hemorrhage and preeclampsia

Question 1

EGBUS

Answer 1

external genitalia
barthalons glands
urethra
skenes glands

Question 2

placenta previa

Answer 2

placental tissue over or adjacent to cervical ox

suspected with painless antepartum bleeding after 20wks

Question 3

marginal placenta previa

Answer 3

edge of placenta is at margin of os

Question 4

low lying placenta

Answer 4

implanted in lower uterine segment, does not actually touch os

Question 5

vasa previa

Answer 5

fetal vessels present at os, very bad

Question 6

risk factors for placenta previa

Answer 6

previous placenta previa 
previous c-section
multiple gestation
muliparity
advanced maternal age
infertility Tx
previous abortion
previous intrauterine surgical procedure
maternal smoking
maternal cocaine use
male fetus
non-white

Question 7

asymptomatic previa

Answer 7

moniotr placental postion
avoid strenuous exercise
planned c-section

Question 8

bleeding previa

Answer 8

potnetial emergency
1st bleed- hospitalize until stable
2nd bleed-hospitalize until stable
3rd bleed- c-section
emergency c-section if hemorrhage significant

Question 9

when can you do vaginal delivery

Answer 9

if placental edge >10mm from os

Question 10

post partum hemorrhage

Answer 10

> 500ml if vag delivery
1000ml during c-section
d/t tone, trauma, tissue, thrombus

Question 11

uterine atony

Answer 11

spiral aa and decidual vv continue to bleed

75-85% of PPH

Question 12

Tx of uterine atony hemorrhage

Answer 12

massage
pitocin and cytotec
methergine (CI with HTN) or hemabate (CI with asthma)

Question 13

predisoposing factors to uterine atony

Answer 13

over distension of uterus
multiple gestations
polydydramnios
fetal macrosomia
prolonged labor
oxytocin augmentation of labor
magnesium sulfate Tx
chorioamnioitis
halogenated anesthetics
leiomyomas

Question 14

what is the second most common cause of PPH

Answer 14

trauma

lacerations

Question 15

tissue

Answer 15

uterus is unable to contract and involute around retained placental tissue mass
must manually remove placental with D&C

Question 16

thrombus

Answer 16

rare
ITP
amniotic fluid embolus
vWB disease

Question 17

risk factors for preeclampsia

Answer 17

nullparity
previous preeclampsia
>40 or <18
FHx (either parent)
chronic HTN
chronic renal disease
antiphospholipid Ab syndrome
thrombophilia
vascular or CT disease
SM
multiple gestatons
high BMI
black race
hydrops fetalis 
fetal growth resistriction
mom was SGA
abruptio placenat
mole
genetics

Question 18

Dx preeclampsia

Answer 18

systolic >140 or diastolic >90 2x after 20 weeks
>160 or >110 and proteinuria 1x
if proteinuria is absent these other factors count:
platelets 1.1 or if it doubles
liver transaminase 2x normal
pulmonary edema
cerebral or visual symptoms

Question 19

early onset preeclampsia

Answer 19

<34weeks
high risk for fetal death
high risk for perinatal death

Question 20

late onset preeclampsia

Answer 20

> 34 weeks
not highly associated with fetal death
still high risk for perinatal death

Question 21

preeclampsia indications for delivery

Answer 21

FHR
ruptured membrane
uncontrollable BP
oligohydramnios with AFI 1.5
pulmoary edema
SOB or chest pain with <94% O2
persistent severe HA
RUQ tenderness
HELLP

Question 22

Maternal complications of preeclampsia

Answer 22

placental abruption
acute renal failure
cerebral hemorrhage
heaptic failure or rupture
pulmonary edema
DIC
eclampsia

Question 23

HELLP

Answer 23

hemolysis
elevated liver enzymes
low platelet count

Question 24

Dx of HELLP

Answer 24

RUQ tenderness, leg edema, HTN

platelet schistocytes and bilirubin

Question 25

Tx of HELLP

Answer 25

delivery
antihypertensive
platelet transfusion
steroids debated

Question 26

PRES

Answer 26

posterior reversible encephalopathy syndrome
cerebral edema seen on MRI/CT
d/t HTN
risk factors are eclampsia, HTN, immunosuppression