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OBGYN 2 > Obstetric Hemorrhage > Flashcards

Obstetric Hemorrhage Flashcards

1
Q

What are causes of 3rd trimester hemhorrage?

A

Placental Abruption
Placenta Previa
Vasa Previa

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2
Q

What is the triad of Placental abruption

A

PAINFUL Uterine Bleeding
PAINFUL Uterine Hypertonus
Fetal Distress

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3
Q

What is Grade 1 Placental abruption?

A 
Slight Bleed
Uterine Irritability
Maternal BP Normal
Maternal Fibrinogen normal
FHT normal
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4
Q

What is Grade 2 Placental abruption?

A 
Mild to Mod Bleed
Uterus irritable, Tetanic or Frequent Contractions
BP maint (orthostatic)
HR Elevated
Fibrinogen Dec
FHT show distress
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5
Q

What is Grade 3 Placental abruption?

A 
Mod to Severe Bleeding
Uterus Tetanic and painful
Maternal Hypotension
Fetal Death
Fibrinogen
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6
Q

What causes placental abruption?

A 
Advancedage or parity
smoker
Cocaine
Poor Nutrition
Chorioamnion
HTN **
Abdominal Trauma
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7
Q

What is management of a placental abruption?

A 
Obs in Gr 1
Tocolysis (anti contraction meds)
Continuous fetal monitoring
Urin output, fibrinogen, HCt
Delivery- Vaginal vs C/S
Restore Blood Vol
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8
Q

What are the types of Placenta previa?

A

Total (20-40%)
Partial
Marginal
Low lying

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9
Q

What is presentation of Placenta previa

A

PAIN-LESS Vaginal Bleeding

Leading cause of 3rd Trimester Hemorrhage

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10
Q

What are the Risk facotrs of Placenta Previa?

A

Advanced maternal age
Black and other minorities
Previous C/S ****

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11
Q

What is the management of Placenta previa?

A 
Can consider vaginal delivery if Marginal with min bleeding
Expectant management (plan)
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12
Q

What are different abnormalities of placental attachment? What layer is lost?

A

Accreta= to myometrium
Increta= invades the myometrium Percreta= Penetrates MM
Decidua basalis is lost and inc devt of Fibrinoid layer

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13
Q

What is Vasa Previa?

A

Fetal(umbilical) vessels traverse the membranes and cover the OS (on their way to the placenta)

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14
Q

What is presentation of Vasa Previa?

A

Spontaneous Rupture of Membranes
Laceration of fetal vessel
Rapid fetal death

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15
Q

What are causes of Post-partum Hemorrhage?

A

Uterus cannot contract to shear off placenta and shut off blood flow. Leads to retained placental fragments

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16
Q

What are reasons for Myometrial dysfunction?

A

Overdistention of uterus
Oxytocin stim labor
Episiotomy

17
Q

How can post partum blood loss be prevented: Before delivery?

A 
HCT
Blood Type and Screen
IV acess
Baseline Coag Studies
Risk factors?
18
Q

How can post partum blood loss be prevented: During delivery?

A

Avoid excess traction on Umb cord
Careful use of vacuum forceps
Examine Placenta
Oxytocin before placental del

19
Q

How can post partum blood loss be prevented: In recovery?

A

Observe for bleeding
Continue Uterotonic agents(oxytocin, prostaglandins, misoprostol)
Palpate uterus with fundal massage
Vital Signs

20
Q

How much does one pk of RBCs increase Hct?

A

3% or Hgb by 1g/dL

21
Q

How much does one pk of platelets increase count?

A

5,000-10,000

22
Q

How much does one pk of Fresh Frozen Plasma increase Fibrinogen?

A

10 mg/dL

23
Q

How much does one pk of Cryoprecipitate increase Fibrinogen?

A

10 mg?dL

24
Q

What are the different Degrees of Vaginal Lacerations?

A

1st: fourchette, vaginal mucosa, perineal skin
2nd: muscles of perineal body. Anal sphincter intact
3rd: Includes anal sphincter
4th: Ext through rectal mucosa

25
Q

What are the types of pelvic hematomas?

A

Vulvar
Vaginal
Retroperitoneal

26
Q

What is a vulvar hematoma?

A

Laceration of vessel in superficial fascia of ant or post pelvic triangle
Subacute blood loss
Pain

27
Q

What is a Vaginal hematoma?

A

Trauma to soft tissue during delivery
Blood accumulates in plane above pelvic diaphragm
Rectal pressure
Mass protruding into vagina

28
Q

What is a Retroperitoneal hematoma?

A

Laceration of vessel from hypogastric artery
Can dissect to renal vasculature
Uterus will be displaced
May look shocky

OBGYN 2 (15 decks)

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