Obstetric Hemorrhage and Puerperal Sepsis Flashcards
What do we want to avoid until placenta previa has been ruled out?
-digital exam
What kind of speculum do we use for hemorrage?
-sterile spectum
What does that sinusoidal wave mean?
-severe fetal anemia
If the hemorrhage is before 20 weeks, what do we think of?
-abortion or ectopic…stuff like that
bleeding after 20 weeks?
- placental abruption
- placenta previa
- infection
- etc…
What is the most common type of abnormal placentation?
placenta previa
How does placenta previa classically present?
-painless vaginal bleeding
What does marginal, partial , and complete placenta previous mean?
-just how much is covering the os
how is placenta previa diagnosed?
- U/S
- repeat at 30 weeks because it will migrate 90% of the time
Placenta accreta?
- abnormal firm attachment to the superficial lining of the myometrium
- most common
palcenta increta
-invades myometrium
placenta percreta?
- through the myometrium into uterine serosa
- least common
What is the most common cause of third trimester bleed and how does it present?
- Placental Abruption!
- PAINFUL bleeding
What is the most common cause of DIC in pregnancy?
-placental abruption
In general, when managing these hemorrhagic patients in the hospital, what kind of diet are they on?
- NPO
- we are probs going to have to open them up
- type and cross 4 units of blood
What is the most common risk factor for uterine rupture?
-prior uterine incision
how does uterine rupture present?
- sudden onset of intense abdominal pain
- regression of presenting part of fetus
What is the other rare but important cause of third trimester bleeding?
- velamentous insertion of the umbilical cord
- cord inserts away from palcenta and has to travel across a lot of stuff
- vasa previa if over the cervical os
definition of postpartum hemorrhage following vaginal and cesarean section?
- vaginal: 500cc
- C section: 1000cc
most common cause of primary postpartum hemorrhage?
- uterine atony
- secondary happens later and happens with subinvolution of the uterus…
When do more than half of all maternal deaths occur?
-within 24 hrs of delivery
What drug can we give them if there is uterine atony?
-oxytocin (pitocin)
if there is uterine inversion, when should we remove the placenta?
-after the inversion is corrected
What is febrile morbidity?
- temp> 100.4 or higher that occurs for more than 2 consecutive days during the first 10 postpartum days
- most fevers are due to endometritis…. from organsims in the vagina
What kind of organisms cause 70% of peurperal sepsis?
-anaerobic cocci
clinical features of peurperal sepsis
- postpartum fever and increasing uterine tenderness on postpartum day 2-3 are key***
- for diagnosis, extrapelvic causes of fever should be excluded
What drugs do we give a lady with puerperal sepsis?
- ones that fight anaerobic coverage
- ampicillin and gentamicin
What is the major pathogen that is resistant to that drug combo?
- bacteroides fragilis
- run that bitch over with clindamycin
What is Virchow’s triad?
- endothelial damage
- venous stasis
- hypercoagulable state of pregnancy
main way we can tell ovarian vein thrombophlebitis from deep septic pelvic vein thrombphlebitis
- ovarian vein: appear clinically ill
- Deep septic pelvic vein: do NOT appear clinically ill
