Obs. hemorrhage Flashcards
2 general times of hemorrage
- antepartum
2. post partum
3 causes of antepartum
- placental abruption
- placenta previa
- vasa previa
4 normal types of bleeds
- tiny separation
- bloody show
- post-coital
- hemorroids
what does APH cause risk to
both mother and fetus
def. placental abruption
premature sep. of the placenta - partial or complete
- blood work way in between endo and membranes and out the cervix - may also be concealed, which is more dangerous
most common etiology
unknown, then previous abruption
clinical features of abruption (5)
- bleeding with pain
- abnormal fetal heart trace
- decreased fetal bleed
- contractions of hypertonus
- maybe on placenta
what may be seen on US
large avocado sized clots
possible consequences of abruption on BB
small may have no consequences
- large may cause death
consquences for mom
- sig. blood loss
- consumptive coagulopathy
mgmt of abruption
- depends on status
- from monitor to crash CS
- RhIG if indicated
4 classes of P previa
- complete
- partial - covering os
- marginal - edge is at OS
- low lying - 2 cm from Os
what is problem with PP
- in T3, much of growth is in lower 3rd of uterus
- this can cause shearing of placenta, which is fixed
- requires C-section
5 risk factors for PP
- advance mat. age
- multiparity
- previous uterine surg.
- smoking
- multigestation
3 classes of P acreta
acreta - to mymetrium
increta - into myometrium
perceta -through myometrium
what is placenta previa + previous surgery
acreta until proven otherwise
clin. features P previa
painless vag. bleeding - light to heavy
golden rule of P previa
never do a physical exam until P previa has been ruled out
what is important about low-lying placentas
they may look like previa early on, but as the uterus grows, they will move up and away
what is issue with lower third of vag.
does not clamp down as well
see true and false questions
they’re good
def. vasa previa
normal umbilical cord inserts in middle of placenta
- in velamentous , they insert in membrane and have to traverse through membrane in the placenta
- more likely to be compressed
how to diagnoe
usually through US
mgmt of vasa previa
hospital and cortiocteroids
- early CS
impact of post-partum hemo
leading cause of death world wide
4th leading in dev. countries
def. of PPH
primary - excessive blood loss in first 24hrs (5ooml vag, 1000 CS)
secondary - from 24hrs -6 wks
4 Ts of PPH
Tone - uterine atony - most common
Tissue - retained placenta
Trauma - laceratiokns
Thrombin - coagulopathy
what is normal uterine physio
normally contracts firmly to occlude vasculature
what happen in abnormal tone
failure to contract
- clot feeds forward causing further distension
- lower pressure in vessel
- further hemo
risk factors for PPH
- overdistention of uter
- uterine fatigue
- previous PPH
- infection
- anatomic distortion
- medications
4 signs of placental separation (normal)
- gush of blood
- uterus becomes globular
- cord lengtening
- uterus rises
3 types of tissue risk factos
- retained placenta
- abnormal placenta placemnt
- retained clot
key to preventing tissue retention
active mgmt of 3rd stage of labor
types of traums
- lacerations
- CS
- uterine rupture
- uterine inversion
- fibroids
2 types of throbim issues
- pre-existing
2. aquired
4 types of aquired issues
- ITP - idiopathic
- HELLP
- DIC
- anticoagulation
what is major prevention approach
active mgmt of 3rd stage of labor
- prophylacitic oxytocin - most important
- controlled traction of cord
most important PPH intervention
bimanual massage - uterus punch
other specific interventions (5)
- uterotinics - oxytocin, ergovane, hemabate, misoprostol
- clotting aids - traxamenic acids
- mechanical compression - bimanual, balloon
- radiological - uterine artery embolosm
- surgical - compression sutures, ligation
