Hemorrhage And Sepsis - Moulton Flashcards
When do you deliver baby w/placenta previa?
36-37 weeks, do not want her to go into labor
Crypercipitate has what effect?
Inc fibrinogen by 10 mg/dL
Deep septic Vein thrombophlebitis fever?
Clinical presentation?
Diagnose how?
Unlocalized fever non-responsive to Abs in first few days
Do NOT appear clinical ill
No radiograph, dx of exclusion
What surgical tx used for uterine hemorrhage?
O’Leary stitch - ligation of uterine a.
B-Lynch suture
Tx septic pelvic thrombophlebitis?
Specifically tx ovarian vein thrombosis?
UF Heparin or LMW heparin
Anticoagulate 6 weeks, repeat imaging
Most common reasons for placental abruption?
Most common cause of what?
Cocaine use
Car wreck
HTN
DIC
How to treat puerperal sepsis?
What is the major Ab-resistant pathogen?
Ampicillin
Gentamicin
Clindamycin
Bacteroides fragilis
Risk of uterine rupture w/low transverse uterine incision?
Classic vertical?
1%
4-7& –> must do c section
Oxytocin CI in whom?
Dinoprostone (PGE2)?
Undiluted rapid IV infusion
Pt hypotensive
FFP has what effect?
Inc. fibrinogen by 10 mg/dL
Unprotected vessels that pass over the cervical os is called what?
Vasa previa - inc mortality rate
Platelets have what effect?
Inc platelet count by 5-10,000
What is associated w/copious bleeding and hypovolemic shock?
Uterine inversion
Secondary hemorrhage occurs when?
Due to what?
24 hours to 12 weeks
Subinvolution of uterus, sloughing of the Escher or retained POC
Invades the myometrium is what?
Placenta increta
How to diagnose placenta previa?
Mean gestational age when bleeding occurs?
US
30 weeks
Methylergonovine is CI in whom?
15-methyl PGF2a?
HTN pt
Asthma pt
What is defined as temp > 100.4 (38) that occurs for more than 2 consecutive days during first 10 postpartum days?
Febrile morbidity - puerperal sepsis
After delivery the pH becomes what?
More alkaline
Primary hemorrhage occurs when?
Due to what?
W/in 24 hours
Uterine atony
Ovarian Vein Thrombophlebitis fever present?
Cx presentation?
Dx how?
Fever and ABD pain w/1 week after delivery
Appear clinically ill
20% seen on radiograph
Vaginal bleeding before 20 weeks and painless dilation indicates?
Cervical insufficiency
Tx for uterine atony?
Bimanual massage Oxytocin Methylergonovine 15-Methyl PGF2 Dino/Mist
What is assoc w/extravasation of blood into the uterus?
Couvelaire uterus
Boggy uterus means what?
Uterine atony –> PPH
Placenta previa is what?
Presents how?
Implantation of placenta over cervical os (most common abnormality)
Painless vaginal bleeding
Postpartum hemorrhage (PPH) defined how after vaginal birth?
C section?
> 500 cc
> 1000 cc
Packed red cells have what effect?
Inc Hct by 3%, Hb by 1 g/dL
What is defined as premature separation of the normally implanted placenta?
Placental abruption
Management of uterine rupture?
If large?
Laparotomy and deliver baby
Cesarean hysterectomy
What presents as painful bleeding, uterine tenderness, uterine hyperactivity, and fetal distress/death?
Abruptio placenta
3 types of placenta previa?
Marginal - does not cover os
Partial
Complete
What is causing sudden onset of intense abdominal pain w/or w/out vaginal bleeding, abnormal FHR or palpation of fetal parts?
Uterine rupture
What causes 3 trimester bleeding?
Fetal vessel rupture secondary to velamentous insertion of umbilical cord
Thought the myometrium into the uterine serosa is what?
Placenta percreta
Abnormal firm attachment to the superficial lining of the myometrium is what?
Placenta accreta
