Obstetric Hemorrhage

Question 1

What are the for Ts in obstetric hemorrhage?

Answer 1

Tone
Tissue
Trauma
Thrombin

Question 2

What is the risk of placenta previa with concurrent placenta accreta with one prior CSD ?

Answer 2

1 CSD : 3%
2 CSD : 11%
3 CSD : 40%
4 CSD: 61%
5 CSD: 67%

Question 3

This is the abnormal implantation of the placenta over the internal cervical os?

Answer 3

Placenta previa

Question 4

This is the tendency of >90% of low-lying placentas to move away from the cervix & out of the lower uterine segment to better vascularized regions?

Answer 4

Trophotropism

Question 5

What is the preferred mode of delivery for placenta previa patients who are asymptomatic and without bleeding?

Answer 5

Outpatient management until CSD

Question 6

What will you call the condition wherein villi penetrate through the myometrium and to or throughthe serosa?

Answer 6

Placenta precreta

Question 7

What arethe 2 most important risk factor for placenta accreta?

Answer 7

1. Placenta previa hx
2. Prior CSD

Question 8

What is the management for placenta accreta patients with significant bleeding? And if asymptomatic?

Answer 8

Bleeding: CS hysterectomy regardless AOG
Asymptomatic: CS Hysterectomy at 34 weeks

Question 9

What percentage of abruptions occur before labor and after 30 weeks ? During labor? Identified on placental inspection after delivery?

Answer 9

Before labor: 50%
After 30 wks AOG: 50%
During labor: 15%
Identified after delivery: 30%

Question 10

What is the risk for uterine rupture in patients with a prior LTCSD? With Classical CSD?

Answer 10

LTCSD: 0.05-0.1%
Classical CSD: 6-12%

Question 11

What is the management for uterine rupture?

Answer 11

Immediate laparotomy and delivery of fetus

Question 12

What test is used to diagnose fetal vessel rupture and involves looking for nucleated fetal RBCs in maternal blood?

Answer 12

Apt Test: Examination of blood for nucleated fetal RBCs

Question 13

This occurs when blood vessels insert between the amnion and chorion away from the placenta, instead of inserting directly into the chorion plate?

Answer 13

Velamentous cord insertion

Question 14

Which in the px hx is most likely to inc the probability of placenta previa?

Answer 14

Cesarean section scar

Question 15

As many as 7% of cases of placenta previa may be associated with?

Answer 15

Placenta accreta

Question 16

What is the cause of spontaneous hemorrhage believed to be related to?

Answer 16

Development of lower uterine segment

Question 17

Which exam should never be done in px with placenta previa unless she is already in the OR?

Answer 17

Internal Examination

Question 18

What site of placenta previa implantation is associated with profound hemorrhage?

Answer 18

Anterior

Question 19

Vaginal bleeding accompanying rupture of membranes in labor?

Answer 19

Vasa previa

Question 20

Expected fetal tracing indicative of fetal anemia?

Answer 20

Sinusoidal variation of fetal heart rate

Question 21

Coagulation blood test for patients with antepartum bleeding?

Answer 21

D-dimer

Question 22

Predisposing factors of placenta previa ?

Answer 22

1. Prior CSD & uterine surgery
2. Multiparity
3. Multiple gestation
4. Erythroblastosis
5. Smoking
6. History of placenta precia
7. Increasing maternal age

Question 23

Procedure done to control postpartum bleeding in women who still desire future fertility?

Answer 23

Uterine artery embolization done by an interventional radiologist

Question 24

Patient bleeding greater than 2-3L will commonly develop what complication?

Answer 24

Consumptive Coagulopathy