Obs. hemorrhage

Question 1

2 general times of hemorrage

Answer 1

1. antepartum

2. post partum

Question 2

3 causes of antepartum

Answer 2

1. placental abruption
2. placenta previa
3. vasa previa

Question 3

4 normal types of bleeds

Answer 3

1. tiny separation
2. bloody show
3. post-coital
4. hemorroids

Question 4

what does APH cause risk to

Answer 4

both mother and fetus

Question 5

def. placental abruption

Answer 5

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

Question 6

most common etiology

Answer 6

unknown, then previous abruption

Question 7

clinical features of abruption (5)

Answer 7

1. bleeding with pain
2. abnormal fetal heart trace
3. decreased fetal bleed
4. contractions of hypertonus
5. maybe on placenta

Question 8

what may be seen on US

Answer 8

large avocado sized clots

Question 9

possible consequences of abruption on BB

Answer 9

small may have no consequences

- large may cause death

Question 10

consquences for mom

Answer 10

• sig. blood loss

- consumptive coagulopathy

Question 11

mgmt of abruption

Answer 11

• depends on status
• from monitor to crash CS
• RhIG if indicated

Question 12

4 classes of P previa

Answer 12

1. complete
2. partial - covering os
3. marginal - edge is at OS
4. low lying - 2 cm from Os

Question 13

what is problem with PP

Answer 13

1. in T3, much of growth is in lower 3rd of uterus
2. this can cause shearing of placenta, which is fixed
3. requires C-section

Question 14

5 risk factors for PP

Answer 14

1. advance mat. age
2. multiparity
3. previous uterine surg.
4. smoking
5. multigestation

Question 15

3 classes of P acreta

Answer 15

acreta - to mymetrium
increta - into myometrium
perceta -through myometrium

Question 16

what is placenta previa + previous surgery

Answer 16

acreta until proven otherwise

Question 17

clin. features P previa

Answer 17

painless vag. bleeding - light to heavy

Question 18

golden rule of P previa

Answer 18

never do a physical exam until P previa has been ruled out

Question 19

what is important about low-lying placentas

Answer 19

they may look like previa early on, but as the uterus grows, they will move up and away

Question 20

what is issue with lower third of vag.

Answer 20

does not clamp down as well

Question 21

see true and false questions

Answer 21

they’re good

Question 22

def. vasa previa

Answer 22

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

Question 23

how to diagnoe

Answer 23

usually through US

Question 24

mgmt of vasa previa

Answer 24

hospital and cortiocteroids

- early CS

Question 25

impact of post-partum hemo

Answer 25

leading cause of death world wide | 4th leading in dev. countries

Question 26

def. of PPH

Answer 26

primary - excessive blood loss in first 24hrs (5ooml vag, 1000 CS) secondary - from 24hrs -6 wks

Question 27

4 Ts of PPH

Answer 27

Tone - uterine atony - most common Tissue - retained placenta Trauma - laceratiokns Thrombin - coagulopathy

Question 28

what is normal uterine physio

Answer 28

normally contracts firmly to occlude vasculature

Question 29

what happen in abnormal tone

Answer 29

failure to contract - clot feeds forward causing further distension - lower pressure in vessel - further hemo

Question 30

risk factors for PPH

Answer 30

1. overdistention of uter 2. uterine fatigue 3. previous PPH 4. infection 5. anatomic distortion 6. medications

Question 31

4 signs of placental separation (normal)

Answer 31

1. gush of blood 2. uterus becomes globular 3. cord lengtening 4. uterus rises

Question 32

3 types of tissue risk factos

Answer 32

1. retained placenta 2. abnormal placenta placemnt 3. retained clot

Question 33

key to preventing tissue retention

Answer 33

active mgmt of 3rd stage of labor

Question 34

types of traums

Answer 34

1. lacerations 2. CS 3. uterine rupture 4. uterine inversion 5. fibroids

Question 35

2 types of throbim issues

Answer 35

1. pre-existing | 2. aquired

Question 36

4 types of aquired issues

Answer 36

1. ITP - idiopathic 2. HELLP 3. DIC 4. anticoagulation

Question 37

what is major prevention approach

Answer 37

active mgmt of 3rd stage of labor 1. prophylacitic oxytocin - most important 2. controlled traction of cord

Question 38

most important PPH intervention

Answer 38

bimanual massage - uterus punch

Question 39

other specific interventions (5)

Answer 39

1. uterotinics - oxytocin, ergovane, hemabate, misoprostol 2. clotting aids - traxamenic acids 3. mechanical compression - bimanual, balloon 4. radiological - uterine artery embolosm 5. surgical - compression sutures, ligation