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ENRP Exam 1 > Obstetric Hemorrhage > Flashcards

Obstetric Hemorrhage Flashcards

1
Q

How much will the Hct and Hgb be raised by 1 unti of PRBC’s?

A

Raise Hct by 3% and Hgb by 1g/dL

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2
Q

What should be avoided during the initial examination of antepartum hemorrhage?

A
  • AVOID digital exam until placenta previa is ruled out
  • Instead do sterile speculum exam
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3
Q

How many units of blood should you type and crossmatch for during antepartum hemorrhage?

A

4 untis of blood

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4
Q

Placenta previa classically presents how?

A

PAINLESS vaginal bleeding

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5
Q

Risk factors for placenta previa?

A
  • Maternal age >35
  • Multiparity
  • Prior previa
  • Previous C-section
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6
Q

What is the most serious type of placenta previa and is associated with the most blood loss?

A

COMPLETE

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7
Q

Placent previa is almost exclusively diagnosed how?

A

By U/S

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8
Q

How likely are placenta previas to resolve on their own?

A

90% will resolve by placental migration

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9
Q

What is goal of management of placenal previa in preterm pregnancy; can these patients go home?

A
  • Goal is to attempt to obtain fetal maturation
  • If bleeding not profuse, pt is managed on bed rest initially
  • If stable and bleeding stops may send home on pelvic rest
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10
Q

What is the most common abnoraml placental implantation other than previa?

A

Placent ACCRETA; firm attachment ot the superficial linign of the myometrium

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11
Q

What is the most common cause of third trimester bleeding?

A

Placental Abruption

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12
Q

Which condition most often presents as painful third trimester bleeding, uterine tenderness, uterine hyperactivity, and fetal distress and/or death?

A

Placental abruption

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13
Q

What is the most common risk factor for placental abruption?

A

Maternal HTN

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14
Q

If pregnant mother presents after MVA or physical abuse how long should they be monitored for placental abruption?

A

Monitor for 4-6 hours

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15
Q

What is the most common cause of DIC in pregnancy?

A

Placental abruption

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16
Q

What is the proper management of placental abruption based on maternal and fetal stability?

A
  • If both stable then proceed with vaginal delivery
  • Often a rapid delivery ensues w/ abruption
  • If remote from vaginal delivery w/ signs of fetal distress or uncontrolled bleeding then C-sections
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17
Q

What is couvelarire uterus?

A

Occurs during placental abruption with extravasation of blood into the uterus

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18
Q

Uterine rupture is associated with what signs/sx’s?

A
  • Sudden onset of INTENSE abdominal pain +/- vaginal bleeding
  • Abnormal FHR pattern or cessation of fetal heart tones
  • Regression of the presenting part
19
Q

How is uterine rupture managed?-

A
  • Immediate laparotomy and delivery of fetus
  • If feasible repair ruptured site
  • If large rupture may have to do a cesarean hysterectomy
20
Q

Fetal bleeding that occurs during the third trimester is most often due to what?

A

2’ to velamentous insertion of umbilical cord

21
Q

Postpartum hemorrhage is defined as how much blood loss following a vaginal birth vs. C-section?

A
  • >500cc following vaginal birth
  • >1000cc following C-section
22
Q

Differentiate primary vs. secondary postpartum hemorrhage?

A
  • Primary is that which occurs within first 24 hours; often uterine atony
  • Secondary occurs from >24 hours to 12 weeks
23
Q

What will palpation of a uterus that fails to contract after delivery reveal (uterine atony)?

A

Will reveal “Boggy Uterus”

24
Q

Effective hemostasis after separation of the placenta is dependent on what?

A

Myometrium to compress the severed vessels

25
What are some strategies to managin uterine atony?
- **BIMANUAL MASSAGE** of the **uterus** - Start **pharmacologic agents**: oxytocin, etc... - **Uterine packing** or **large volume balloon catheter** - **Interventional radiology**
26
Methylergonovine can be given for tx of postpartum hemorrhage, but should be avoided in whom?
Avoid in **HTN** patients
27
15-methyl PGF2a (Hemabate) can be given for management of postpartum hemorrhage but should be avoided in which pt's?
Avoid in **asthmatics**
28
Dinoprostone (PGE2) can be given for postpartum hemorrhage, but should be avoided in which pt's?
Avoid if patient is **HYPO**tensive
29
What is the second most common cause of postpartum hemorrhage following vaginal delivery?
**Trauma** during **delivery**
30
What is the treatment for retained placenta?
- **Manual** removal if **bleeding** is **profuse** - **+/- uterine curettage** with or without U/S guidance being careful not to perforate
31
How should uterine inverion be managed if placenta has not been delivered?
**DO NOT remove placenta** until the inversion is corrected
32
Uterine inversion is associated with what complications?
**Copious bleeding** and **HYPOvolvemic shock** can ensue
33
How much is the platelet count increased per unti of platelets given?
**5000-10,000/mm3 per unit**
34
What are the contents of fresh frozen plasma and how much does one unit increase the fibrinogen?
- Contains **fibrinogen, antithrombin III****,**and**Factors V**and**VIII** - Increases fibrinogen by **10 mg/dL**
35
What are the blood components of Crypercipitate and how much does one unit increase the fibrinogen?
- **Fibrinogen** + **vWF** + **Factors VIII and XIII** - Increases **fibrinogen** by **10 mg/dL**
36
Febrile morbidity is defined as what?
**Temp \>100.4 (38 C)** or **higher** occuring **\>2 consecutive days** during the **first 10 postpartum days**
37
Majority of the postpartum fevers are due to what?
Endometritis
38
Organism with what oxygen dependence cause majority of puerperal infections; which organisms most commonly?
**ANAEROBIC** ---\> *Peptostreptococcus, Peptococcus, and Streptococcus*
39
What are the key clinical findings for puerpral sepsis?
**Postpartum fever** and ↑ **uterine tenderness** on **postpartum day 2-3**
40
What is an effective antibiotic regimen for puerperal sepsis; what if causative organism is *Bacteroides fragilis?*
- **Ampicillin** + **Gentamicin** - *Bacterioides fragilis* is **resistant** to this combo, but **sensitive** to **Clindamycin**
41
Septic pelvic thrombophlebitis fufills the criteria for which pathogenesis of thrombosis?
- **Virchow's triad** - **Endothelial damage** + **Venous stasis** + **hypercoagulable state** of **pregnancy**
42
How does the presentation of ovarian vein thrombophlebitis differ from deep septic pelvic vein thrombophlebitis?
- **Ovarian vein** will have **fever + abdominal pain** within **1 week** of delivery ---\> appear **critically ill** - **Pelvic vein** will usually have **unlocalized fever** in **first few days** that is NON-responsive to Abx and pt's do **NOT** appear critically ill
43
If ovarian vein thrombosis is seen radiographically anticoagulants should be continued for how long?
**6 weeks**

ENRP Exam 1 (30 decks)

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