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Womens Health > Complications of Pregnancy > Flashcards

Complications of Pregnancy Flashcards

1
Q

14 Complications of Pregnancy

A 
Abortion
Ectopic Pregnancy
Gestational Trophoblastic Disease
Multiple Gestation
Hypertension in Pregnancy
Rh Incompatability
Gestational Diabetes
Premature Rupture of Membranes
Placenta Previa
Abruptio Placentae
Dystocia
Fetal Distress
Cesarean Section
Postpartum Hemorrhage
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2
Q

Human Chorionic Gonadotropin (HCG) values

A

Titer < 5 IU/L is negative
Titer > 20 – 25 IU/L is positive
Urine Test detects > 25 IU/L
will double every 48 hours

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3
Q

What is Human Chorionic Gonadotropin (HCG)

A

is a hormone produced by the syncytiotrophoblast, a portion of the placenta, following implantation

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4
Q

Ultrasound (Transvaginal)

A

Gestational sac visible @ 5 weeks gestation

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5
Q

Diagnostic Classification for abortions

A 
Threatened 
Missed 
Empty Sac (blighted ovum)
Inevitable 
Incomplete 
Complete 
Septic 
Recurrent 
Elective
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6
Q

Spontaneous Abortion

A

Recognized pregnancy loss before 20th week.
Most common complication of early pregnancy.
8-20% of clinically recognized pregnancies less than 20 weeks of gestation will undergo spontaneous abortion.
80% of these occur in the first 12 weeks of gestation.

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7
Q

what are 5 fetal factors?

A

Chromosomal abnormalities 50% of the time they have abnormal chromosomes
Congenital anomalies chromosomal deletions etc
Exposure to teratogens high percent abort
Trauma
Only about 2% of babies have abnormalities

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8
Q

What maternal factors make for higher risk of abortion?

A 
Advanced maternal Age
Previous spontaneous abortion
Uterine structural issues
Maternal disease thyroid dz etc
Maternal smoking
Unexplained
alcohol/ cocaine/ NSAIDs
extremes in maternal weight
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9
Q

3 clinical presentations common with abortion?

A

Vaginal Bleeding
Pelvic pain
Incidental finding on ultrasound

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10
Q

What is the most useful exam for abortion?

A

U/S

can detect fetal activity at ~5.5 weeks

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11
Q

What are 4 potential predictors of failed pregnancy

A 
Abnormal Gestational Sac
Should be round some might be irregular
Abnormal Yolk Sac
Slow Fetal Heart Rate <100 beats per min might be indication that might be abort
Subchorionic Hemorrhage
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12
Q

3 lab evals done for abortion

A

HCG
Blood Type and Antibody Screen
CBC

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13
Q

What is a threatened abortion?

A

cervix closed
used to describe vaginal bleeding that occurs in the first 20 weeks of pregnancy. Vaginal bleeding could indicate risk of miscarriage.
stomach cramps
expectant management

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14
Q

Inevitable abortion?

A 
Cervix is opened
Bleeding usually heavier
Cramps or pain lower abdomen
Treatment
Await spontaneous abortion
Consider surgical removal
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15
Q

Missed abortion?

A 
Fetus has died but still in the uterus
Spotting may or may not be present
No pain
Uterus enlarged but may be smaller than expected
Treatment
Await spontaneous abortion
Surgical removal
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16
Q

What is a complete abortion?

A

Pregnancy completely expelled from uterus

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17
Q

What are 6 symptoms of complete abortion?

A 
Bleeding
Pain
Passage of tissue
Cervix closed
Uterus smaller than expected
Tissue may be present in vagina
Follow serial HCG until <5
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18
Q

What is an incomplete abortion?

A

Only part of pregnancy expelled

Surgical removal as soon as possible

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19
Q

What are symptoms of incomplete abortion?

A 
Bleeding
Cramps
Passage of tissue
Cervix open
Tissue at cervical os or in vagina
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20
Q

What is septic abortion?

A

form of abortion with intrauterine infection
Uncommon with spontaneous abortion/very rare
Frequently associated with induced abortion
Can be life-threatening
Usually caused by Staphylococcus aureus

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21
Q

What are symptoms of septic abortion?

A 
Fever, chills, malaise
Abdominal pain
Vaginal bleeding and discharge which is sanguinopurulent
Tachycardia
Low abdominal tenderness
Boggy, tender uterus with dilated cervix
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22
Q

What is the treatment for septic abortion?

A

Parenteral antibiotics

Evacuate uterus

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23
Q

What is recurrent abortion?

A

Three or more consecutive losses of clinically recognized pregnancies prior to the 20th week.
Spontaneous abortion occurs about 10-15 % of the time

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24
Q

What are the chances of having another spontaneous abortion after 1?
after 2?

A

After one spontaneous abortion the chance of a second is about 15%
It rises after 2 consecutive spontaneous abortion to 17-31%
25-46% after three consecutive spontaneous abortions

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25
Q

What are 5 causes of recurrent abortion?

A 
Uterine factors
Endocrine uncontrolled thyroid or polycystic ovarin
Karyotype abnormalities
Environmental toxins
Autoimmune disease lupus
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26
Q

What is an empty sac?

A

Where the embryonic development arrested at a very early stage or failed altogether
Defined sonographically as a gestational sac larger than 25 mm without evidence of embryonic tissue
Can present as a missed, inevitable, incomplete or complete abortion

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27
Q

What is an ectopic pregnancy?

A

It is an extrauterine pregnancy
98% occur in the fallopian tube
Ampullary portion of tube most common
Isthmic next most frequent site.

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28
Q

What are high risk factors for having ectopic pregnancy?

A 
previous ectopic pregnancy
previous tubal surgery
current IUD use
tubal ligation, tubal patho
in utero DES exposure
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29
Q

Incidence and epidemiology of ectopic pregnancy

A

The prevalence of ectopic pregnancy of woman who go to the ED for first trimester bleeding, pain or both ranges from 6-16%.
The overall incidence has increased in the mid twentieth century, plateauing at approx. 20 per 1000 pregnancies in the early 1990’s
The rising incidence associated with pelvic inflammatory disease

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30
Q

What is a tubal abortion?

A

body forces the pregnancy out the fallopian tube

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31
Q

What is a tubal rupture?

A

pregnancy blows out the fallopian tube

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32
Q

What is an abdominal pregnancy?

A

body sends the pregnancy out but it gets stuck in the abdomen

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33
Q

How do you diagnose an ectopic pregnancy?

A

Based on measurement of serum HCG & transvaginal ultrasound, Hgb, HCT
Accounts for 4-10% of all pregnancy related deaths
HCG should double every 48 hours in a normal pregnancy if it doesn’t think its abnormal or ectopic

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34
Q

Signs and symptoms for ectopic pregnancy?

A 
Vaginal bleeding and/or abdominal – pelvic pain
Asymptomatic
Abnormal menstruation
Uterine changes
Blood pressure & pulse
Temperature
Pelvic mass
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35
Q

What is the leading cause of pregnancy related maternal death in the 1st trimester?

A

Hemorrhage from ectopic

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36
Q

What are 3 treatments for ectopic pregnancy?

A

Dilatation & Curettage
Laparoscopy
Laparotomy= unstable patients

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37
Q

2 types of laparoscopy?

A 
Salpingostomy= open the fallopian tube
Salpingectomy= remove the fallopian tube
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38
Q

What is the criteria to use medical management?

A 
< 6 weeks
Tubal mass < 3.5 cm in diameter
Fetus has died
B-HCG < 15,000 mIU
Patient has to be willing to do blood work
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39
Q

Medical management used for ectopic pregnancy?

A

Methotrexate Inhibits DNA synthesis

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40
Q

Contraindications for the use of methotrexate?

A 
Breastfeeding
Immunodeficiency
Alcoholism
Liver or kidney disease
Blood dyscrasias
Active pulmonary disease
Peptic ulcer
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41
Q

What are the side effects of medical management for ectopic pregnancy

A

Liver dysfunction
Stomatitis
Gastroenteritis
Pneumonitis

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42
Q

What is the prognosis of ectopic pregnancy

A

Recurrent ectopic 4-28%

Intrauterine pregnancy 38-89%

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43
Q

Gestational Trophoblastic Disease

A

is a group of conditions in which tumors grow inside a woman’s uterus (womb). The abnormal cells start in the tissue that would normally become the placenta

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44
Q

4 distinct types of GTD

A

Hydatidiform Mole (complete is MC or partial)
Persistent/invasive gestational trophoblastic neoplasia (GTN)
Choriocarcinoma
Placental site trophoblastic tumors

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45
Q

What are complete and partial moles of GTD?

A

noninvasive localized tumors that develop as a result of an aberrant fertilization event that leads to a proliferative process
They comprise 90% of GTD cases
The other three categories represent malignant disease

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46
Q

What are partial moles?

A

Originates from one maternal and usually two paternal haploid compliments
Fetus of partial mole has triploidy with congenital malformations & IUGR, and it is usually nonviable

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47
Q

Gestational Trophoblastic Disease epidemiology

A

Varies worldwide
North American & European countries 1 per 1000 to 1500 pregnancies
Asia & Latin America 1 per 12 to 500 pregnancies

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48
Q

What are 2 risk factors of GTD?

A

Extremes in age, older than 35 and < 20

History of previous GTD

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49
Q

Clinical Manifestations of Gestational Trophoblastic Disease

A 
Vaginal bleeding 
Enlarged uterus
Pelvic pressure or pain
Theca lutein cysts get large, tumors of the ovaries usually bilateral and can get to 10-15mm in size
Anemia
hyperthyroid
preeclampsia before 20 wks
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50
Q

How to diagnose Gestational Trophoblastic Disease

A 
High levels of hCG
Ultrasound
Absence of embryo or fetus
No amniotic fluid
Snowstorm pattern
Theca lutein cysts= can produce testosterone
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51
Q

How to treat Hydatidiform mole

A

Immediate evacuation
Measure serum hCG, q2 weeks, once negative , monthly for 6 months.
Pregnancy allowed after 6 months

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52
Q

Persistent/invasive Gestational Trophoblastic Disease mole

A

20% of molar pregnancies can develop this
Usually limited to the uterus
Good prognosis with chemotherapy
3% relapse

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53
Q

Choriocarcinoma

A

uncommon cancer that occurs during pregnancy. A baby may or may not develop in this type of pregnancy

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54
Q

What do you need to check for if you find choriocarcinoma

A

Check for metastasis
Lung, Vagina, Vulva, Kidneys
Liver, Ovaries, Brain, Bowel

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55
Q

How do you treat Choriocarcinoma?

A

Immediate evacuation
Chemotherapy
Methotrexate
Actinomycin D

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56
Q

What is Placental site trophoblastic tumors

A

Rare malignant tumors that originate from intermediate cytotrophoblast cells
Arise months to years after a term gestation
Can occur after a spontaneous abortion or a molar pregnancy
Patients present with abnormal uterine bleeding, mass in uterus or amenorrhea
Secrete small amounts of B-HCG

57
Q

Epidemiology of Placental site trophoblastic tumors

A

70% of tumors are confined to the uterus
30% of patients present with metastatic disease
Mortality 50% with metastasis present
Prolonged remission possible with combined chemotherapy

58
Q

Placental site trophoblastic tumors prognosis?

A

Nonmetastatic malignant trophoblastic disease
Extremely good prognosis
Metastatic disease
Remission 45-65%

59
Q

epidemiology of multiple gestations?

A

Twins naturally occur in approximately 1 in 80 pregnancies
Triplets naturally occur in approximately 1 in 8,000 pregnancies
Multiple pregnancies increasing disproportionately in the US
Due to older age & use of fertility treatments

60
Q

What is the cause of multiple gestations?

A

Monozygotic twins unknown
Dizygotic twins results from ovulation of multiple follicles
Dizygotic twins result from fertilization of 2 separate ova during a single ovulatory cycle
Monozygotic twins result from a single fertilized ovum that subsequently divides into 2 separate individuals

61
Q

What are the 4 types of placentation

A

Diamniotic, dichorionic placentation occurs with division prior to the morula stage(within 3 days postovulation)
Diamniotic, monochorionic placentation occurs with division between days 4-8 days postovulation
Monoamniotic, monochorionic placentation occurs with division between 8-12 days postovulation
One of the worst types
Division at or after day 13 results in conjoined twins
Siamese twins

62
Q

What are Monoamniotic twins

A 
same amniotic sac
Increases perinatal mortality
Cord entanglement
Congenital anomalies
Discordant birth weight (twin-twin transfusion syndrome)
One twin takes things
63
Q

How are multiple gestations diagnosed?

A

Ultrasound
Uterine size
Fetal heart sounds

64
Q

Maternal adaptation involves what? (6)

A

Increase nausea & vomiting
Increase blood volume expansion
Increase in iron & folate requirements
Increase cardiac output due to increase stroke volume and heart rate
Displacement of many abdominal viscera
Displacement of lungs by elevated diaphragm

65
Q

What is the outcome of multiple gestations?

A 
Abortion
Malformations
Birth weight lower
Prematurity
Operative deliver
66
Q

How are most conjoined twins attached?

A

Ventral union 87% (joined in the front)

67
Q

What needs to be available during delivery with multiple gestations?

A 
Experienced obstetrician
Blood available
IV access
Anesthesiologist available
Pediatrician available
OR notified
68
Q

4 Major HTN disorders in pregnancy

A

Gestational HTN
Chronic HTN
Preeclampsia – eclampsia
Preeclampsia – eclampsia superimposed on chronic HTN

69
Q

What is gestational HTN

A

Increased BP after 20 weeks gestation

No proteinuria

70
Q

What is chronic HTN

A

BP 140/90 or higher before pregnancy or before 20 weeks gestation
HTN first diagnosed after 20 weeks but persists after 12 weeks postpartum

71
Q

What is Preeclampsia – eclampsia

A

Syndrome of new onset HTN & either proteinuria or end organ dysfunction, most often after 20 weeks gestation in a previously normotensive woman
Eclampsia diagnosed when seizures occur

72
Q

What is Preeclampsia – eclampsia superimposed on chronic HTN

A

When chronic HTN develops worsening HTN with new onset of proteinuria or other features of preeclampsia (elevated liver enzymes, low platelets)
one of the four causes of maternal death

73
Q

Preeclampsia with severe features are?

A 
thrombocytopenia
pulm edema
renal insufficiency
systolic >160
diastolic >110
74
Q

What is the HELLP Syndrome= severe subset of preeclampsia

A

Hemolysis
Elevated Liver Enymes
Low Platelets

75
Q

What is the prevelance of preeclampsia?

A

Prevalence of preeclampsia

  1. 5 % worldwide
  2. 4% in the US
76
Q

Eclampsia

A

occurrence of seizures in a woman with preeclampsia that cannot be attributed to other causes.
The seizures are grand mal and may appear before, during or after labor.
Presents with headaches
Put on mag sulfate

77
Q

How to manage eclampsia?

A

Termination of pregnancy with the least possible trauma to mother & fetus
Birth of an infant who subsequently thrives
Complete restoration of health to the mother
Antihypertensive therapy
Labetalol
Hydralazine
Anticonvulsive therapy
Magnesium sulfate

78
Q

What is the cure for preeclampsia?

A

deliver the baby

79
Q

What is Rh Incompatibility

A

Rhesus (Rh) negative woman who deliver an Rh positive baby or who are otherwise exposed to Rh positive RBC’s are at risk for developing anti-Rh antibodies.
Rh positive fetuses/neonates of these mothers are at risk for developing hemolytic disease of the fetus and newborn

80
Q

What are the Rh Antigens

A 
Rh negative (no D antigen)
Rh positive (contains D antigen)
D antigens are highly immunogenic
Individuals who do not produce the D antigen (ie Rh negative) will produce anti-D if they encounter the D antigen (become Rh sensitized)
81
Q

What occurs during the second pregnancy for Rh incompatability?

A 
1st pregnancy mom built up antibodies
2nd pregnancy:
IgG antibodies cross the placenta
Maternal antibodies attach to fetal RBC antigen
Hemolysis of fetal RBC’s
82
Q

What happens to the baby with prolonged hemolysis?

A 
Hepatomegaly
Splenomegaly
Hyperbilirubinemia
fetal jaundice
hydrops fetalis
83
Q

How to diagnose Rh incompatability?

A

Detection of anti-Rh(D) antibody in maternal serum by performing a type and antibody screen
The antibody titer is then quantified.
If titer is above critical level further evaluation is indicated
The titer below which the fetus will not die from hemolytic disease is usually 1:16

84
Q

What is hydrops fetalis?

A

serious condition in which abnormal amounts of fluid build up in two or more body areas of a fetus or newborn.

85
Q

What does hyrops fetalis cause?

A 
Hepatosplenomegaly
Portal hypertension
Ascites
Fetal hypoxia
Anemia
Congestive cardiac failure
Hyperproteinemia secondary to hepatic dysfunction
86
Q

How to Prevent Rh Sensitization

A 
Give Rh Immunoglobin:
Pregnancy loss
Termination of pregnancy
Procedure-amniocentesis
Any bleeding during pregnancy
At 28-29 weeks
Following delivery if baby is Rh positive
87
Q

What is Gestational diabetes mellitus

A

defined as carbohydrate intolerance of variable severity with onset or first recognition during pregnancy

88
Q

How do you screen for gestational diabetes mellitus

A

All pregnant woman are screened using 50-g of glucose
Screening is usually done after 26 weeks gestation
A value of > 135 mg/dl requires further evaluation with a 3 hour GTT

89
Q

What happens during a 3 hour GTT

A 
FBS
100-g glucose
Values
FBS – 95
1 hour – 180
2 hour – 155
3 hour – 140
Need 2 out of 3 to constitute gestational DM
If FBS is abnormal patient has GDM
90
Q

2 types of gestational diabetes mellitus

A

A1 Diet controlled gestational diabetes

A2 Insulin treated gestational diabetes

91
Q

What are maternal and fetal affects due to gestational diabetes mellitus

A 
Unexplained fetal death
Preclampsia
Hydramnios
Maternal & infant birth trauma
Neonatal respiratory problems & metabolic problems
(hypoglycemia, hyperbilirubinemia, hypocalcemia)
Macrosomia very large babies
Operative delivery
92
Q

Glucose targets?

A

Fasting blood glucose < 95 mg/dl
One-hour postprandial blood glucose < 140 mg/dl
Two-hour postprandial blood glucose < 120 mg/dl

93
Q

How do you treat gestational diabetes mellitus?

A 
Diet
Insulin
Oral anti-hyperglycemic agents
Glyburide
Metformin
94
Q

4 ways to manage gestational diabetes?

A

Good glucose control
Nonstress Tests
Biophyisical profile
Amniotic fluid index

95
Q

Advantages of induction for gestational diabetes?

A

Avoidance of stillbirth

Avoidance of delivery related complications trauma or shoulder dyslocia

96
Q

Disadvantages of induction for gestational diabetes?

A

Cesarean section

Neonatal morbidity if < 39 weeks

97
Q

Based on the 2 types of gestational diabetes at what week would you deliver the baby?

A

A1 GDM
Deliver by 41 weeks
A2 GDM
Deliver @ 39 weeks

98
Q

What should the levels be for patients at their postpartum follow up?

A 
75 gram oral GTT
Fasting
< 140 impaired GTT
> 140 DM
2 Hour	
140 – 199 impaired GTT
> 200 DM
99
Q

Premature Rupture of Membranes

A

Refers to rupture of the fetal membranes prior to the onset of regular uterine contractions
It may occur at term > 37 weeks or preterm < 37 weeks
3% of pregnancies
Associated with 33% of preterm births

100
Q

How to diagnose premature rupture of membranes

A 
Sterile speculum exam
Leaking of fluid
Nitrazine test
Fern test
ROM Plus, AmniSure
101
Q

What are 2 ways to manage premature rupture of membranes?

A

Induce labor

Expectant

102
Q

4 risk factors of PROM

A

Previous PPROM (13.5%)
Genital tract infection
Antepartum bleeding
Cigarette smoking

103
Q

PROM Management from 23-37 weeks

A

Antenatal corticosteroids– helps mature the lungs in 2 days
Antibiotics
Tocolytic drugs– stop the labor for at least 2 days so that you get better lung maturity

104
Q

Placenta Previa

A

Placenta previa refers to the presence of placental tissue that extends over or lies proximate to the internal cervical os
Painless vaginal bleeding 3rd trimester****

105
Q

Placenta Previa Risk factors

A 
Previous placenta previa
Previous cesarean section
Multiple gestation
Multiparity many babies
Advanced maternal age
Infertility treatment
Previous abortion
Previous intrauterine surgical procedure
106
Q

Placenta Previa diagnosis

A

Suspect with painless vaginal bleeding
Do not do digital vaginal exam
Obtain ultrasound

107
Q

Placenta Previa management

A

Follow with US
If uncomplicated deliver between 36-37.6 weeks
Unstable deliver by C/S

108
Q

Abruptio Placentae

A

The separation of the placenta from its site of implantation before delivery of the fetus.
Also termed Placental Abruption

109
Q

Abruptio Placentae patho

A

The immediate cause of the premature separation of the placenta is rupture of the maternal vessels in the decidua basalis, where it interferes with the anchoring villi of the placenta
unknown etiology

110
Q

Abruptio Placentae signs and symptoms

A 
Abrupt onset of vaginal bleeding with abdominal pain
Bleeding can be mild or profuse
Contractions
Uterus is firm, may be rigid & tender
Maternal hypotension
Fetal distress
DIC
111
Q

Abruptio Placentae diagnosed by

A

U/S and clinically

112
Q

Abruptio Placentae

A

Nonsevere abruption @ 34 – 36 weeks – deliver
Nonsevere abruption @ 36 weeks - deliver
**Most by C-section

113
Q

Dystocia

A

difficult labor & is characterized by abnormally slow labor
Disproportion between the presenting part of the fetus and the birth canal
It is a consequence of 4 distinct abnormalities that may exist singly or in combination

114
Q

What can cause dystocia?

A

abnormalities involving the cervix, uterus, fetus, maternal bony pelvis or other obstructions in the birth canal
ACOG simplified into 3 categories:
Abnormalities of the powers (uterine contractility & maternal expulsive effort)
Abnormalities involving the passenger (the fetus)
Abnormalities of the passage (the pelvis)

115
Q

When does labor begin

A

contracting every 5 min

116
Q

What are 2 types of uterine dysfunction?

A

Hypotonic uterine dysfunction mild contractions

Hypertonic uterine dysfunction uterus contracts and is “too contracted”

117
Q

What are 3 causes of uterine dysfunction?

A

Epidural analgesia slow labor down
Chorioamnionitis
infection

118
Q

What is Fetopelvic Disproportion

A

Contracted pelvis

Excessive fetal size small pelvis

119
Q

What are second stage disorders of dystocia?

A

women is not pushing forcefully
Causes of inadequate expulsive forces
Heavy sedation
Conduction analgesia

120
Q

Maternal-Fetal Effects of Dystocia

A

Intrapartum infection
Uterine rupture rare
Fistula formation due to pushing for long periods and the baby is larger causing lacerations to the vagina + rectum
Pelvic floor injury

121
Q

What is fetal acidemia classified as

A

is an umbilical arterial blood pH of <7.00

122
Q

What is the rationale for monitoring fetal heart rate?

A

FHR patterns are indirect markers of the fetal cardiac and medullary responses to blood volume changes, acidemia and hypoxemia, since the brain modulates heart rate

123
Q

FHR Patterns based on category?

A

Category I Observation
Category II Intervention, no improvement deliver
Category III Deliver
Change the position of the patient with category II

124
Q

Cesarean section

A

Refers to the delivery of a baby through surgical incisions in the abdomen and uterus.
Categorized as either primary or repeat
C/S rate in the U.S. is about 33%

125
Q

3 most common indications account for about 80% of these deliveries

A

Failure to progress during labor (35%) dystocia
Nonreassuring fetal status (24%)
Fetal malpresentation (19%) breach or a face presentation

126
Q

What are some less common causes for C-Section

A

Abnormal placentation (eg. placenta previa)
Maternal infection (eg. Genital HSV active)
Multiple gestation
Cord prolapse cord comes out first
Fetal bleeding diathesis
Suspected macrosomia (5000 gms in woman without DM, 4500 gms in woman with DM)
Mechanical obstruction to vaginal birth

127
Q

What is used for anesthesia during C-Section?

A

Anesthesia
Spinal(best cause immediate) or epidural 30 min to go into effect
General

128
Q

What are the 2 types of incisions for C-Section

A

External incision
Low transverse
Vertical— only time is if she already had this
Internal incision
Low transverse
Vertical (This is the incision that matters for subsequent pregnancies)

129
Q

Vaginal Birth After Cesarean (VBAC) requirements?

A 
Vertex
Only one prior C/S
Previous C/S  > 18 months 
Full consent of patient
Available OR for emergency C/S
Blood available
No pitocin
130
Q

Postpartum Hemorrhage

A

Obstetrical emergency that can follow a vaginal delivery or cesarean section
Major cause of maternal morbidity
Top 3 causes of maternal mortality
excessive bleeding that makes the patient symptomatic
Occurs in 1-5% of deliveries

131
Q

2 types of postpartum hemorrhage

A

Primary (first 24 hours after delivery)

Secondary or delayed (24 hours to 12 weeks after delivery)

132
Q

What are some of the causes of postpartum hemorrhage

A 
Overdistension of uterus
Uterine infection
Uterine relexants
Uterine fatigue
Uterine inversion
Retained placenta
trauma
coag deficiencys
133
Q

What are some risk factors for postpartum hemorrhage?

A 
Retained placenta
Failure to progress during second stage of labor
Placenta accreta
Lacerations
Instrumental delivery
Large for gestational age
Hypertensive disorders
Induction & augmentation of labor
134
Q

What is the goal of postpartum hemorrhage?

A

Restore or maintain adequate circulatory volume
Restore or maintain adequate tissue oxygenation
Reverse or prevent coagulopathy
Eliminate the obstetric cause of PPH

135
Q

Management of postpartum hemorrhage

A 
Check for lacerations
Retained placenta
Treat uterine atony
Intrauterine balloon tamponade
Laparotomy
Hysterectomy
136
Q

Complications of postpartum hemorrhage

A 
Hypovolemic shock & organ failure (renal failure, stroke, MI, Sheehan syndrome)
Fluid overload (pulmonary edema)
Anemia
Abdominal compartment syndrome
Transfusion related complications (ie: electolyte imbalance)
Acute respiratory distress syndrome
Anesthesia-related complications
sepsis
death
137
Q

secondary hemorrhage for Postpartum Hemorrhage

A

Secondary postpartum hemorrhage (occurring 24 hours to 12 weeks postpartum)
Occurs 0.5-2%
Pathogenesis
Diffuse uterine atony
Subinvolution of placental site (retained products of conception, infection)
Bleeding diathesis
Choriocarcinoma

138
Q

What is the recurrence rate of postpartum hemorrhage?

A

10-15% risk of recurrence in a subsequent pregnancy

Womens Health (5 decks)

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