Lecture 4 - Maternal Hemorrhage Flashcards
What are the three antepartum hemorrhages:
- Placenta previa
- Abruptio Placentae
- Uterine rupture
What is the most common presentation of placenta previa?
-Vaginal bleeding
What is a complete previa;
-When cervical is entirely covered by placenta
T/F: All patient with vaginal bleeding are considered to have a placenta previa until proven negative by ultrasound.
TRUE
Patients with a history of previous C-section and a current placenta previa are at very high risk of placenta _______
Accreta
T/F: A regional anesthetic is appropriate in placenta previa if patient is euvolemic, bleeding is not severe or ongoing and patient is stable.
TRUE
What two medication are considered to be used on induction if emergency C-section is evident and patient is hemodynamically unstable?
- Ketamine
- Etomidate
What is Placenta accreta:
-Abnormally deep attachment of the placenta through the endometrium and into the myometrium.
What are the stages of placenta accreta:
- Accreta: does not penetrate entire thickness of myometrium
- Increata: invades further into myometrium
- Percreta: completely through myometrium, into serosa, and potentially outside of uterus, with invasion into surrounding structures
Placenta accreat is suspected if the placenta has not been delivered within __ minutes of the fetuw delivery.
30
What is the treatment of Placenta accreta:
- Planned c-section
- abdominal hysterectomy
- Uterus sparing approaches
What is Abruptio placentae:
- Premature separation of the normal placenta
- Most common cause of intrapartumm fetal death
What are the risk factors of abruptio placentae:
- Hypertension
- Trauma
- Cocaine use
- Structural uterine abnormality
- Multiparity
- Alcohol use
T/F: Mild to moderate abruption may be managed with vaginal delivery but severe abruption mandate emergency C-section.
TRUE
T/F: In abruptio placentae bleeding may remain concealed in the uterus resulting in underestimated blood loss.
TRUE
