Chapter 5 Antepartum Hemorrhage

Question 1

placenta previa

Answer 1

abnormal implantation of placenta over internal cervical os.

Question 2

partial previa

Answer 2

placenta covers a portion of the internal os

Question 3

marginal previa

Answer 3

edge of placenta reaches margin of the os

Question 4

low lying placenta

Answer 4

implanted in lower uterine segment in close proximity but not extending to the internal os.

Question 5

vasa previa

Answer 5

fetal vessel lying over the cervix.

Question 6

with progression of pregnancy, more than 90% of low lying placentas identified early in pregnancy will appear to move away from the cervix and out of lower uterine segment.

Answer 6

true

Question 7

placental migration

Answer 7

placenta does not actually move. most likely due to development of lower uterine segment. additionally, it may be that placenta grows preferentially toward a better vascularized fundus (trophotropism), whereas placenta overlying the less well-vascularized cervix may undergo atrophy.

Question 8

placenta accreta

Answer 8

defined as superficial attachment of the placenta to the uterine myometrium.

Question 9

increta occurs:

Answer 9

when placenta invades the myometrium

Question 10

percreta

Answer 10

occurs when placenta invades through myometrium to the uterine serosa.

Question 11

predisposing factors for placenta previa

Answer 11

1. prior CS and uterine surgery
2. multiparity
3. multiple gestation
4. erythroblastosis
5. smoking
6. history of placenta previa
7. increasing maternal age.

Question 12

patients with placenta previa present with sudden and profuse

Answer 12

painless vaginal bleeding.

Question 13

is it ok to do vaginal exam in placenta previa?

Answer 13

NO. CONTRAINDICATED. digital exam can cause further separation of the placenta and trigger catastrophic hemorrhage.

Question 14

US exam can diagnose placenta previa.

Answer 14

true. sensitivity is > 95%.

Question 15

predisposing factors for Placenta abruption

Answer 15

1. Hypertension
2. Previous placental Abruption
3. AMA
4. Multiparity
5. Uterine distension
6. Multiple pregnancy
7. Polyhydramnios
8. Vascular deficiency
9. Diabetes Mellitus
10. Collagen vascular disease
11. Cocaine use
12. Methamphetamine use
13. cigarette smoking
14. alcohol use (>14drinks/week)
15. circumvallate placenta
16. short umbilical cord.

Question 16

most common factor associated with increased incidence of abruption is

Answer 16

hypertension

Question 17

in cases of abruptions that are severe enough to cause fetal death, 50% are due to hypertension, 25% of these are from chronic htn, and 25% are from preeclampsia.

Answer 17

true

Question 18

historically taught that __ uterine bleeding signifies placental abruption, whereas __ uterine bleeding is indicative of placenta previa

Answer 18

painful, painless.

Question 19

diagnosis of placental abruption is primarily clinical.

Answer 19

only 2-25% of abruptions are diagnosed by ultrasound.

Question 20

negative findings on US exam do NOT exclude

Answer 20

placental abruption.

Question 21

diagnosis of abruption may be confirmed by inspection of the placenta at deliery. presence of a ___ with overlying placental destruction confirms the dx.

Answer 21

retroplacental clot.

Question 22

if a patient’s placenta previa persists into the 3rd trimester, she is at most risk for ___ in the presence of an anterior placenta previa and hx of 2 previous c/s.

Answer 22

placenta accreta

Question 23

if placenta previa persists, it can be complicated by an associated

Answer 23

placenta accreta.

Question 24

patients with a complete / partial previa to have complete pelvic rest which means

Answer 24

no intercourse, in order to preveng significant bleeding.

Question 25

the special precautions regarding placenta previa are

Answer 25

1. complete pelvic rest

2. close observation.

Question 26

what further imaging may be helpful in dx of placenta accreta?

Answer 26

MRI is imaging modality of choice to evaluate myometrial and/or bladder invasion of the placenta, particularly when it is not clear on US.

Question 27

what does a sinusoidal pattern on continuous fetal heart rate monitoring indicate?

Answer 27

fetal anemia.

Question 28

when there is a true sinusoidal pattern, prompt emergent delivery

Answer 28

true

Question 29

late decelerations are the typical fetal tracing when ___ occurs

Answer 29

uteroplacental insufficiency