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ENDOREPRO II Exam I > [CLMD] Obstetric Hemorrhage and Puerperal Sepsis [Moulton] > Flashcards

[CLMD] Obstetric Hemorrhage and Puerperal Sepsis [Moulton] Flashcards

1
Q

How much will the Hct and Hgb be raised by 1 unti of PRBC’s?

A

Raise Hct by 3% and Hgb by 1g/dL

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2
Q

What should be avoided during the initial examination of antepartum hemorrhage?

A
  • AVOID digital exam until placenta previa is ruled out
  • Instead do sterile speculum exam
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3
Q

How many units of blood should you type and crossmatch for during antepartum hemorrhage?

A

4 untis of blood

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4
Q

Placenta previa classically presents how?

A

PAINLESS vaginal bleeding

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5
Q

Risk factors for placenta previa?

A
  • Maternal age >35
  • Multiparity
  • Prior previa
  • Previous C-section
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6
Q

What is the most serious type of placenta previa and is associated with the most blood loss?

A

COMPLETE

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7
Q

Placent previa is almost exclusively diagnosed how?

A

By U/S

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8
Q

How likely are placenta previas to resolve on their own?

A

90% will resolve by placental migration

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9
Q

What is goal of management of placenal previa in preterm pregnancy; can these patients go home?

A
  • Goal is to attempt to obtain fetal maturation
  • If bleeding not profuse, pt is managed on bed rest initially
  • If stable and bleeding stops may send home on pelvic rest
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10
Q

What is the most common abnoraml placental implantation other than previa?

A

Placent ACCRETA; firm attachment ot the superficial linign of the myometrium

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11
Q

What is the most common cause of third trimester bleeding?

A

Placental Abruption

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12
Q

Which condition most often presents as painful third trimester bleeding, uterine tenderness, uterine hyperactivity, and fetal distress and/or death?

A

Placental abruption

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13
Q

What is the most common risk factor for placental abruption?

A

Maternal HTN

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14
Q

If pregnant mother presents after MVA or physical abuse how long should they be monitored for placental abruption?

A

Monitor for 4-6 hours

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15
Q

What is the most common cause of DIC in pregnancy?

A

Placental abruption

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16
Q

What is the proper management of placental abruption based on maternal and fetal stability?

A
  • If both stable then proceed with vaginal delivery
  • Often a rapid delivery ensues w/ abruption
  • If remote from vaginal delivery w/ signs of fetal distress or uncontrolled bleeding then C-sections
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17
Q

What is couvelarire uterus?

A

Occurs during placental abruption with extravasation of blood into the uterus

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18
Q

Uterine rupture is associated with what signs/sx’s?

A
  • Sudden onset of INTENSE abdominal pain +/- vaginal bleeding
  • Abnormal FHR pattern or cessation of fetal heart tones
  • Regression of the presenting part
19
Q

How is uterine rupture managed?-

A
  • Immediate laparotomy and delivery of fetus
  • If feasible repair ruptured site
  • If large rupture may have to do a cesarean hysterectomy
20
Q

Fetal bleeding that occurs during the third trimester is most often due to what?

A

2’ to velamentous insertion of umbilical cord

21
Q

Postpartum hemorrhage is defined as how much blood loss following a vaginal birth vs. C-section?

A
  • >500cc following vaginal birth
  • >1000cc following C-section
22
Q

Differentiate primary vs. secondary postpartum hemorrhage?

A
  • Primary is that which occurs within first 24 hours; often uterine atony
  • Secondary occurs from >24 hours to 12 weeks
23
Q

What will palpation of a uterus that fails to contract after delivery reveal (uterine atony)?

A

Will reveal “Boggy Uterus”

24
Q

Effective hemostasis after separation of the placenta is dependent on what?

A

Myometrium to compress the severed vessels

25
Q

What are some strategies to managin uterine atony?

A
  • BIMANUAL MASSAGE of the uterus
  • Start pharmacologic agents: oxytocin, etc…
  • Uterine packing or large volume balloon catheter
  • Interventional radiology
26
Q

Methylergonovine can be given for tx of postpartum hemorrhage, but should be avoided in whom?

A

Avoid in HTN patients

27
Q

15-methyl PGF2a (Hemabate) can be given for management of postpartum hemorrhage but should be avoided in which pt’s?

A

Avoid in asthmatics

28
Q

Dinoprostone (PGE2) can be given for postpartum hemorrhage, but should be avoided in which pt’s?

A

Avoid if patient is HYPOtensive

29
Q

What is the second most common cause of postpartum hemorrhage following vaginal delivery?

A

Trauma during delivery

30
Q

What is the treatment for retained placenta?

A
  • Manual removal if bleeding is profuse
  • +/- uterine curettage with or without U/S guidance being careful not to perforate
31
Q

How should uterine inverion be managed if placenta has not been delivered?

A

DO NOT remove placenta until the inversion is corrected

32
Q

Uterine inversion is associated with what complications?

A

Copious bleeding and HYPOvolvemic shock can ensue

33
Q

How much is the platelet count increased per unti of platelets given?

A

5000-10,000/mm3 per unit

34
Q

What are the contents of fresh frozen plasma and how much does one unit increase the fibrinogen?

A
  • Contains fibrinogen, antithrombin III,andFactors VandVIII
  • Increases fibrinogen by 10 mg/dL
35
Q

What are the blood components of Crypercipitate and how much does one unit increase the fibrinogen?

A
  • Fibrinogen + vWF + Factors VIII and XIII
  • Increases fibrinogen by 10 mg/dL
36
Q

Febrile morbidity is defined as what?

A

Temp >100.4 (38 C) or higher occuring >2 consecutive days during the first 10 postpartum days

37
Q

Majority of the postpartum fevers are due to what?

A

Endometritis

38
Q

Organism with what oxygen dependence cause majority of puerperal infections; which organisms most commonly?

A

ANAEROBIC —> Peptostreptococcus, Peptococcus, and Streptococcus

39
Q

What are the key clinical findings for puerpral sepsis?

A

Postpartum fever and ↑ uterine tenderness on postpartum day 2-3

40
Q

What is an effective antibiotic regimen for puerperal sepsis; what if causative organism is Bacteroides fragilis?

A
  • Ampicillin + Gentamicin
  • Bacterioides fragilis is resistant to this combo, but sensitive to Clindamycin
41
Q

Septic pelvic thrombophlebitis fufills the criteria for which pathogenesis of thrombosis?

A
  • Virchow’s triad
  • Endothelial damage + Venous stasis + hypercoagulable state of pregnancy
42
Q

How does the presentation of ovarian vein thrombophlebitis differ from deep septic pelvic vein thrombophlebitis?

A
  • Ovarian vein will have fever + abdominal pain within 1 week of delivery —> appear critically ill
  • Pelvic vein will usually have unlocalized fever in first few days that is NON-responsive to Abx and pt’s do NOT appear critically ill
43
Q

If ovarian vein thrombosis is seen radiographically anticoagulants should be continued for how long?

ENDOREPRO II Exam I (26 decks)

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