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OB Final Exam > Module 7: Part 1 > Flashcards

Module 7: Part 1 Flashcards

1
Q

most common cause of maternal mortality worldwide, accounting for 15% of maternal deaths

A

obstetrical hemorrhage

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2
Q

Most common cause for obstetrical admission to ICU and a risk factor for myocardial ischemia and infarction, and stroke

A

obstetrical hemorrhage

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3
Q

Majority of hemorrhage-related adverse outcomes are considered

A

preventable

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4
Q

Uterine contraction is stimulated by ____________ after delivery

A

endogenous oxytocin

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5
Q

primary mechanism for controlling blood loss at delivery

A

uterine contraction (endogenous oxytocin)

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6
Q

____________ creates a shearing forces that cleaves the placenta from the uterine wall

A

Uterine tetany

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7
Q

Uterine contraction constricts the ____________ (2) supplying the placental bed

A

spiral arteries and placental veins

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8
Q

After disruption of vascular integrity…

A

the coagulation cascade begins

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9
Q

homeostasis depends on…(3)

A

Vascular tissue
Platelets
Coagulation factors

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10
Q

initial homeostasis response (3)

A

Loss of vessel integrity
Platelets adhere to exposed collagen
Facilitated by von Willebrand factor (vWF)=primary hemostasis

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11
Q

primary factor of hemostasis

A

von Willebrand factor (vWF)=primary hemostasis

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12
Q

secondary hemostasis

A
  • Unstable platelet plug
  • initiation of coagulation cascade with deposits and stabilization of fibrin
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13
Q

which coag factor is ↓ in pregnancy

A

Protein S

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14
Q

which coag factors don’t demonstrate change in pregnancy

A

Protein C
Antithrombin III

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15
Q

EBL for vaginal vs cesarean delivery

A

EBL ≥ 500 ml for vaginal delivery
≥ 1000 ml for cesarean delivery

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16
Q

blood loss in OB is notoriously…

A

inaccurate, as bleeding is concealed within uterus, the drapes, retroperitoneal space

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17
Q

physiologic impact of blood loss depends on…

A

mother’s initial blood volume, hematocrit, and speed of blood loss

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18
Q

⭐️
late signs of blood loss

A

hypotension & tachycardia

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19
Q

____________ % may experience antepartum vaginal bleeding

A

25%

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20
Q

most cases of antepartum hemorrhage occur..when?

A

in 1st trimester

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21
Q

some causes of antepartum hemorrhage (2)

A

Cervicitis

Abnormalities in placentation (placenta previa or abruption)

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22
Q

greatest threat during antepartum hemorrhage is to…

A

the fetus

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23
Q

Placenta Previa is present when the placenta implants

A

in advance of the fetal presenting part.

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24
Q

placenta previa cause

A

is unclear but prior uterine trauma (scar) in common

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25
Q

low lying placenta previa

A

placenta near the os

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26
Q

placenta previa types (image)

A
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27
Q

____________ is an important anatomical part of the uterus

A

lower uterine segment (LUS)

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28
Q

the LUS has anatomical and functional aspects that can be

A

utilized to produce better outcomes in pregnancy and labor

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29
Q

Attachment of the placenta to the LUS leads to increased risk of

A

bleeding

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30
Q

Conditions associated with placental previa (6)

A

Conditions associated with placental previa

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31
Q

gold standard for diagnosis of placenta previa

A

transvaginal ultrasound (distance from the placental edge to the internal os can predict likelihood of antepartum hemorrhage and cesarean delivery)

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32
Q

CLASSIC SIGN of Placenta Previa is

A

painless vaginal bleeding during the second or third trimester

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33
Q

what distinguishes placenta previa from abruption

A

Lack of abdominal pain and/or absence of abnormal uterine tone in placenta previa

34
Q

Obstetric management of placenta previa

A

Active labor, persistent bleeding, mature fetus (>36 wks) or NRFS = prompt delivery

35
Q

management of placenta previa is based on

A

severity of vaginal bleeding, maturity and status of fetus

36
Q

placenta previa risk to fetus

A

Uteroplacental insufficiency from progressive or sudden placental separation

Preterm delivery and its issues

37
Q

non medical management of previa

A

Bed rest, limit physical activity and NO sex or vaginal exams

38
Q

medication given for anyone 24-34 weeks if bleeding

A

steroids (fetal lung development)

39
Q

Lower uterine segment is ____________ vascular than normal sites of implantation

A

less

40
Q

where does the placenta usually adhere to?

A

fibrous tissue (scar tissue) from a previous CS

41
Q

Association btwn placenta previa and IUGR

A

Higher incidence of first trimester bleeding → placental separation → decreasing area for placental exchange

42
Q

anesthetic management of placenta previa

A
43
Q

with placenta previa, there is a potential risk for injury to ____________ during uterine incision

A

the placenta

44
Q

____________ site lacks uterine muscle and won’t contract well

A

Lower uterine implantation

45
Q

Increased risk of placental accreta especially if previous history of

A

previous cesarean delivery

46
Q

Because the placental site is the source of hemorrhage, bleeding continues until

A

the placenta is removed and uterus contracts

47
Q

placental abruption

A

Complete or partial separation of the placenta from the decidua basalis before delivery of the fetus

48
Q

maternal hemorrhage with placental abruption

A

Complete or partial separation of the placenta from the decidua basalis before delivery of the fetus

49
Q

fetal compromise with placental abruption

A

Fetal compromise due to loss of placental surface are for maternal-fetal exchange of oxygen and nutrients

50
Q

placental abruption diagram

A
51
Q

maternal comorbidities assoc. with placental abruption (5)

A

Hypertension
Acute/chronic respiratory illness
Substance abuse
Maternal cocaine use
Maternal or paternal tobacco use

52
Q

obstetric conditions assoc. with placental abruption (5)

A

Advanced maternal age
Multiparity
Preeclampsia
PROM
Chorioamnionitis

53
Q

trauma and placental abruption

A

Direct (blunt abdominal)
Indirect (acceleration/deceleration injury)

increase risk

54
Q

classic presentation of abruption (3)

A

Vaginal bleeding
Uterine tenderness and tense to palpation
Increased uterine activity (hypertonus)

55
Q

breakthrough pain in otherwise effective epidural can be a sign of

A

placental abruption

56
Q

FHT in placental abruption

A

Bradycardia
Late/Variable decels and/or loss of variability

57
Q

____________ is 96% specific to placental abruption and useful in determining placental location

A

ultrasound

58
Q

abruption classifications

A
59
Q

complications of abruption (3)

A

Hemorrhagic shock
Coagulopathy
Fetal compromise or death

60
Q

One-third of coagulopathies are from abruption and coagulopathy is associated with

A

fetal demise

61
Q

strong association between abruption and

A

fetal growth restriction and Preeclampsia

61
Q

Bleeding with placental abruption results from exposure of

A

decidual vessels because the uterus is unable to selectively constrict the area of abruption

62
Q

couvelaire uterus is a complication of

A

abruption

63
Q

couvelaire uterus occurs when

A

vascular damage within the placenta causes hemorrhaging that progresses to and infiltrates the wall of the uterus into the peritoneum

64
Q

significant abruption requires

A

emergent cesarean delivery

65
Q

anesthetic considerations with placental abruption (5)

A

Regional or General
Maternal volume status and massive blood loss
Large bore IVs and possible Aline
Uterotonics available
Uterine atony, coagulopathy

66
Q

uterine rupture definition

A

Separation of a uterine scar that is clinically apparent and results in fetal distress and maternal hemorrhage requiring emergency delivery or postpartum laparotomy

67
Q

most common cause of uterine rupture

A

Uterine scar dehiscence

68
Q

uterine scar dehiscence does not result in

A

massive hemorrhage, FHT abnormalities, does not require emergent cesarean or postpartum laparotomy

69
Q

is a uterine wall defect with hemorrhage and/or fetal compromise with emergent cesarean or postpartum laparotomy

A

uterine rupture

versus Uterine scar dehiscence, which does not:
-result in excessive hemorrhage & FHR abnormalities
-require emergency cesarean or postpartum laparotomy

70
Q

single most important risk factor for uterine rupture

A

prior uterine surgery

71
Q

Rupture of a ____________ scar is associated with greatest morbidity and mortality

A

classical

72
Q

OB conditions associated with uterine rupture (6)

A
  • Prior uterine surgery (myomectomy or cesarean)
  • Rapid labor
  • Induction of labor, high dose oxytocin, prostaglandin induction
  • Grand multiparity (>5)
  • Severely adherent placenta
  • Congenital uterine abnormalities (bicornuate uterus)
73
Q

maternal comorbidities assoc with uterine rupture

A

Connective tissue disorders

74
Q

how is trauma associated with uterine rupture

A

Obstetric (forceps, version or excessive fundal pressure)

Nonobstetric (blunt or penetrating trauma)

75
Q

The most common and most reliable clinical sign of uterine rupture in labor is ____________

A

fetal bradycardia

76
Q

Other clinical findings assoc with uterine rupture… (8)

A

vaginal bleeding
hypotension
hematuria
absence of uterine contractions
change in fetal positioning
FHR abnormality
severe abdominal pain
shoulder pain

77
Q

breakthrough pain with neuraxial anesthesia is assoc with

A

uterine rupture

also a/w placental abruption

78
Q

high index of suspicion of uterine rupture in

A

TOLAC

79
Q
A

OB Final Exam (15 decks)

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