Lecture 3 - 3rd Trimester Complications

Question 1

what is placenta previa?

Answer 1

attachment of placenta to lower uterine segment over cervical OS

can be complete, partial, marginal

Question 2

placenta previa is associated with ____ ____-trimester bleeding

Answer 2

painless, 3rd

Question 3

2 risk factors for placenta previa

Answer 3

multiparity, prior C section

Question 4

placenta previa:

is placenta closer or farther away from cervical OS at at a early gestational age vs at birth?

Answer 4

closer when early; migrates from OS as age

Question 5

placenta accreta:

defective ___ layer –> abnormal attachment and seperation after delivery. accreta is attachment to the _____

Answer 5

decidual;

myometrium

Question 6

what is placenta increta?

what is placenta percreta?

Answer 6

increta = placenta penetrates into myometrium;
percreta = penetrates through myometrium to uterine serosa

Question 7

what is vasa previa?

Answer 7

fetal vessels run over or close to cervical OS

Question 8

triad of vasa previa:

Answer 8

membrane rupture
painless vaginal bleeding
fetal bradycardia

Question 9

classic difference between placental abruption and placenta previa?

Answer 9

placental abruption has abdoimnal pain and uterine contractions

Question 10

placenta previa requires ____ delivery

Answer 10

C-section

Question 11

supine hypotension syndrome:

compression of _____ –> decreased venous return/CO –> hypotension when ______

Answer 11

IVC;

lying down

Question 12

Management of placenta previa:

administer ______ to help improve fetal lung maturity (if 24-34 weeks);

Answer 12

corticosteroids

Question 13

3 risk factors for placenta accreta:

prior ______, _____, placenta _____

Answer 13

C-section, inflammation, previa

Question 14

placental _____ is premature separation of placenta from uterine wall ____ delivery of infant

Answer 14

abruption, before

Question 15

placental abruption:

presents as abrupt, ____ bleeding in the ____ trimester. ____ is rock hard and tender to palpation

Answer 15

painful (very), third;

uterus

Question 16

placental abruption:

risk factors include _____, _____, hypertension, preeclampsia, ____ abuse

Answer 16

trauma, smoking;

cocaine

Question 17

placental abruption:

when tissue factor is released from decidual cells, ____ is active and is a potent _____ agent.

Answer 17

thrombin;

uterotonic

Question 18

placental abruption:

complications include ____ due to tissue factor release, maternal shock, and fetal distress due to decreased ______

Answer 18

DIC;

oxygen

Question 19

placental abruption:

if blood has extravsated into the myometrium, therean increased risk of uterine ____ (called _____ uterus)

Answer 19

atony, couvelaire

Question 20

pre-ecclampsia:

new onset HTN with either _____ or _____ after the 20th week of pregnancy

Answer 20

proteinuria, end-organ dysfunction

Question 21

pre-ecclampsia:

caused by abnormal _____ _____ arterities –> endothelial dysfunction, vasocconstriction, ischemia –> ____ necrosis

Answer 21

placental spiral;

fibrinoid

Question 22

what is the difference between gestional HTN and pre-ecclampsia?

Answer 22

no end-organ damage or proteinuria

Question 23

eeclampsia is pre-ecclampsia + _____

Answer 23

maternal seizures

Question 24

HELLP syndrome stands for….

Answer 24

Hemolysis, Elevated Liver enzymes, Low platelets

Question 25

what is seen on blood smear with HELLP syndrome?

Answer 25

schistocytes

Question 26

eeclampsia:

loss of protein causes peripheral and pulmonary _____, ____ failure

Answer 26

edema;

renal

Question 27

pre-ecclampsia:

IV ____ ____ prevents seizure. what is the definitive treatment of pre-ecclampsia, ecclampsia, and HELLP?

Answer 27

magnesium sulfate;

delivery of fetus

Question 28

what prophylactic treatment can be used in subsequent pregnancies in patients with preeclampsia?

Answer 28

baby aspirin

Question 29

HELLP syndrome can lead to hepatic subcapsular ____ –> rupture –> severe ______

Answer 29

hematoma; hypotension

Question 30

4 anti-Hypertensives that can be given to pregnant women

Answer 30

hydralizine, alpha methyldopa, labetalol, nifedipine