Glines bleeding Flashcards

1
Q

What is Nitabuch’s layer?

A

another term for decidua basalis? Absence of this layer may lead to weird placental attachements i.e. accreta

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2
Q

What are the trends in childbirth death rate and cerebral palsy?

A

death rates at childbirth have significantly decreased, cerebral palsy has not

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3
Q

Define the 3 types of placenta previas

A

complete = completely covers the os, incomplete = partially covers os, marginal previa = margin of placenta encroaches on margin of os

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4
Q

How is a low lying placenta different from a placenta previa?

A

low lying placenta is a placenta that forms low in the uterus but does not cover or touch the os

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5
Q

What placental issue is there an increased risk for in a woman using crack cocaine?

A

placental abruption

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6
Q

What is a complete separation of uterine musculature through all layers, what previous procedure puts one at increased risk for this?

A

uterine rupture, prior casearian

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7
Q

Is more blood lost in vaginal delivery or casarean?

A

casarean loses 1000 whereas vaginal only 500 ml

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8
Q

When the vessels of the umbilical cord insert between the layers of the amnion and chorion but away from the placenta, this is called ________

A

velamentous cord insertion

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9
Q

What is vasa previa?

A

When there is velamentous cord insertion but they pass over the os and predispose to rupture

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10
Q

Aside from the aorta, what artery in a pregnant woman is particularly dangerous to rupture in a trauma situation?

A

uterine artery, it has a much higher blood flow than a non pregnant woman’s uterine artery

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11
Q

What happens to total peripheral resistance in pregancy?

A

decreases

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12
Q

What are the 2 most common causes of antepartum bleeding?

A

placenta previa and placenta abruptio

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13
Q

When doing a physical exam, you must rule out this to before checking uterine tenderness?

A

placenta previa

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14
Q

What is the most accurate means of determining the cause of bleeding

A

ultrasound

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15
Q

What % of placental abruptions does ultrasound miss?

A

50%

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16
Q

What accounts for 20% of all antepartum bleeding?

A

placenta previa

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17
Q

In which type of placenta previa may you still be able to do a vaginal delivery?

A

a marginal one because the head of the fetus may tamponade off the margin of the placenta near the os without compromising fetal blood flow entirely

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18
Q

T/F advanced maternal age is a risk factor for placenta previa

A

true

19
Q

What other placental anomaly is commonly present with placenta previa?

A

placenta accreta

20
Q

What is the classic presentation of placenta previa?

A

painless bright red blood

21
Q

How do you diagnose placenta previa with US? What if inconclusive?

A

Transabdominal is 95% effective whereas transvaginal is 100% but increases bleeding risk; if inconclusive do a “double set up exam”

22
Q

The fetus is ________- weeks old if the fundus reaches the umbilicus

A

20

23
Q

Which illicit drug puts women at risk for abruptio placentae?

A

crack cocaine

24
Q

Why is polyhyramnios associated with abruptio placentae?

A

because of the rapid decompression that occurs when the water breaks, this causes shearing of the membranes

25
Q

If a mother had a placental abruption but delivered the baby and when trying to breast feed she could not lactate, then what might you think had occurred?

A

She may have had Sheehan’s syndrome due to the hemorrhage from the abruption

26
Q

What term describes the bluish-purple color to the uterus from blood dissecting into the myometrium from an abruption?

A

couvelaire uterus

27
Q

What is the classic presentation of placental abruption?

A

painful vaginal bleeding, uterine tenderness, hyperactivity, and increased tone

28
Q

T/F ultrasound is the gold standard for Dx of placental abruption

A

false it is not very effective and placental abruption is a clinical Dx

29
Q

How does the appearance of blood from placenta previa differ from that of abruption?

A

previa = bright red; abruption = dark red

30
Q

What is the mgmt of placental abruption?

A

stabilize the mother and attempt a vaginal birth

31
Q

Define uterine rupture

A

complete separation of the uterus through all of its layers. Possibly, with extrusion of the fetus into the abdomen!

32
Q

Which type of incision for a C-section carries with it the lowest risk for future uterine rupture?

A

low transverse (vertical has greater risk)

33
Q

What is a metroplasty? What effect does it have on future uterine rupture?

A

this is when they fix a septum in the uterus i.e. from defective paramesonephric development, this increases the risk of uterine rupture

34
Q

What is the usual mgmt of uterine rupture?

A

total abdominal hysterectomy (removal of uterus and cervix)

35
Q

What should you do if a woman has a uterine rupture and still wants more kids?

A

attempt local debridement and primary closure

36
Q

Describe the pathophysiology of postpartum hemorrhage

A

after placental separation, the uterus does not contract down on the spiral arterioles

37
Q

What is a very common cause of post-partum hemorrhage?

A

uterine atony

38
Q

How can the Tx of pre-ecclampsia lead to uterine atony?

A

magnesium sulfate is a smooth muscle relaxant

39
Q

What are some treatment options for uterine atony (post partum hemorrhage)?

A

IV pitocin, massage, methergine, PGF2 alpha, cytotec

40
Q

How do you diagnose genital tract trauma?

A

exploration

41
Q

What is the treatment for retained placenta?

A

D/C or manual removal; if it is a placenta accreta you may need to do a hysterectomy

42
Q

What is the most common cause of uterine inversion? What is the major complication for the patient?

A

iatrogenic from pulling too hard on the cord; the patient can go into vasovagal shock

43
Q

What is the mgmt of uterine inversion?

A

immediate IV volume expansion, halothane anesthesia or terbutaline to relax uterus, replace with your fist and give immediate pitocin