Obstetric Hemorrhage and Peurperal Sepsis Flashcards
What are common causes of vaginal bleeding at < 20 wks gestation
Abortion Ectopic Cervical/Vaginal issue Cervical insufficiency Retroplacental clot Subchorionic hemorrhage
What are the 3 most common causes of bleeding > 20 wks gestation
Placenta abruption
Placenta previa
Uterine rupture
Def = separation of normally implanted placenta
Placenta abruption
Sx’s = painful vaginal bleeding, uterine tenderness, fetal distress
Placenta abruption
What is the most common cause of DIC in pregnancy
Placenta abruption
Def = extravasation of blood into the uterus causing red/purple discoloration under serosa
Couvelaire uterus
How do you deliver when there is a placenta abruption
Vaginally if both are stable
Def = implantation of the placenta over the cervical os
Placenta previa
What is the most common type of abnormal placentation
Placenta previa
Sx’s = painless vaginal bleeding
Placenta previa
What is the Tx for placenta previa
Bed rest if not profuse bleeding
C-section of > 36 wks
What is the Tx for a uterine rupture
Immediate laparotomy and delivery
Def = firm attachment of the placenta to the superficial lining of the myometrium
Placenta accreta
Def = placenta invades into the myometrium
Placenta increta
Def = placenta invades into the uterine serosa
Placenta precreta
Def = fetal blood vessels covering the uterine os
Vasa previa
What is the likely cause of 3rd trimester fetal bleeding
Velamentous cord rupture
What is the criteria for primary vs secondary PPH
Primary = < 24 hrs PP Secondary = 24 hrs - 12 wks PP
What are the 4 main causes of primary PPH
Uterine atony
Retained placenta
Coagulopathies
Uterine inversion
What are the Tx options for uterine atony
Bimanual massage
Pitocin
Uterine packing
What is the Tx option for retained placenta
Manual removal
If a uterine inversion occurs with the placenta still attached, what should you do with the placenta
Leave it attached until the uterus is replaced
What are the 4 common causes of secondary PPH
Subinvolution of placental site
Retained products of conception
Infection
Coagulation defects
What is the leading cause of maternal death worldwide
PH
What are the 1st and 2nd most common causes of PPH
1st = uterine atony 2nd = genital tract trauma
What are the Sx’s of Virchow’s triad
Endothelial damage
Venous stasis
Hypercoagulable state
What is the difference between Ovarian Vein Thrombophlebitis and Deep Septic Pelvic Vein Thrombophlebitis
Ovarian Vein Thrombophlebitis –> pt appears ill w/ fever and ab pain
What is the Tx for Septic pelvic thrombophlebitis
Unfractionated/LMW Heparin
