OBGY/Burn Exam 5 Flashcards by Felicia Woodall

What is the difference between marginal, partial, and complete placenta previa?

Marginal – within 2 cm of os

Total – completely covers os ( C section)

Partial – partially covers os ( C section)

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What is the problem with complete placenta previa and dilation?

Even with modest cervical dilatation, copious hemorrhage would be anticipated.

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premature separation of the placenta results in what two types of bleeding?

apparent bleeding and concealed bleeding

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What is the difference between apparent and concealed bleeding?

apparent bleeding is when the placenta comes away from the wall of the uterus and bleeding exits through the cervix and is noticeable.

concealed bleeding is when the placenta comes away from the uterus wall but the two “ends” of the placenta are still attached to the uterus wall and the bleeding that has occurred is trapped/concealed and not noticeable externally. (external hemorrhage)

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Be able to identify concealed hemorrhage, partial placental previa, and complete abruption.

slide 6 and 7 in the power point

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Extensive placental abruption but with the periphery of the placenta and the membranes still adherent - what is this known as?

concealed hemorrhage

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If total placental abruption with concealed hemorrhage occurs, what occurs to the fetus?

The fetus is now dead

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What is placenta accreta?

what type of bleeding takes place with placenta accreta after delivery?

placenta adhesion to uterine myometrium without invasion leading to massive bleeding after delivery

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Describe placenta increta?

what type of bleeding takes place after delivery?

placenta invasion to myometrium leading to massive bleeding after delivery

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What is placenta percreta?

placenta invasion to myometrium, serosa and adjacent pelvic structures.

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What is described:

placenta adhesion to uterine myometrium without invasion ?

Placenta accreta

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What is described:

placenta invasion to myometrium?

placenta increta

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What is described: placenta invasion to myometrium, serosa and adjacent pelvic structures?

placenta percreta

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How do you dx abnormal placental implantations?

U/S or MRI

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What is the management for someone who has abnormal placental implantation?

C/S or postpartum hysterectomy

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what are the three types of abnormal placental implantations?

placenta accreta
placenta increta
placenta percreta

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What are the two most common causes of 3rd trimester bleeding?

placenta previa and placenta abruption

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What is placental previa?

abnormally implanted on the lower uterine segment and covers or borders on the cervical os.

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Dx of placenta previa will be made how?

U/S or MRI

NO VAGINAL EXAM

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Signs and symptoms of placenta previa?

Painless vaginal bleeding which stops automatically

Preterm labor

Maternal hemorrhage with hypotension

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with placenta previa the mother may try to deliver early, if the lungs of the fetus are not mature what can be done?

give steroid shot to mom if L/S = immature lungs

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if someone has placenta previa what kind of delivery MUST they have?

C/S

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If a mom has placenta previa you want to maintain the crit at what level?

> 30

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< 37 weeks with mild to moderate bleeding what is the management?

most likely placenta previa, hospitalization with bed rest and observation

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If a mom has placenta accreta what must be performed with delivery?

hysterectomy

complications with placenta previa?

post partum hemorrhage premature delivery - most common cause of neonatal mortality and morbidity. placenta accreta - do hysterectomy

What is abruptio placenta?

Occurs when the normally implanted placenta separates from decidua basalis prior to delivery, bleeding may be overt or concealed.

Occurs when the normally implanted placenta separates from decidua basalis prior to delivery, bleeding may be overt or concealed, this describes what?

abruptio placenta

incidence of abruptio placenta?

1/100

cocaine use and smoking can cause what to a pregnant mother (risk factor for this condition before delivery)?

abruptio placenta

risk factors for abruptio placenta include?

``` Maternal hypertension Cocaine , smoking * Trauma Preterm premature rupture of membranes Hypertonic uterus Previous history ```

Dx of abruptio placenta ?

clinical suspicion | U/S

What is the most common cause of DIC in the pregnant mom?

abruptio placenta

what are some of the signs and symptoms of abruptio placenta?

painful vaginal bleeding, high volumes uterine tenderness hypovolemia retroplacental hematoma (2500ml) contractions with low amplitude and high frequency abdominal/back pain fetal bradycardia (fetal distress) due to loss of maternal gas exchange area fetal demise - most common cause maternal coagulopathy- most common cause of DIC (replacement of clotting factors and plts)

complications of abruptio placenta are?

DIC Shock ARF loss of fertility

what will your labs look like with DIC?

low plts, factor five, factor 8 increased fibrin split products

uterine atony secondary to "couvelaire uterus" that occurs as a complication of abruptio placenta can cause what?

loss of fertility

if the fetus is in distress with a mom who has abruptio placenta what will need to occur?

C section once mothers coagulopathies are fixed first.

If a mother has abruptio placenta will you place an epidural?

NO EPIDURAL if concerns over volume and coagulation

to fix a mothers coagulopathies with abruptio placenta, what does that typically mean replacing?

replacing clotting factors and platelets

placental abruption with placental separation and a fetus in distress =

prompt delivery

placental abruption with maternal hemorrhage and a fetus in distress =

vigorous transfusion and prompt delivery

placental abruption with fetal hemorrhage and a fetus in distress =

immediate delivery and infant transfusion

placental abruption with uterine hypertonus and a fetus in distress =

prompt delivery

Know the differences between abruptio placenta and placenta previa

see slide 20 for a chart visual of the differences

pathophysiology of abruptio placenta compared to placenta previa

AP = Premature separation of normally implanted placenta PP= Abnormal implantation near or at os

incidence of abruptio placenta compared to placenta previa

AP = 1/100 PP = 1/200

symptoms of abruptio placenta compared to placenta previa

AP = HTN, abd trauma, tobacco or cocaine use PP = Prior C/S, grand multiparous

diagnosis of abruptio placenta compared to placenta previa

AP and PP are the same = Transabdominal/transvaginal U/S

management of abruptio placenta compared to placenta previa

AP = Stabilize the pt with premature fetus; expectant management with frequent monitoring Moderate to severe: immediate delivery ``` PP = NO vaginal exam! Stabilize Mag sulf Fetal lung maturity Delivery if unstable Bleeding ```

complications of abruptio placenta compared to placenta previa

AP = DIC Shock Ischemic necrosis of distal organs Fetal anemia PP = Placenta accreta. Fetal anemia

Birth before 37 weeks gestation is considered ?

prematurity

complications in the premature fetus is due to?

immature organs

if a premature infant has resp. distress syndrome what will you give?

surfactant inhalation

Premature infants and PDA?

patent ductus arteriosus (idk the information yet, need to listen to lecture lol)

hypoxia or shock in a premature infant can cause?

can cause gut ischemia

What do you give a laboring mother to stop premature contractions?

Beta 2 agonist ritodrine

Side effects of ritodrine to mom?

hypokalemia, hyperglycemia, tachycardia

side effects of ritodrine to fetus?

hypokalemia, hyperglycemia, tachycardia (+/-)

what should be avoided with ritodrine use and why?

atropine | can cause tachycardia leading to pulmonary edema

premature infants after delivery are at high risk for postanesthetic apnea... what would you give?

aminophylline or caffeine

what is a normal Pa02 level?

60-80 mmHg

you want to avoid fluctuations in Pa02 of a premature infant, what will you do to help decrease fluctuations?

monitor pulse ox constantly and avoid excessive oxygenation

what vitamin may prevent retinopathy in the premature infant?

vitamin E

what is a baseline amount of bpm variability to be normal?

3-6 bpm

VEAL CHOP means what?

Variable decelerations = cord compression early decelerations = head compression ? late decelerations = decreased uteroplacental perfusion

What is normal fetal HR ?

120-160 bpm

Decelerations (decreased FHR) begin and end at approximately the same time as the uterine contraction: this describes?

early deceleration which = head compression and shows NO fetal distress.

Where does CMV naturally occur?

on everyone's skin

Do you want to increase or decrease fentanyl requirements with premature fetus?

decrease is favored

decrease in fetus heart rate that persists after contraction is over is known as?

decreased uteroplacental perfusion, associated with fetal hypoxia

possible reason for late decelerations?

possibly due to maternal hypotension or abruption

What should you assess in relation to the fetus if late decelerations are present?

assess fetal pH (deliver ASAP if fetus is acidotic)

You will deliver the baby ASAP with late decelerations if? (3 answers)

fetal acidosis persistent late decelerations fetal bradycardia