Obs Flashcards

1
Q

What is normal labour?

When diagnosed?

A

Process where foetus and placenta are expelled from uterus

Painful uterine contractions + dilation/effacement of cervix

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2
Q

Mechanical factors in labour?

A

power
passage
passenger

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3
Q

Braxton-Hicks contractions?

A

painless uterine contractions from 30/40

can be palpated

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4
Q

who has poor uterine activity?

A

nulip

induced labour

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5
Q

where is the ‘pacemaker’ of the uterus?

A

junction of fallopian tube and uterus

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6
Q

physiological changes due to contractions?

A

permanent shortening of muscle fibres –> distension

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7
Q

what causes pain in contractions?

A

ischaemia in myometrial fibres

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8
Q

RFs for abnormal lie?

A

polyhydramnios
multip
fetal/uterine abnormalities
preterm

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9
Q

what position in extended breech?

A

buttocks present; legs extended by head

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10
Q

what is presentation?

A

part of fetus occupying the lower segment of uterus

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11
Q

how common is abnormal lie?

A

1/200

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12
Q

3 main parts of passage?

A

bony pelvis -inlet, mid cavity, outlet
ishial spine - used to assess descent
soft tissues - cervical dilation, vagina and perineum

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13
Q

what does station 0 mean?

A

head level with ischial spines
+ve = below
-ve = above

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14
Q

which presentation is best?

A

Vertex (narrowest diameter)

occipito-anterior normal deliver

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15
Q

3 stages of labour

A

1 - initiation to full cervical dilatation

  • -> Latent - slow dilation up to 3cm
  • -> Active - about 1cm/hr

2 - full cervical dilation to delivery of fetus

  • -> passive - til head reaches pelvic floor (desire to push)
  • -> active - mother pushing

3 - delivery of foetus to delivery of placenta

  • -> normall 15 mins
  • -> expectant or active management
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16
Q

how to epidurals affect labour?

A

remove desire to push

so labour is longer

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17
Q

expectant management of 3rd stage?

active?

A

light massage of uterus through abdo

IM - syntocinon

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18
Q

normal blood loss in delivery?
VD?
CS?

A
VD = 500ml
CS = 1000ml
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19
Q

Identifying abnormal labour?

A

partogram

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20
Q

most common cause of slow progress in primip?

A

inefficient uterine action

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21
Q

what is the worry in multip with slow progress in labour?

A

malposition –> uterine rupture is more likely

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22
Q

when do you use tocolysis?

A

iatrogenic uterine hyperactivity eg prostaglandin

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23
Q

why is eating discourage in labour?

whats this called?

A

aspiration of stomach contents

under anaesthetic = Mendelson’s syndrome

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24
Q

general care points in labour?

A

physical - obs, mobility, delivery positions

mental - environment, control, partner

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25
Q

what to do in persistent inefficient uterine action?

A

augmentation (ARM)

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26
Q

Hyperactive uterine action can lead to…?

A

placental abruption

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27
Q

mx of hyperactive uterine action?

A

if no evidence of abruption –> tocolytic eg salbutamol

usually LSCS

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28
Q

what is augmentation? egs?

A

artificial strengthening of contractions in established labour
ARM, amniotomy, artificial oxytocin

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29
Q

nulip with slow 1st stage?

poor descent in passive 2nd stage?

longer than 1h in active second stage?

A

augementation –> if no full dilation by 16h –> LSCS

P2nd - oxytocin infusion

A2nd -> episiotomy, ventouse

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30
Q

how frequent do you auscultate fetal heart?

A

1st stage - /15mins

2nd - /5mins

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31
Q

intrapartum fetal problems?

A

meconium aspiration
fetal blood loss
trauma
infection (GBS)

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32
Q

what is fetal destress?

signs?

A

hypoxia that could lead to fetal damage / death

colour of meconium, auscultate fetal heart, CTG, fetal blood sampling (scalp)

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33
Q

CTG mnemoic

A
DR C BRAVADO (normal values)
Define risk 
Contractions / 10mins (<5)
Base rate (110-160)
Variability (>5)
Accelerations (with movement/contractions)
Deceleration
Overall assessment
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34
Q

What might fetal tachycardia indicate?

Fetal bradycardia?

A

fever, infection, hypoxia

sustained deterioration –> distress due to hypoxia

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35
Q

what do early, variable and late deceleration suggest?

A

early - synchronous with contraction = normal

variable - cord compression causing hypoxia

late - persist after contraction = hypoxia

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36
Q

what to do with sustained fetal brady?

A

deliver urgently!

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37
Q

pain relief in labour?

A

non-pharma –> warm towel / massage

pharma –> entonox, opiates (+antiemetic), epidural

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38
Q

perineal trauma degrees?

mx?

A

1 - skin only
2 - perianal muscles but not sphincter
3 - involving anal sphincter
4 - anal sphincter + epithelium

1/2 - suture under LA
3/4 - epidural + physio

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39
Q

how frequently do you USS in multiple pregnancy?

A

monthly from 20/40

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40
Q

gestration for an elective CS?

A

37/40

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41
Q

comps of multiple pregnancy?

A

prem

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42
Q

twin-twin transfusion?

when is it concerning?

A

arterial blood flow from donor through placenta to vein of recipient

if >30% discordance

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43
Q

comps of twin-twin transfusion?

A

donor - IUGR, oligohydramnios, hypovolaemia, hypotension, anaemia

recipient - poyhydramnios, hypertension, polycythaemia, oedema, kernicterus, CHF

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44
Q

mx of twin-twin transfusion?

A

doppler analysis
therapeutic amniocentesis to decrease polyhydramnios of recipient
+/- intra-uterine blood transfusion

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45
Q

RFs for shoulder dystocia?

A

high birth weight, maternal DM, induced labour, prev shoulder dystocia, oxytocin, abnormal lie

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46
Q

what is shoulder dystocia?

A

failure of the shoulder to deliver

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47
Q

comps of shoulder dystocia?

A

cord compression
asphyxiation
Erb’s palsy

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48
Q

mx of shoulder dystocia

A
HELPERR
"Help!"
Episiotomy
Legs (McRoberts)
Pressure (suprapubic)
Enter (rotational manouevers)
Remove posterior arm
Roll patient onto hands + knees
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49
Q

last resort in shoulder dystocia?

A

deliberate clavicular fracture
Zavanelli’s (push head back in + CS)
abdo surgery with hysterectomy

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50
Q

RFs for cord prolapse?

A
preterm
breech
abnorm lie
multiples
**AMNIOTOMY**
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51
Q

mx of cord prolapse

A

elevate presenting part to prevent cord comp
tocolytics (nifedipine, terbutaline)
CS

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52
Q

Pres of amniotic fluid embolus?

A

sudden dyspnoea, hypoxia, hypotension
can occur at any time in pregnancy
–> ARDS

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53
Q

mech of amniotic fluid embolus?

A

liquor enters maternal circulation –> anaphylaxis +/- seizures and cardiac arrest

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54
Q

mx of amniotic fluid embolus?

A

O2, fluids
bloods
blood transfusion + FFP
ICU

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55
Q

RFs for uterine rupture?

A

labour with scared uterus
CS / prev
obstructed labour

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56
Q

sx of uterine rupture

A
fetal heart rate abnomalities
constant abdo pain 
VB
cessation of contractions 
maternal collapse
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57
Q

comps of uterine rupture

A

fetal hypoxia
massive internal haemorrhage
high recurrence rate

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58
Q

mx of uterine rupture

A

maternal resus

urgent laparotomy for delivery

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59
Q

uterine inversion?

pres?

A
fundus inverts into uterine cavity 
PPH 
lower abdo pain
vaginal mass
CV collapse
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60
Q

mx of uterine inversion

A
GA
fluid replacement
1 - manually push back
2 - fill with warm saline
3 - laparotomy
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61
Q

mx of epileptiform seizures?

A

clear airway, O2
diazepam if epilepsy
MgSO4 if eclampsia

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62
Q

induction vs augmentation?

A
induction = artificial initiation of labour
augmentation = promotes contractions when spont contractions are inadequate
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63
Q

what is a ripe cervix? how can you ripen it?

A

soft, short, think, anterior cervix with open os

prostaglandin

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64
Q

CIs for induction of labour?

A

fetal distress
cord presentation
pelvic tumour
praevia

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65
Q

comps of induced labour

A
failure
infection 
bleeding 
cord prolapse
instrumental / CS
66
Q

Bishops score?

A

pre-labour scoring

? IoL is required

67
Q

how to induce labour?

A

if bishops<6 –> cervical ripening with PG

Induction:
amniotomy, monitor fetal HR, oxytocin IV

68
Q

when do you use misoprostol?

A

after intra uterine death –> to deliver

69
Q

mx for BV in pregnancy?

A

oral metronidazole (if not in 1st trimester)

70
Q

RF for preterm labour?

A
prev
BV
short cervix
bacteiruria
prev abdo surgery
polyhydramnios
fetal hydrops
71
Q

maternal causes of preterm labour?

A

infection
HTN, DM, chronic illness
prev surgery
smoking, alcohol, drugs

72
Q

what is fetal fibroniectin?

A

glycoprotein in amniotic fluids

73
Q

what is fetal hydrops?

A

abnormal fluid in >=2 areas = underlying disease

74
Q

mx of preterm labour?

A

hydration
tocolytics (nifedipine, terbutaline)
dexamethasone

75
Q

CI for tocolytics?

A

absolute - fetal death, chorioamnionitis, poor maternal condition

relative - pre-eclampsia, placenta praevia, cervix > 4cm, pulm oedema

76
Q

periventricular malacia?

A

white matter surround ventricles is deprived of blood –> cerebral palsy

77
Q

when is cervical cerclage performed? removed?

indications?

A

sutures placed at internal os at the end of 1st trimester
removed in 3rd trimester

cervical incompetence, silent cervical dilation

78
Q

Define PROM?

A

rupture of membranes prior to labour at any gestational age

79
Q

Define prolonged ROM?

A

> 24h between rom and onset of labour

80
Q

Define preterm ROM?

A

ROM < 37/40

81
Q

Define PPROM?

A

ROM < 37/40 AND prior to onset of labour

82
Q

what is cervical effacement?

A

change in shape from bulb to flat

83
Q

normal rate of cervical dilation?

A

1-3cm/h

84
Q

Define APH?

A

Bleeding >24/40

85
Q

Causes of APH?

A

placenta previa, placental abruption, vasa previa

86
Q

What is placenta praevia?
major?
minor?

A

low lying placenta (common <20/40 but moves ‘upwards’ as pregnancy continues)

minor - in lower segment, does not cover os
major - covers internal os

87
Q

features of placenta praevia?

A

intermittent PAINLESS bleeding - red/profuse

88
Q

ix in placenta praevia?

A

USS (often incidental finding)
NEVER do vaginal examination
FBC + cross match if bleeding

89
Q

Mx of placenta previa?

A

delivery

if major –> elective c-section at 39/40

90
Q

what is placental abruption?

A

part/all of placenta separates from the lining of the uterus before delivery of fetus

91
Q

complications of placental abruption?

A

fetal death
DIC
maternal death

92
Q

causes of placental abruption?

A

IUGR
pre eclampsia
smoking, cocaine
multiples

93
Q

pres of placental abruption?

signs?

A

PAINFUL bleeding - dark
can be concealed bleeding

o/e –> tachycardia, hypotension, tender uterus
WOODY, HARD ABDOMEN

94
Q

ix in placental abruption

A

CTG

95
Q

mx of placental abruption?

A

admission
IV fluids +/- blood transfusion
urgent CS

96
Q

what is vasa praevia?

A

fetal blood vessels running in front of presenting part. When membranes rupture, fetal blood vessels rupture –> massive fetal bleeding –> copious bleeding and fetal death

97
Q

pres of vasa previa?

A

membrane rupture –> painless VB + fetal bradycardia

98
Q

mx of vasa praevia?

A

immediate CS

often too slow to save fetus

99
Q

define primary PPH?

A

> 500mls of blood loss in first 24h after delvery

100
Q

causes of primary PPH?

A
4T's
Uterine aTony
Tissue (retained placenta)
Trauma (uterine rupture)
Thrombin (clotting disorder)
101
Q

mx of primary PPH?

A

oxytocin
bimanual compression
blood transfusion

102
Q

what is uterine atony?

RFs?

A

reduced tone –> doesnt compress vessels

prev atony
uterine abnorm
large placenta
placenta previa/abruption

103
Q

Define secondary PPH?

A

Excess blood loss after 24h

104
Q

Causes of secondary PPH?

A

retained placental tissue

clot

105
Q

Ix in secondary PPH?

A

USS - identify retained products

106
Q

mx of secondary PPH?

A

ampicillin + metronidazole (prevent 2dary infection)

curette of uterus

107
Q

comps of prematurity

A

developmental delay
CLD
cerebral palsy
visual/hearing impairment

108
Q

egs of teratogenic drugs?

A
warfarin
ACEi
carbimazole
propylthiouracil
angiotensin II antagonists
anitepileptics (bar lamotrigine)
MTX
isotretinoin
alocohol
cocaine
109
Q

When are the 3 trimesters?

A

1 - LMP-12/40
2 - 13/40-27/40
3 - 28/40-40/40

110
Q

Pre-existing HTN defined as?

mx?

A

> 140/90 before 20/40

labetalol or nifedipine

DO NOT USE ACEi –> teratogenic

111
Q

Diagnosis of pre-eclampsia?

Sx?

A

BP > 140/90 + proteinuria > 0.3g/24h [20/40]

Headache, visual disturbance, N+V, epigastric pain, oedema

112
Q

Comps of pre-eclampsia?

A
Eclampsia -> MGSO4
CVA
Renal failure
DIC
ARDS
HELLP
IUGR
113
Q

What is HELLP?

A

Haemolysis elevated liver enzymes low platelet count

114
Q

pres of HELLP?

A

mostly 27-37/40

non-specific: malaise, fatigue, RUQ/epigastric pain

115
Q

Ix in HELLP?

A

raised bilirubin
raised LDH
raised AST / ALT
Platelets < 100

116
Q

mx of HELLP

A

if after 34/40 -> deliver
if <34/40 -> corticosteroids
blood transfusion / FFP

BP control

+/- liver transplant

117
Q

Mx of pre-eclampsia?

A

admit
labetalol if >150/100
regular monitoring
+/- delivery

118
Q

Diagnosis of DM?

A

glucose >7mmol/l fasting

HbA1c > 48mmol/L

119
Q

mx of gestational DM?

A

lifestyle
monitor BMs
metformin –> insulin if severe

120
Q

rhesus isoimmunisation?

A

Rh -ve mother mounts an immune response against Rh +ve baby via anti-D antibodies

121
Q

sensitising events in rhesus isoimmunisation?

A

delivery, ToP, ectopic, intrauterine death, invasive uterine procedure

122
Q

prevention of Rhesus disease?

A

Anti-D to Rh -ve women at 28/40 + after sensitising events

123
Q

how does anti-D work?

A

mops up fetal RBCs without initiation of immune response

124
Q

mx of epilepsy in pregnancy?

A

carbamazepine / lamotrigine

125
Q

mx of VTE in pregnancy?

A

LMWH

126
Q

mx of depression in pregnancy?

A

TCA / SSRI

127
Q

mx of bipolar in pregnancy?

A

haloperidol / olanzipine

[Lithium causes Epstein’s anomaly]

128
Q

mx of hyperemesis gravidarum?

A

metoclopramide/cyclizine/ondansetron + thiamine

129
Q

which infections can be teratogenic in pregnancy?

how do you treat them?

A

CHRiST
CMV: hearing/visual/mental impairmnet -> gancyclovir
HZV: rare -> Ig + aciclovir
RUBELLA: hearing/visual/mental impairment -> TOP if <16/40
SYPHILLIS: miscarriage, congenital disease or still birth -> Benzypenicillin
TOXOPLASMOSIS: retardation, convulsions, visual impairment -> Spiramycin

130
Q

infection causing maternal death?

A

Group A strep -> sepsis

131
Q

mx of Group B strep in pregnancy?

A

penicillin - prevents transmission to baby

132
Q

types of miscarriage?

A

threatened - fetus alive, os closed
inevitable - os open
incomplete - some fetal parts passed + os open
complete - fetal tissue passed, bleeing stopped, uterus no longer enlarged, os closed
septic - contents infected
missed - no fetus, os closed

133
Q

drugs given post miscarriage?

A

IM ergometrine -> uterine contraction

Anti-D

134
Q

how many miscarriages = recurrent?
common cause?
mx?

A

3

anti-phospholipid syndrome –> low dose aspirin

135
Q

ectopic pregnancy?

A

egg implants outside uterine cavity (95% in fallopian tubes)

136
Q

RFs for ectopic?

A
PID
prev ectopic
endometriosis
smoking
pelvic surgery
assisted conception
137
Q

pres of ectopic?

A

abdo pain, PV bleeding, adnexal tenderness

138
Q

ix in ectopic?

A

any female of childbearing age that present with collapse needs a pregnancy test

USS

139
Q

Mx of ectopic?

A

Medical; MTX

surgical: salpingectomy / sapingotomy

140
Q

when is booking visit?

A

<10/40 - screen for complications

141
Q

when is combined test?

A

11-13/40

142
Q

when is anomaly scan?

A

18-21/40

143
Q

what is involved in combined test?

A

PAPP-A
B-hCG
Nuchal translucency

PAPP-A is low in downs

144
Q

what happens in anomaly scan?

what is measured?

A

look for obvious abnormalities

measure - HC, AC, FL

145
Q

screening for pre-eclampsia?

A

regular GP, urinalysis

146
Q

prevention of pre-eclampsia?

A

75mg aspirin <16/40 in high risk women

147
Q

which maternal antibodies can cross placenta?

A

IgG

148
Q

scalp pH indicating fetal hypoxia?

A

<7.2

149
Q

dx of hyperemesis gravidarum?

A

severe vomiting with dehydration and electrolyte imbalances

+ wt loss + ketosis

150
Q

mx of hyperemesis gravidarum?

A

IV fluids
anti-emetics
thiamine

151
Q

cause of gestational DM?

A

increased insulin resistance

physiological increase allows the fetus to absorb more glucose from the placenta

152
Q

Dx of gestational DM?

A

GTT at 24-28/40

153
Q

Mx of gestational DM?

A

1 - metformin

2 - insulin

154
Q

mx of cholestasis of pregnancy?

A

induce at 37/40

ursodeoxycholic acid
Vit K if prolonged clotting

155
Q

surgical mx of PPH?

A
  1. rusch ballon
  2. brace suture
  3. hysterectomy
156
Q

CI to entonox?

A

pneumothorax

157
Q

RF for hyperemesis?

A

young
primip
hyperthyroid
multiples

158
Q

placenta accreta?

A

chorionic villi penetrate decidua basalis to attach to the myometrium

159
Q

placenta increta?

A

chorionic villi penetrate deeply into the myometrium

160
Q

placenta percreta?

A

chorionic villi breech myometrium into the peritoneum

161
Q

mx of placenta accretas?

A

CS +/- hysterectomy

162
Q

mx of miscarriage?

A

mifepristone (progesterone inhibitor)

misoprostol (prostaglandin)