Obstetric Hemorrhage and Sepsis Flashcards
What is the immediate course of action for a patient who is bleeding profusely after delivery
- Get the appropriate team
- 2 Large bore IV
- Draw labs (CBC/Coag, Serial H/H, Type and cross)
how much will one unit of blood increase Hct and Hgb?
3% hct
1g/dL hgb
What do you need to rule out before a digital exam in heavy postpartum bleeding?
Rule out placenta previa
name common causes of vaginal bleeding prior to 20 weeks
Abortions
Ectopics
Cervical/vaginal path
Cervical insufficiency
Name causes of vaginal bleeding after 20 weeks in the upper gential tract
Placental Abruption
Placenta Previa
Uterine Rupture
Vasa Previa
Name causes of vaginal bleeding after 20 weeks in the lower genital tract
Blood show labor Cervical polyps Infections Trauma Cancer Vulvar varicosities Blood dyscrasia
what is the most common type of abnormal placentation
Placenta Previa
accounts for 20% of all antepartum hemorrhages
How does placenta previa present
Painless vaginal bleeding
20% will have associated contractions
Mean gestational age: 30 weeks
What are some risk factors for placenta previa
>35 y/o Multiparity Cocaine/smoking Prior Previa C-section
What are the three classifications of Placenta previa
Marginal
Partial
Complete
What percent of previas will resolve by weeks 32-35?
90%
What is the main goal of managing placenta previa
keep baby gestating as long as possible.
Only deliver if fetal lung maturity confirmed or imminent threat
What are the three types of abnormal placental implantation
Placenta Accreta - superficial lining of myometrium
Placenta Increta - invades myometrium
Placenta precreta - through the myometrium into uterine serosa
what is placental abruption
premature separation of the normally implanted placenta
most common cause of 3rd trimester bleeding
How does placental abruption present
Painful bleeding, uterine tenderness, uterine hyperactivity
What is the most common risk factor for placental abruption
maternal HTN
What is a dangerous pathology associated with placental abruption
DIC, most common cause of DIC in pregnancy
what is couvelaire uterus
in placental abruption, extravasation of blood in the uterus, causing red & purple discoloration of the serosa
What are risk factors associated with uterine rupture
Prior uterine incision
Trauma
Multiparity
Velamentous insertion of the umbilical cord is responsible for what
fetal bleeding -> third trimester bleeding
A woman presents for a check up. randomly she begins to bleed and the fetal heart rate skyrockets then begins to slow below normal. What occurred and what is the next step
Some sort of fetal bleeding
must proceed to delivery
What is the most common cause of primary postpartum hemorrhage
uterine atony
what are risk factors for uterine atony
enlargement of uterus
abnormal labor
conditions interfere with contractions of uterus
how do you manage uterine atony clincally
bimanual massage of the uterus Start oxytocin, and other pharmacological factors Uterine packing Interventional radiology Surgical Measure/hysterectomy
