Mehl uterine atony

Question 1

uterine atony. Most common cause of postpartum bleeding (70-80%).

Answer 1

.

Question 2

uterine atony. CP?

Answer 2

Presents as vaginal bleeding in the context of large, boggy uterus.

Question 3

uterine atony. what decreases risk?

Answer 3

Uterine massage
immediately following Stage 2 delivery ̄ risk.

Question 4

uterine atony. refractory bleeding Tx?

Answer 4

Refractory bleeding can be treated oxytocin to enhance uterine tone and
contractions. If ineffective, ergonovine/methylergonovine can be administered.

Question 5

uterine atony. the last resort Tx?

Answer 5

Surgery such as uterine artery embolization or hysterectomy is last resort.

Question 6

uterine atony. Ergonovine contraindicated in what conditions?

Answer 6

Ergonovine is contraindicated in HTN, preeclampsia, migraine with aura, smokers,
and cardiovascular disease.

Question 7

Vaginal laceration. seen in what pathology?

Answer 7

Usually seen in the setting of fetal macrosomia (e.g., maternal diabetes), as
discussed earlier.

Question 8

Vaginal laceration. what can be performed in case to decr. risk?

Answer 8

Episiotomy can be performed to decr. risk.

Question 9

Placenta previa. definition?

Answer 9

Placenta implants over the internal cervical os.

Question 10

Placenta previa. causes bleeding when?

Answer 10

Causes PAINLESS 3rd trimester bleeding.

Question 11

Placenta previa. C section when?

Answer 11

C-section recommended 37 weeks onward.

Question 12

Placenta previa. what happens prior 36 weeks?

Answer 12

Prior to 36 weeks, placental implantation site can occasionally move off the cervical
os as the uterus continues to grow.

Question 13

Placenta previa. what incr. risk?

Answer 13

Hx of prior interventions to the uterus (i.e., myomectomy, previous Caesars) ­risk
of placenta previa due to ­ probability of abnormal implantation (i.e., if the endometrial lining is disrupted in any form, then chance of normal implantation is decr.).

Question 14

Abruptio placentae. definition?

Answer 14

Placenta detachment from the uterine wall prior to parturition.

Question 15

Abruptio placentae. bleeding when?

Answer 15

Causes PAINFUL 3rd trimester bleeding.

Question 16

Abruptio placentae. CP? 1

Answer 16

Can present as intense cramping.

Question 17

Abruptio placentae. classic causes? 2

Answer 17

Classic causes are cocaine and deceleration injury (i.e., car accident).

Question 18

Placenta accreta. definition?

Answer 18

Placental attachment to the surface of the myometrium.

Question 19

Placenta accreta. what bleeding?

Answer 19

Causes postpartum bleeding.

Question 20

Placenta increta. definition?

Answer 20

Placental attachment into the myometrium.

Question 21

Placenta increta. what bleeding?

Answer 21

Causes postpartum bleeding.

Question 22

Placenta percreta. definition?

Answer 22

Placental attachment through the myometrium, sometimes onto adjacent structures such as the bladder (percreta = perforates).

Question 23

Placenta percreta. what bleeding?

Answer 23

Causes postpartum bleeding.

Question 24

Vasa previa. definition?

Answer 24

Fetal vessels overly the internal cervical os and are prone to shearing forces and bleeding.

Question 25

Vasa previa. CP triad?

Answer 25

Presents as triad of 1) painless third trimester bleeding, 2) rupture of membranes,
3) fetal bradycardia.

Question 26

Vasa previa. causes?

Answer 26

caused by conditions such as velamentous cord insertion or succenturiate lobe of
placenta.

Question 27

Vasa previa. what is velamentous cord insertion?

Answer 27

Velamentous cord insertion = portion of fetal vessels normally protected by
Wharton jelly within umbilical cord are exposed within the fetal membranes before they insert onto the placenta à ­ risk of shearing/trauma incr.­ incr. risk of bleeding. Sometimes the vessels overly the internal cervical os, ­ risk of vasa previa.

Question 28

Vasa previa. what is succenturiate lobe?

Answer 28

A succenturiate lobe is an accessory/extra lobe of the placenta that is separate from
the main body of the placenta but remains connected to it by blood vessels. When
vessels connecting the main placenta and the succenturiate lobe run across the cervical os, this can cause vasa previa.

Question 29

Retained placental
tissue. definition? what CP?

Answer 29

Fragments of the placenta or membranes remaining in the uterus post-delivery.

Just be aware it’s a cause of postpartum bleeding.

Question 30

Heme disorders. definition?

Answer 30

Conditions such as DIC, ITP, and vWD ­ risk of postpartum bleeding.

Question 31

Uterine inversion. definition?

Answer 31

Uterus turns inside out following the delivery of the placenta.

Question 32

Uterine inversion. CP?

Answer 32

Typically presents as postpartum bleeding and abdominal pain following/during
delivery of the placenta + the Q will say the uterus is not palpable (abdominally).

Question 33

Uterine inversion.
The Q does not need to say vigorous cord traction was applied. There is a 2CK
Obgyn Q where they literally say “gentle cord traction,” and the answer is still uterine inversion.

Answer 33

.

Question 34

Uterine rupture. definition? assoc. with what?

Answer 34

wall of uterus tears; often associated with labor or previous uterine surgery like
Caesars (especially classic vertical incision, rather than low, horizontal incision).

Question 35

Uterine rupture.
USMLE Q will tell you oxytocin was given + there were strong and persistent contractions + now fetal parts are palpable in the RUQ. Student says, “What do they mean there’s fetal parts in RUQ?” Exactly. They shouldn’t be there, which indicates
there was a rupture of the uterus.

Answer 35

.

Question 36

Uterine rupture. how oxytocin incr. risk?

Answer 36

Oxytocin can cause tachysystole and hypertonus, which incr.­ risk of rupture.

Question 37

Uterine rupture. what is tachysystole due to oxytocin?

Answer 37

Tachysystole = abnormally high frequency of uterine contractions, usually more than five contractions in 10 minutes, averaged over a 30-minute window.

Question 38

Uterine rupture. what is hypertonus?

Answer 38

Hypertonus = prolonged contraction of the uterus > 2 minutes.

Question 39

Uterine rupture. what are normal contractions (duration, frequency).

Answer 39

Contractions should normally occur once every 2-5 minutes and last 30-60 seconds.