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Undeleted > Obs. hemorrhage > Flashcards

Obs. hemorrhage Flashcards

1
Q

2 general times of hemorrage

A
  1. antepartum

2. post partum

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2
Q

3 causes of antepartum

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

4 normal types of bleeds

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

what does APH cause risk to

A

both mother and fetus

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5
Q

def. placental abruption

A

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

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6
Q

most common etiology

A

unknown, then previous abruption

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7
Q

clinical features of abruption (5)

A
  1. bleeding with pain
  2. abnormal fetal heart trace
  3. decreased fetal bleed
  4. contractions of hypertonus
  5. maybe on placenta
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8
Q

what may be seen on US

A

large avocado sized clots

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9
Q

possible consequences of abruption on BB

A

small may have no consequences

- large may cause death

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10
Q

consquences for mom

A
  • sig. blood loss

- consumptive coagulopathy

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11
Q

mgmt of abruption

A
  • depends on status
  • from monitor to crash CS
  • RhIG if indicated
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12
Q

4 classes of P previa

A
  1. complete
  2. partial - covering os
  3. marginal - edge is at OS
  4. low lying - 2 cm from Os
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13
Q

what is problem with PP

A
  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
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14
Q

5 risk factors for PP

A
  1. advance mat. age
  2. multiparity
  3. previous uterine surg.
  4. smoking
  5. multigestation
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15
Q

3 classes of P acreta

A

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

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16
Q

what is placenta previa + previous surgery

A

acreta until proven otherwise

17
Q

clin. features P previa

A

painless vag. bleeding - light to heavy

18
Q

golden rule of P previa

A

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

19
Q

what is important about low-lying placentas

A

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

20
Q

what is issue with lower third of vag.

A

does not clamp down as well

21
Q

see true and false questions

A

they’re good

22
Q

def. vasa previa

A

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
23
Q

how to diagnoe

A

usually through US

24
Q

mgmt of vasa previa

A

hospital and cortiocteroids

- early CS

25
Q

impact of post-partum hemo

A

leading cause of death world wide

4th leading in dev. countries

26
Q

def. of PPH

A

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

27
Q

4 Ts of PPH

A

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

28
Q

what is normal uterine physio

A

normally contracts firmly to occlude vasculature

29
Q

what happen in abnormal tone

A

failure to contract

  • clot feeds forward causing further distension
  • lower pressure in vessel
  • further hemo
30
Q

risk factors for PPH

A
  1. overdistention of uter
  2. uterine fatigue
  3. previous PPH
  4. infection
  5. anatomic distortion
  6. medications
31
Q

4 signs of placental separation (normal)

A
  1. gush of blood
  2. uterus becomes globular
  3. cord lengtening
  4. uterus rises
32
Q

3 types of tissue risk factos

A
  1. retained placenta
  2. abnormal placenta placemnt
  3. retained clot
33
Q

key to preventing tissue retention

A

active mgmt of 3rd stage of labor

34
Q

types of traums

A
  1. lacerations
  2. CS
  3. uterine rupture
  4. uterine inversion
  5. fibroids
35
Q

2 types of throbim issues

A
  1. pre-existing

2. aquired

36
Q

4 types of aquired issues

A
  1. ITP - idiopathic
  2. HELLP
  3. DIC
  4. anticoagulation
37
Q

what is major prevention approach

A

active mgmt of 3rd stage of labor

  1. prophylacitic oxytocin - most important
  2. controlled traction of cord
38
Q

most important PPH intervention

A

bimanual massage - uterus punch

39
Q

other specific interventions (5)

A
  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

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