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
Uterine Rupture is most ________ seen in patients with prior classical C-section although there is an elevated risk even in patient with prior low _________ C-section if attempting vaginal birth after C-section.
- commonly
- Transverse
Other risk factors for Uterine Rupture would be:
- History of myomectomy
- Prolonged labor with oxytocin infusion
- Enlarged uterus
What is the most common presentation of uterine rupture:
-Sudden profound fetal distress with continuous severe abdominal pain.
T/F: An epidural will mask the pain of a uterine rupture.
FALSE
At what blood loss do you consider postpartum hemorrhage:
EBL of 500 cc
What is the causes of postpartum hemorrhage:
Uterine atony
- Twins
- Ployhydraminios
What is the treatment of uterine atony:
- Oxytocin 20-30 unit in 1 liter IV fluid
- Methylergonovine 0.2 mg IM
- Prostaglandin 0.25 mg IM
Can you give prostaglandin to an asthmatic?
No, will cause bronchospasm
T/F: If patient is hypovolemic a neuraxial block is still the best choice over a general anesthetic.
FALSE
What is another name for amniotic fluid embolism:
Anaphylactoid syndrom of pregnancy
What is the mortality rate of amniotic fluid embolism:
85%
Mechanism of ___________ fluid embolism is thought to involve entry of amniotic fluid into maternal ___________ through breaks in ___________ membrane. this probably happens _____ but reaction are rare.
-amniotic
circulation
uteroplacental
a lot
What is the typical presentation in amniotic fluid embolism:
- Sudden tachypnea
- cyanosis
- shock
- generalized bleeding
What is the pathophysiology of amniotic fluid embolism:
- Acute pulmonary embolism
- DIC
- uterine atony
When can amniotic fluid embolism occur:
- Labor
- delivery
- C-section
- postpartum
Why are chest compression worthless if baby is still in utero:
- Aortocaval compression
- Lateral chest compression are do not work
How is a diagnoses made of amniotic fluid embolism in the maternal circulation?
Often times an autopsy
