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OB > OB HEMORRHAGES > Flashcards

OB HEMORRHAGES Flashcards

1
Q

Postpartum Hemorrhage

A

Cumulative blood loss > 1000 mL accompanied by signs and symptoms of HYPOVOLEMIA

NSD > 500 mL
CS > 1000 mL

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2
Q

4 Ts

A

Tone
Trauma
Tissue
Thrombin

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3
Q

Bleeding during pregnancy

A

Antepartum Hemorrhage

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4
Q

Frequent causes of Postpartum Hemorrhage

A

uterine atony with placental site bleeding

genital tract trauma

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5
Q

Most frequent cause of obstetrical hemorrhage

A

Uterine Atony

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6
Q

Antimicrobial prophylaxis after manual removal of placenta

A

Ampicillin or Cefazolin

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7
Q

Uterotonic agents – UTERINE CONTRACTION

A 
Oxytocin
Ergot Derivative - Methylergonovine (Methergine), Ergonovine
Carboprost
Prostaglandin E2 - Dinoprostone
Misoprostol - Cytotec
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8
Q

Degrees of Uterine Inversion

1st Degree

A

Inverted fundus extends to but not through the cervix

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9
Q

Degrees of Uterine Inversion

2nd Degree

A

Inverted fundus extends through the cervix but remains within the vagina

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10
Q

Degrees of Uterine Inversion

3rd Degree

A

Inverted fundus extends outside the vagina

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11
Q

Degrees of Uterine Inversion

Total Inversion

A

Vagina and uterus are inverted

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12
Q

Occurs more commonly in patients with previous caesarian delivery (classical CS)

A

Uterine Rupture

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13
Q

Risk Factors for Uterine Rupture

A 
Prior uterine surgery/uterine scar
Injudicious use of oxytocin
Grand multiparity
Marked uterine distension
Abnormal fetal lie
Large fetus
External version
Trauma
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14
Q

Treatment of choice when intractable uterine bleeding occurs or when the uterine rupture sites are multiple, longitudinal or low lying

A

HYSTERECTOMY

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15
Q

Premature separation of the placenta from the uterine wall

A

Placental Abruption

vaginal bleeding (3rd trimester)
sudden onset abdominal pain
uterine tenderness
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16
Q

Maternal sequelae of placental abruption

A 
DIC
shock
transfusion
hysterectomy
renal failure
death
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17
Q

Fetal complications of placental abruption

A

nonreassuring fetal status
growth restriction
death

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18
Q

Neonatal outcomes

A

death
preterm delivery
growth restriction

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19
Q

Risk factors for placental abruption

A 
prior abruption
increased age and parity
preeclampsia
chronic HPN
chorioamnionitis
preterm ruptured membranes
multifetal gestation
low birthweight
hydramnios
cigarette smoking
single umbilical artery
cocaine use
uterine leiomyoma
20
Q

Placental abruption

A 
hypovolemic shock
consumptive coagulopathy
Couvelaire uterus
end organ injury
Sheehan syndrome
21
Q

Classic sign of placental abruption that can be seen at the time of cesarean delivery

life threatening condition

A

Couvelaire uterus

bluish purple myometrium

22
Q

Abnormally implanted placenta

Placenta goes before the fetus into the birth canal

A

Placenta Previa

23
Q

Describe the apparent movement of the placenta AWAY from the INTERNAL OS

A

Placental migration

24
Q

Internal os is covered partially or completely by placenta

A

PLACENTA PREVIA

complete/totalis
partial/partialis
marginalis
low-lying

25
Q

Implantation in the lower uterine segment

placental edge does not cover the internal os but lies within a 2 cm wide perimeter around the os

A

Low Lying Placenta

26
Q

The most characteristic event with placenta previa

A

PAINLESS BLEEDING

27
Q

Predisposing factors for placenta previa

A 
prior CS and uterine surgery
multiparity
multiple gestation
erythroblastosis
smoking
hx of placenta previa
increasing maternal age
28
Q

Fetal complications associated with Placenta previa

A 
preterm delivery and its complications
preterm premature rupture of membranes
intrauterine growth restriction
malpresentation
vasa previa
congenital abnormalities
29
Q

Recommended delivery in placenta previa

A

b/w 34 and 37 weeks

30
Q

Abnormal placental adherence to the myometrium

A

partial or total absence of decidua basalis

imperfect devt of fibrinoid or Nitabuch layer

31
Q

Frequent and serious complication associated with placenta previa

A

morbidly adherent placentas

32
Q

Villi are attached to the myometrium

A

Placenta ACCRETA

Total placenta accreta
Focal placenta accreta

33
Q

Villi INVADE the myometrium

A

Placenta INCRETA

34
Q

Villi that PENETRATE through the myometrium and to or through the serosa

A

Placenta PERCRETA

35
Q

Confirmation of a percreta or increta almost always mandates

A

Hysterectomy

36
Q

2nd MC severe maternal morbidity indicator

A

Disseminated Intravascular Coagulation (DIC)

37
Q

Classic triad of amniotic fluid embolism

A

abrupt hemodynamic
respiratory compromise
DIC

38
Q

For treatment of hypovolemia from catastrophic hemorrhage

A

Compatible Whole Blood

39
Q

Massive Transfusion Protocol

A

Cryoprecipitate
Fresh frozen plasma
Packed RBCs
Platelets

40
Q

EFM tracing associated with abruptio

A

recurrent late or variable decelerations
reduced variability
bradycardia
sinusoidal pattern

41
Q

Complications of Placental Abruptio

A 
Perinatal mortality (25-30%)
Hemorrhage
Couvelaire uterus (Uteroplacental apoplexy)
Acute renal failure (23 %)
DIC
42
Q

Risk Factors for massive bleeding during CS with previa

A

advanced maternal age
previous CS
(+) sponge like US findings in the cervix

43
Q

Widespread systemic activation of coagulation –> thrombotic obstruction of small and midsize vessels –> tissue ischemia and bleeding from consumption of platelets and coagulation factors

A

Disseminated Intravascular Coagulation (DIC)

44
Q

Intrinsic pathway (Endothelial damage)

A

septic abortion

chorioamnionitis

45
Q

Extrinsic pathway (massive tissue injury)

A

abruptio placenta
amniotic fluid embolism
retained dead fetus
saline induced abortion

46
Q

Risk factors of DIC

A 
pregnancy
abruptio placenta
preeclampsia/eclampsia
intrauterine fetal demise (> 1 mo)
septic abortion
amniotic fluid embolism

OB (16 decks)

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