OB8 maternal hemorrhage

Question 1

what is the most common presentation of placenta prevue

Answer 1

painless vag bleeding

Question 2

termed a ____ when cervical is entirely covered by placenta, or can be some variation of partial cover

Answer 2

complete previa

Question 3

patients with a hx of previous ___ and a current ___ are at very high risk of placenta accreta

Answer 3

c/s, placenta previa

Question 4

placenta previa : if bleeding is not ongoing or severe and patient is stable and euvolemic, a ____ anesthetic may be appropriate

Answer 4

regional

Question 5

placenta previa emergency c/s under GA - consider ____ or ____ as induction agents if pt hemodynamically unstable

Answer 5

ketamine, etomidate

Question 6

placenta accreta definition

Answer 6

abnormally deep attachment of the placenta, through the endometrium and into the myometrium

Question 7

pacanta accreta varies by ____

Answer 7

depth of penetration

Question 8

___ does not penetrate entire thickness of myometrium

Answer 8

accreta (75-78%)

Question 9

___ invades further into myometrium

Answer 9

increta (17%)

Question 10

_____ completely thru myometrium, into serosa, and potentially outside of uterus, with invasion into surrounding structures (bladder, colon)

Answer 10

percreta (5%)

Question 11

placenta accreta is suspected if the placenta ____

Answer 11

has not been delivered within 30min of fetus delivery. manual blunt dissection or placenta traction is attempted but can cause hemorrhage

Question 12

placata accreta has an increased risk with:

Answer 12

• placenta previa,
• uterine scar (asherman’s syndrome):[ D&C, myomectomy, c-section]
• thin placental decidua
• female gender

Question 13

Treatment for placenta accreta

Answer 13

planned c/s and abd hysterectomy

Question 14

anesthetic implications for placenta accreta

Answer 14

2 large IVs, Aline, fluid warmer, type and cross 4 units, GA.

consider c/s under epidural (surgery might outlast SAB).
must balance risks of GETA cs. venous dilation with neuraxial block in the setting of hemorrhage. often times a SAB converted to GETA.

Question 15

Painful vaginal bleeding is a sign of

Answer 15

abruptio placentae

Question 16

what is the most common causes of intrapartum fetal death

Answer 16

abruptio placentae

Question 17

what are the risk factors for abruptio placentae

Answer 17

hypertension, trauma, cocaine, structural uterine abnormality, multiparty, alcohol use

Question 18

mild to moderate abruption may be managed with ___ but severe abruption mandates _____

Answer 18

vaginal delivery, emergency C/S

Question 19

bleeding may remain concealed in the uterus resulting in ____

Answer 19

underestimated blood loss

Question 20

abruptio placentae - massive bleeding is possible requiring ____, ____ and _____

Answer 20

blood therapy, platelets, FFP

Question 21

how rare is uterine rupture?

Answer 21

1/2000 deliveries or less

Question 22

uterine rupture is most commonly seen in patients with _____ although there is an elevated risk even in patients with prior ____ if attempting

Answer 22

prior classical c/s
low transverse c/s
VBAC

Question 23

other risk factors of uterine rupture include

Answer 23

hx of myomectomy, or prolonged labor with oxytocin infusion, enlarged uterus

Question 24

whats the treatment for uterine rupture

Answer 24

volume resuscitation and emergency laparotomy under GA

Question 25

postpartum hemorrhage is considered present when postpartum blood loss exceeds ___ ml

Answer 25

500

Question 26

common associations with postpartum hemorrhage include

Answer 26

prolonged labor, preeclampsia, multiple gestation

Question 27

causes of postpartum hemorrhage

Answer 27

• uterine atony
• perineal laceration
• retained placenta
• uterine inversion

Question 28

what is uterine atony associated with?

Answer 28

uterine overdistention (twins, polyhydramnios)

Question 29

whats the tx for uterine atony?

Answer 29

oxytocin, methylergonovine (serotonin agonist), prostaglandin F2- alpha

Question 30

why wouldn’t you give methylergonovine IM?

Answer 30

can cause htn and vasoconstriction

Question 31

porstaglandin F2 is sometimes given intrauterine during C/S. why wouldn’t you give it to asthmatic patients?

Answer 31

will causes bronchospasm

Question 32

perineal laceration usually can be fixed with ___ or ____

Answer 32

LA or pudendal block

Question 33

retained placenta most often requires

Answer 33

general anesthesia

Question 34

uterine inversion requires ___ where ____ allows uterus to be put right-side-in again

Answer 34

GA, uterine relaxation

Question 35

if patient is ____, neuraxial block is not a good idea

Answer 35

hypovolemic

Question 36

how rare is amniotic fluid embolism?

Answer 36

1:20,000 delivery’s

Question 37

what is also called anaphylactoid syndrome of pregnancy

Answer 37

amniotic fluid embolism

Question 38

when can amniotic fluid embolism occur

Answer 38

during labor, deliver,y c/s. even postpartum

Question 39

mortality for amniotic fluid embolism

Answer 39

85%

Question 40

what condition presents with sudden tachypnea, cyanosis, shock, and generalized bleeding? (dyspnea, hypoxia, hypotension, cv collapse, coagulopathy)

Answer 40

amniotic fluid embolism

Question 41

pathophysiology of AFE involves ___, ____, and ____

Answer 41

acute pulm embolism, DIC, uterine atony.

Question 42

presentation of AFE can mimic ____, ____ or _____

Answer 42

pulm thromboembolism, air embolism, or septicemia

Question 43

why are chest compressions worthless if the baby is still in?

Answer 43

aortaocaval compression makes supine resuscitation impossible and compressions dont work in the lateral position

Question 44

the diagnosis of AFR rests on demonstrating ____ in the maternal circulation, often at ___

Answer 44

fetal elements, autopsy