Obstetric Hemorrhage Flashcards
What are causes of 3rd trimester hemhorrage?
Placental Abruption
Placenta Previa
Vasa Previa
What is the triad of Placental abruption
PAINFUL Uterine Bleeding
PAINFUL Uterine Hypertonus
Fetal Distress
What is Grade 1 Placental abruption?
Slight Bleed Uterine Irritability Maternal BP Normal Maternal Fibrinogen normal FHT normal
What is Grade 2 Placental abruption?
Mild to Mod Bleed Uterus irritable, Tetanic or Frequent Contractions BP maint (orthostatic) HR Elevated Fibrinogen Dec FHT show distress
What is Grade 3 Placental abruption?
Mod to Severe Bleeding Uterus Tetanic and painful Maternal Hypotension Fetal Death Fibrinogen
What causes placental abruption?
Advancedage or parity smoker Cocaine Poor Nutrition Chorioamnion HTN ** Abdominal Trauma
What is management of a placental abruption?
Obs in Gr 1 Tocolysis (anti contraction meds) Continuous fetal monitoring Urin output, fibrinogen, HCt Delivery- Vaginal vs C/S Restore Blood Vol
What are the types of Placenta previa?
Total (20-40%)
Partial
Marginal
Low lying
What is presentation of Placenta previa
PAIN-LESS Vaginal Bleeding
Leading cause of 3rd Trimester Hemorrhage
What are the Risk facotrs of Placenta Previa?
Advanced maternal age
Black and other minorities
Previous C/S ****
What is the management of Placenta previa?
Can consider vaginal delivery if Marginal with min bleeding Expectant management (plan)
What are different abnormalities of placental attachment? What layer is lost?
Accreta= to myometrium
Increta= invades the myometrium Percreta= Penetrates MM
Decidua basalis is lost and inc devt of Fibrinoid layer
What is Vasa Previa?
Fetal(umbilical) vessels traverse the membranes and cover the OS (on their way to the placenta)
What is presentation of Vasa Previa?
Spontaneous Rupture of Membranes
Laceration of fetal vessel
Rapid fetal death
What are causes of Post-partum Hemorrhage?
Uterus cannot contract to shear off placenta and shut off blood flow. Leads to retained placental fragments
What are reasons for Myometrial dysfunction?
Overdistention of uterus
Oxytocin stim labor
Episiotomy
How can post partum blood loss be prevented: Before delivery?
HCT Blood Type and Screen IV acess Baseline Coag Studies Risk factors?
How can post partum blood loss be prevented: During delivery?
Avoid excess traction on Umb cord
Careful use of vacuum forceps
Examine Placenta
Oxytocin before placental del
How can post partum blood loss be prevented: In recovery?
Observe for bleeding
Continue Uterotonic agents(oxytocin, prostaglandins, misoprostol)
Palpate uterus with fundal massage
Vital Signs
How much does one pk of RBCs increase Hct?
3% or Hgb by 1g/dL
How much does one pk of platelets increase count?
5,000-10,000
How much does one pk of Fresh Frozen Plasma increase Fibrinogen?
10 mg/dL
How much does one pk of Cryoprecipitate increase Fibrinogen?
10 mg?dL
What are the different Degrees of Vaginal Lacerations?
1st: fourchette, vaginal mucosa, perineal skin
2nd: muscles of perineal body. Anal sphincter intact
3rd: Includes anal sphincter
4th: Ext through rectal mucosa
What are the types of pelvic hematomas?
Vulvar
Vaginal
Retroperitoneal
What is a vulvar hematoma?
Laceration of vessel in superficial fascia of ant or post pelvic triangle
Subacute blood loss
Pain
What is a Vaginal hematoma?
Trauma to soft tissue during delivery
Blood accumulates in plane above pelvic diaphragm
Rectal pressure
Mass protruding into vagina
What is a Retroperitoneal hematoma?
Laceration of vessel from hypogastric artery
Can dissect to renal vasculature
Uterus will be displaced
May look shocky
