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natural childbirth II > Midterm-3rd Trimester Bleeding > Flashcards

Midterm-3rd Trimester Bleeding Flashcards

1
Q

DDx of 3rd trimester bleeding

A

Abruption of placenta or vessel at os

Cervical/vaginal bleeding

Bloody show

Uterine rupture

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2
Q

Placental abruptions associated factors

A

Multiparas

Older women

Twins

Dietary deficiencies

Uterine anomaly or tumor

Pressure on vena cava

Drug use –> esp cocaine

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3
Q

Etiologic factors of placental abruption

A

Chronic htn

Trauma

Short umbilical cord

Sudden decompression of uterus

Increased stretch of uterus

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4
Q

Placental abruption pathophysiology

A

Hemmorhage into decidua basilis causes decidue to split –> causes a hematomoa and loss of function of adjacent placenta

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5
Q

Prognosis for placental abruption

A

Perinatal mortality up to 50%

Maternal mortality 1.8-2.8%

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6
Q

Mortality factors for mother in placental abruption

A

Amount of blood loss

Whether hemorrhage is concealed or apparent

Clotting rxn

Time between abruption and tx

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7
Q

Mortality factors for fetus in placental abruption

A

Extent of decreased placental function

Time between abruption and tx

Prematurity

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8
Q

Ssx placental abruption

A
  1. vaginal bleeding 2. uterine tenderness or very painful contractions (blood irritant to uterus and induces contractions) 3. fetal distress 4. hypertonic uterus 5. severe back pain 6. ssx of shock 7. idiopathic premature labor
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9
Q

Lab tests for placental abruption

A
  1. US 2. Non-stress test 3. Complete CBC, coagulation panel, electrolytes 4. Ab screen on Rh= moms
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10
Q

Placental abruption management: non-severe bleeds

A

US

Fetal hrt tones

Bedrest

Vaginal rest

Fetal mvmnt counts

Non stress test or biophysical profile

RTC in 3-7 days or sooner if bleeding returns

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11
Q

Placental abruption management: moderate to severe bleeds

A

Same as for non-severe bleeds but you need to refer -asses coagulation status

Referring doc will asses and consider induction or C-section

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12
Q

Complications of placental abruption

A
  1. DIC 2. Fetal death 3. Maternal hemorrhage leading to maternal shock: renal damage, Sheehan’s syndrome 4. Preterm labor
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13
Q

Ssx of rupture of marginal sinus

A
  1. mild vaginal bleeding which does not continue 2. painless 3. not associated with uterine rigidity 4. not associated w/ fetal heart tone changes
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14
Q

Rupture of marginal sinus rupture management

A
  1. US 2. Fetal heart tones, uterine exam, vitals 3. Bed rest 4. Vaginal rest 5. Mom monitors fetal mvmnt 6. Consider biophysical profile or non-stress test 7. RTC in 3-7 days
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15
Q

Tx marginal sinus rupture

A

Viburnum prunifolium: 30 qtt tincture Q 30 minutes to TID

Homeopathy: Arnica. -Bell, cinnam, Ip, Sabina, Secale. Repertorize.

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16
Q

Placenta Previa

A

Placenta implanted over or near internal os.

4 degrees: 1. Total: Internal os completely covered 2. Partial: Internal os partially covered 3. Marginal: Edge of placenta at margin of internal os 4. Low-lying: placental edge does not touch internal os, but is close to it

17
Q

Risk factors for placenta previa

A

>3 multiparity

>30 y/o

Previous C-section or other uterine surgery

Poor quality of uterine lining

Endometritis following previous pregnancy

18
Q

Ssx placenta previa

A

Painless vaginal bleeding usu at 28-30 wks -usu small but can be life threatening hemorrhage

-intermittent or continuous bright red bleeding -can be precipitated by trauma or intercourse

Possibly early spontaneous abortion

19
Q

Dx of placenta previa

A

US to determine placement of placenta

Do NOT do a vaginal exam w/ a 3rd trimester bleed before doing an US

20
Q

PE placenta previa

A
  1. Gently check presentation 2. Presenting part high 3. Uterus soft and non-tender 4. Fetal heart tones usu normal
21
Q

Management of placenta previa

A

Delayed delivery with the following conditions: 1. blood loss is not life threatening 2. labor hasn’t begun, membranes intact 3. baby alive and not in distress 4. premature fetus

22
Q

Management of delayed delivery in palcenta previa

A
  1. bed rest 2. pt must go to hospital immediately with any bleeding or w/ onset of labor 3. IV fluids or dx and tx of anemia 4. L/S ratio at 36 wks to determine fetus maturity 5. No fetal anomalies or erythroblastosis 6. Mom will stay in bed and there is adequate blood supply ready
23
Q

Indications for C-section in placenta previa

A
  1. usu wait until fetus is mature but may not wait is profuse uncontrollable bleeding or fetal distress
  2. total or partial placeta previa: MUST DO C-SECTION
  3. abnormal presentation: MUST DO C-SECTION
24
Q

Indications for vaginal birth in placenta previa

A
  1. placental <10% of internal os
  2. cervix well effaced and >/= 3 cm dilated
  3. fetal head in pelvis
  4. minimal bleeding
25
Q

Vasa Pevia

A

Fetal blood vessel lying across os

26
Q

Complications of vasa previa

A
  1. compressed vessel leads to decreased fetal heart tones and fetal distress
  2. torn vessel leads to fetal exsanguination
27
Q

Dx of vasa previa

A
  1. vaginal exam
  2. Wright stain of vaginal blood shows nucleated RBCs
  3. Kleinhauer test of vaginal blood: differentiates maternal and fetal blood
  4. Amount of bleeding
28
Q

Management vasa previa

A

Transport Immediately!

Monitor fetal heart tones

C-section

Poor prognosis if vessel has ruptured

29
Q

Cervical/Vaginal bleeding may be due to..

A
  1. Cervicitis, cervical erosion, polyps, cancer
  2. Lacerations, foreign bodies
  3. Varicosities
30
Q

Tx for varicosities

A
  1. Decrease standing
  2. Truss w/ foam pad along perineum supported by sanitary belt
  3. Botanicals
    a. Collinsonia
    b. Hamamelis
  4. Homeopathics: calc, carb-v, ham, lyc, thuj, zinc
  5. Pycnogenols

natural childbirth II (13 decks)

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