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RRPA Clinical Decision Making I > Keppler vaginal bleeding in pregnancy > Flashcards

Keppler vaginal bleeding in pregnancy Flashcards

1
Q

What are some pregnancy related reasons for first trimester bleeding?

A
  1. Ectopic
  2. Spontaneous abortion
  3. Subchorionic bleeding
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2
Q

What are other non-pregnancy related reasons for first trimester bleeding?

A
  1. Bladder (UTI)
  2. Hemorrhoids
  3. Vaginitis
  4. Cervical
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3
Q

What are some things that increase your risk for ectopic pregnancy?

A
  1. IUD
  2. Tubal surgery
  3. Excessive age
  4. PID
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4
Q

True or false: Beta HCG levels should double every 48 hours?

A

True

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5
Q

What are some indications that its an ectopic pregnancy?

A
  1. Beta HCG not rising
  2. You see a mass near the ovaries that looks vascular cystic?
  3. A heart beat near an ovary is never good
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6
Q

If the pt is stable and has an ectopic pregnancy would you treat it medically or surgically?

A

Medically with Methotrexate

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7
Q

What do you need to check weekly if treating an ectopic pregnancy medically with methotrexate?

A

need to check the BHCG weekly until it reaches zero

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8
Q

If the pt has fluid in the pelvis and has an ectopic are the stable or unstable?

A

They are unstable and this will have to be treated surgically

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9
Q

What is considered a spontaneous abortion?

A

IUP 0.5cm w/o Fetal cardiac activity (FCA)

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10
Q

What percent of recognized pregnancies are spontaneous abortions

A

20%

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11
Q

What is the diagnostic criteria for spontaneous abortion?

A
  1. Empty gestational sac 2.5+cm, or unchanged
  2. HCG above discriminatory zone without viable fetal pole
  3. Previous viable fetus with no cardiac activity
  4. Fetal pole > 7 weeks by Crown rump length (CRL) without cardiac activity
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12
Q

What are the three management options for spontaneous abortion?

A
  1. Expectant- just wait and see
  2. Medical- Misoprostol
  3. Surgical
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13
Q

Spontaneous abortions can put the mother at risk of what?

A
  1. infection (septic abortion)
  2. Rare risk of DIC
  3. Bleeding/transfusion
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14
Q

What are some non-obstetric causes for second/third trimester bleeding?

A
  1. Infection
  2. Hemorrhoids
  3. Trauma
  4. Cervical
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15
Q

What are some obstetric causes for second and third trimester bleeding?

A
  1. Labor
  2. Abruption
  3. Placenta/ vasa previa
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16
Q

What is the general management of second and third trimester bleeding?

A
  1. Iv access
  2. Fluids
  3. Rapid transfusion protocol
17
Q

What is the main difference between placenta abruption vs previa?

A

abruption is PAINFUL

18
Q

What are some things that can cause a placenta abruption?

A
  1. HTN
  2. expose to nicotine, tobacco, amphetamines, caffeine
  3. trauma
  4. rupture of membrane
  5. and of course prior history
19
Q

How do you diagnose placenta abruption?

A
  1. Gross bleeding
  2. check for uterine activity
  3. is there pain
  4. ultrasound? labs?
20
Q

True or false: with a placental abruption your only method of delivery is a c-section?

A

False- with placental abruption you can try to deliver the child vaginally

21
Q

What are some things that could cause placenta previa?

A
  1. Advancing maternal age
  2. prior uterine surgery
  3. again happened before
22
Q

If some one gets placenta previa at 20 weeks should it go away by week 28?

A

yes

23
Q

True or false: you can stimulate the cervix of someone with placenta previa?

A

False- no cervical stimulation absolutely no sex

24
Q

True or false: the more C-sections you have the more likely you are to have placenta previa?

A

True

25
Q

What is vasa previa?

A

vasa previa is when membranes that contain fetal blood vessels connecting the umbilical cord and placenta overlie or are with 2cm of the internal cervical os

26
Q

Should you have a low or high index of suspicion for the vasa previa?

A

high index

27
Q

What causes postpartum hemorrhage?

A
  1. Atony
  2. Atony
  3. Atony
28
Q

What is atony?

A

this is when the uterus has no tone and cant contract to slow down the bleeding

29
Q

What are some other reasons for postpartum hemorrhage?

A
  1. Laceration
  2. Retained placenta
  3. Placenta accreta spectrum
  4. Uterine rupture
  5. DIC/Coagulopathies
30
Q

With postpartum hemorrhage would you exam the pt under anesthesia or awake?

A

under anesthesia

31
Q

What are some management option in the OR for postpartum hemorrhage?

A
  1. Uterine curettage
  2. Uterine tamponade
  3. IR embolization
  4. uterine artery ligation
  5. B-lynch suture
  6. Hysterectomy
32
Q

Because atony is the most common reason for postpartum hemorrhage, how would you treat this?

A

you would give uterotonics (pitocin, misoprostol things of this nature)

33
Q

which puts you at a higher risk of coagulopathies, pregnancy or BCPs?

A

pregnancy puts you at an 8x higher risk for VTE

34
Q

What is virchows tried?

A
  1. venous stasis
  2. hypercoaguable state
  3. intervascular vessel wall damage
35
Q

What are some things that can cause a hypercoagulable state?

A
  1. BCP
  2. Pregnancy
  3. Prothrombin gene mutation
  4. Antithrombin III
  5. Factor V leiden
  6. Protein C or 5 deficiencies
36
Q

How would you evaluate someone for DVT/PE

A
  1. Check genetic predisposition/history
  2. Lower extremity doppler ultrasound
  3. VQ/perfusion (rarely used)
  4. CT PE (used frequently)
37
Q

Treatment for DVT/PE in preggos?

A

usually treated with LMWH those that are at a high risk will most likely be prophylaxed with LMWH throughout the pregnancy

38
Q

What are some causes of DIC in pregnancy?

A
  1. Acute blood loss
  2. HELLP/preeclampsia
  3. Amniotic fluid embolism
39
Q

How do you manage DIC?

A
  1. Massive transfusion protocol
  2. Replace clotting factors
  3. Control sources of bleeding

RRPA Clinical Decision Making I (17 decks)

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