what?

A

A Medical Emergency!

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4
Q

A spontaneous abortion is usually classified as a miscarriage at how many weeks?

A

At or before 20 weeks

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5
Q

What percentage of pregnancies end in miscarriage?

half of those spontaneous abortions have what kind of anomaly?

A

25% of pregnancies end in miscarriage

Half of those miscarriages are due to a chromosomal anomaly

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6
Q

80% of miscarriages end at what gestational weeks?

A

12 weeks or before

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7
Q

What are the 6 types of miscarriages?

A

-Threatened
-Inevitable
-Incomplete
-Complete
-Missed
-Recurrent/Habitual

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8
Q

Cervical insufficiency can be (________) and (__________), and typically come during the (__) and (__) trimesters

A

Cervical insufficiency can be (passive) and (painless), and come with during the (2nd) and (3rd) trimesters

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9
Q

What tool is used to measure the length of the cervix in cervical insufficiency?

A

An ultrasound

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10
Q

What is the length of an abnormally short cervix?

A

<25mm

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11
Q

What is a cervical cerclage?

A

A procedure that stitches up the cervix to prevent a preterm birth

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12
Q

When should an ultrasound be given on a patient with a history of preterm births?

A

Between 14-23 weeks

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13
Q

Identify which of the 6 miscarriages are which:

-Vaginal bleeding, cramping, but the cervix is closed

-Cervix is dilated and engaged in effacement

-Retained tissue, D&C will most likely be needed due to bleeding

-No retained tissue

-Fetus dies in utero, body doesn’t get rid of it

-3 or more before 20 weeks/<500g weight

A

-Vaginal bleeding, cramping, but the cervix is closed (Threatened)

-Cervix is dilated and engaged in effacement (Inevitable)

-Retained tissue, D&C will most likely be needed (Incomplete)

-No retained tissue (Complete)

-Fetus dies in utero, body doesn’t get rid of it (Missed)

-3 or more before 20 weeks/<500g weight (Recurrent/Habitual)

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14
Q

How do you manage a threatened miscarriage? (3 ways)

A

-Ultrasound to see if the baby is in there.
-Check the HCG levels, if they are steady and increase it means the fetus is still viable
-No sex for 3 weeks after bleeding stops

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15
Q

How do you treat an inevitable miscarriage?

Why would a D&C be ordered for an inevitable miscarriage?

A

-Monitor for bleeding by weighing the
bloody pads in grams. 1:1 g/mL

-D&C may be ordered to check for polyps, cancer and hyperplasia

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16
Q

In an incomplete miscarriage, what will be administered to assist in the suction from D&C?

A

Pitocin to lower uterine contractions and stop bleeding

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17
Q

(_______) miscarriage will involve heavy (___________) and (________) due to the body trying to get what?

A

(Incomplete) miscarriage will involve heavy (bleeding) and (cramping) due to the body trying to get rid of the fetus

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18
Q

A gestational report will determine how a miscarriage is handled in a missed miscarriage. What is the procedure for a:

-4-6 week missed?
->12 week missed?

A

4-6 week missed: Use a D&C

> 12 weeks will be using Cytotec (misoprostol)

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19
Q

What is the emergent rescue procedure using a cervical cerclage?

A

Use a cerclage to salvage the pregnancy between 16-23 weeks with 1cm or greater dilation of the cervix

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20
Q

An Ectopic pregnancy is when the fertilized ovum is implanted (_______) the (________) cavity; also called “(____) pregnancies”

A

An Ectopic pregnancy is when the fertilized ovum is implanted (outside) the (uterine) cavity; also called “(tubal) pregnancies”

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21
Q

What are 3 primary symptoms of an Ectopic pregnancy?

A

-Abdominal pain
-Late period/Menzies
-Abnormal vaginal bleeding/Spotting

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22
Q

What is a trademark sign of fallopian tube rupture in a patient with suspected ectopic pregnancy?

What causes the fallopian tube rupture in an ectopic pregnancy?

A

Referred pain in the shoulder in the trademark sign

Fallopian tube rupture comes from abdominal pain and abnormal bleeding

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23
Q

Dx for an Ectopic pregnancy can be difficult, but typically you look for what lab levels?

A

Beta HCG levels

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24
Q

If the Beta HCG levels in a mother are between (____-______), then you should be able to see products of conception in an (__________). If not, then that means an (________) pregnancy.

A

If the Beta HCG levels in a mother are between (1500-2000), then you should be able to see products of conception in an (ultrasound). If not, then that means an (ectopic) pregnancy.

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25
Q

What medication is used to handle an ectopic pregnancy?

A

Methotrexate

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26
Q

How does Methotrexate handle an ectopic pregnancy?

A

Methotrexate destroys the rapidly dividing cells in the tubes and your body just absorbs everything

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27
Q

What is a Bilateral Salpingectomy?

A

Removal of the Fallopian Tubes (permanent birth control)

28
Q

How can you surgically salvage the fallopian tubes during an ectopic pregnancy?

A

Cut a hole in the tubes and remove the blastocyst (forming embryo)

29
Q

A Hydatidiform Mole, aka a “(_______) pregnancy”, is what sign of pregnancy?

A

A Hydatidiform Mole, aka a “(Molar) pregnancy”, is what a positive sign of pregnancy

30
Q

There are 2 types of Hydatidiform Mole’s, Complete and Partial.

Complete is no (__________). Partial is some (_______) with (_______) parts but no (____)

A

There are 2 types of Hydatidiform Mole’s, Complete and Partial.

Complete is no (Embryonic). Partial is some (embryonic) with (fetal) parts but no (sac)

31
Q

What is this?

“Benign proliferative growth of the placental trophoblast in which the chorionic villi develop into edematous, cystic, avascular transparent vesicles that hang in a grapelike cluster”

A

Hydatidiform Mole (Molar pregnancy)

32
Q

What are 2 methods to diagnose a Hydatidiform Mole?

A

-Transvaginal ultrasound
-Beta HCG level test (1500-2000)

33
Q

What are 3 signs of a Hydatidiform Mole?

A

-Anemia
-N/V
-Abdominal cramping

34
Q

Placenta Privia vs Abruption:

Privia is when the placenta (_____) the cervical (__/__________).

Abruption is when the placenta (__________) from the (_________) wall.

A

Placenta Privia vs Abruption:

Privia is when the placenta (blocks) the cervical (os/opening).

Abruption is when the placenta (separates) from the (uterine) wall.

35
Q

Privia has (_____) red blood and is pain(____)

Abruption has (____) red blood and is pain(____)

A

Privia has (bright) red blood and is pain(less)

Abruption has (dark) red blood and is pain(full)

36
Q

What trimester does placental privia occur?

A

2nd and 3rd trimester

37
Q

What are risk factors for developing privia? (Name 6)

A

-AMA
-Scar tissue at the cervix
-Multigravida (multiple pregnancies)
-D&C
-Smoking
-Meth/Cocaine use

38
Q

What are infant complications as a result of privia?

A

-Premature birth
-IUGR
-Hemorrhaging

39
Q

What is Placenta Accreta?

A

An emergency issue where the placenta grows through the uterus and into the tissues and organs of the body

40
Q

How do you dx Placenta Accreta?

A

Transvaginal ultrasound

41
Q

If a placenta is low-lying, or privia around the gestational term stage (37 weeks+) and is completely covering the cervical opening, what will need to be done to deliver the baby?

A

A c/sec

42
Q

When can you discharge a pt with late pregnancy bleeding?

A

24 hours after bleeding stops

43
Q

What is the BIGGEST risk factor for placental abruption?

A

Maternal HTN

44
Q

A pregnant patient was in a car wreck and enters the emergency room. Her cervix is presenting with little bleeding, but she is feeling intense contractions and severe abdominal pain with high blood pressure. Uterine upon palpation is tender and board-like.

What is most likely occurring?

A

Abruption

Cervical bleeding can occur or not, but it is primarily r/t HIGH BP and recognized by contractions due to bleeding, and there is SEVERE uterine/abdominal pain. Uterus will be tender and board-like upon palpations because they are bleeding.

45
Q

How would you monitor uterine activity with a suspected abruption?

A

FHM and Toco

46
Q

(____ ______): A rare condition in which fetal (______) lie over the cervical os, and they are implanted into the fetal (__________) rather than into the placenta.

A

(Vasa previa): Rare condition in which fetal (vessels) lie over the cervical os, and they are implanted into the fetal (membranes) rather than into the placenta.

47
Q

What are the 2 types of Vasa Previa?

A

-Velamentous insertion of the cord

-Succenturiate placenta

48
Q

For Vasa Previa, what is a Velamentous insertion of the cord?

A

Cord vessels branch at membranes and then onto the placenta (cord on the outside)

49
Q

For Vasa Previa, what is Succenturiate placenta?

A

The placenta is divided into two or more lobes

50
Q

What is this:
Cord vessels branch at membranes and then onto the placenta (cord on the outside)

A

Vasa Previa:
Velamentous insertion of the cord

51
Q

What is this:
The placenta is divided into two or more lobes

A

Vasa Previa:
Succenturiate placenta

52
Q

A Battledore (Marginal) insertion of the cord increases the risk of what?

A

Fetal Hemorrhaging

53
Q

In normal clotting, there is a delicate balance (Homeostasis) between the opposing (____)static and (______)lytic systems

A

In normal clotting, there is a delicate balance (Homeostasis) between the opposing (Hemo)static and (Fibrino)lytic systems

54
Q

The (____)static system stops the flow of (____) from injured vessels, first by a (______) plug, then by forming a (______) clot

A

The (Hemo)static system stops the flow of (blood) from injured vessels, first by a (platelet) plug, then by forming a (Fibrin) clot

55
Q

What is meant by the “cascade effect” of the coagulation process?

A

Each factor sequentially activates the factor next in line

56
Q

The (_______)lytic system is the process through which the (_____) clot is then split into (_______)lytic (___________) products and circulation is (_________)

A

The (Fibrino)lytic system is the process through which the (fibrin) clot is then split into (fibrono)lytic (degradation) products and circulation is (restored)

57
Q

“Consumptive coagulopathy” and “defibrination syndrome” are other names used to describe what?

A

DIC

58
Q

DIC is NEVER a (______) (__________). It results from an event that triggered (___________)

A

DIC is NEVER a (primary) (diagnosis). It results from an event that triggered (coagulation)

59
Q

DIC (Disseminated Intravascular Coagulation) is an (_________) syndrome characterized by widespread intravascular (___________) - not localized - and results in both excessive (____) formation and (___________)

A

DIC (Disseminated Intravascular Coagulation) is an (acquired) syndrome characterized by widespread intravascular (coagulation) - not localized - and results in both excessive (clot) formation AND (hemorrhaging)

60
Q

In the OB population, DIC (Disseminated Intravascular Coagulation) is most often triggered by the release of (______) amounts of (______) factor as a result of Placental (_________)

A

In the OB population, DIC (Disseminated Intravascular Coagulation) is most often triggered by the release of (large) amounts of (tissue) factor as a result of Placental (Abruption)

61
Q

What should vaginal bleeding during pregnancy always be considered?

A

A warning sign

62
Q

What type of pregnancy is a significant cause of maternal mortality?

A

Ectopic pregnancy

63
Q

Cervical Insufficiency can be treated via a (________) placed either cervically or (__________)

A

Cervical Insufficiency can be treated via a (cerclage) placed either cervically or (abdominally)

64
Q

Molar pregnancy (hydatidiform mole) is a gestational trophoblastic neoplasia (GTN). What is a GTN?

A

GTN’s are a group of pregnancy-related cancers without a viable fetus that are caused by abnormal fertilization

65
Q
A

OB exam 3 (6 decks)

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