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endorepro remediation > Obstetric Hemorrhage (Moulton) > Flashcards

Obstetric Hemorrhage (Moulton) Flashcards

1
Q

In the initial evaluation of antepartum hemorrhage, you want to type and crossmatch for ___ units of blood.

A

4

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2
Q

One unit (250-300cc) of PRBC will raise the __1__ by 3% and __2__ by 1 g/dL.

A

1) Hct

2) Hgb

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3
Q

In the initial evaluation of antepartum hemorrhage, you want to avoid digital exam until ____ has been ruled out by US.

A

Placenta previa

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4
Q

In the initial evaluation of antepartum hemorrhage, a sterile speculum exam is used to look for?

A digital exam is used to assess?

A

1) Genital lacerations or cervical lesions (cancer, polyps)

2) Cervical dilation

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5
Q

Abortions, ectopics, cervical/vaginal etiology (cancer, trauma, polyps), subchorionic hemorrhage/retroplacental clot, and cervical insufficiency can all present with vaginal bleeding at what time?

A

Before 20 weeks

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6
Q

Placental Abruption, Placenta Previa, Uterine rupture, and Vasa previa can all present with vaginal bleeding from the what part of the genital tract?

They result in vaginal bleeding when?

A

1) Upper genital tract

2) After 20 weeks

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7
Q

Cervical polyps, infections, trauma, cancer, vulvar varicosities, and blood dyscrasia an all present with vaginal bleeding from the what part of the genital tract?

They result in vaginal bleeding when?

A

1) Lower genital tract

2) After 20 weeks

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8
Q

What is the most common type of abnormal placentation and accounts for about 20% of all cases of antepartum hemorrhages?

A

Placenta previa

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9
Q

Placenta previa is defined as the implantation of the placenta over the?

It presents classically as?

A

1) Cervical os

2) Painless vaginal bleeding

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10
Q

Maternal age greater than what age is a risk factor for placenta previa?

Multiparity or nulliparity is a risk factor?

Use of what substances are risk factors?

What previous procedure increases risk?

A

1) 35 y/o
2) Multiparity
3) Cocaine and smoking
4) Cesarean section

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11
Q

In the classifications of placenta previa, __1__ is characterized by the edge of the placenta extending to the edge of the cervical os and it does not cover the os.

__2__ is characterized by only slight occlusion of the cervical os by the placenta.

__3__ is characterized by cervical os being fully covered by the placenta and is the most serious type as it is associated with greater blood loss.

A

1) Marginal
2) Partial
3) Complete

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12
Q

With placenta previa the mean gestational age bleeding that occurs is at ___ weeks.

A

30 weeks

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13
Q

90% of placenta previa will resolve by 32-35 weeks by a phenomenon known as ____.

A

Placental migration

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14
Q

__1__ is characterized by abnormal firm attachment to the superficial lining of the myometrium.

__2__ is characterized by invasion into myometrium.

__3__ is characterized by invasion through the myometrium into the uterine serosa.

Which are the most and least common?

A

1) Placenta accreta (Most common)
2) Placenta increta
2) Placenta percreta (Least common)

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15
Q

Previous cesarean section and placenta previa increases the incidence of?

A

Placenta accreta

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16
Q

What is defined as premature separation of the normally implanted placenta?

A

Placental abruption

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17
Q

Placental abruption is the most common cause of __1__ trimester bleeding.

It classically presents as __2__ bleeding.

A

1) Third

2) Painful

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18
Q

What is the most common risk factor for placental abruption?

Use of what substance is a risk factor?

What preceding event is a risk factor?

Polyhydramnios or oligohydramnios is a risk factor?

Multiparity or nulliparity is a risk factor?

A

1) Maternal HTN
2) Cocaine use
3) Physical trauma (MVA and physical abuse)
4) Polyhydramnios
5) Multiparity

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19
Q

If a 36 year old pregnant patient presents with painless vaginal bleeding what is the diagnosis?

If a patient presents with painful vaginal bleeding, uterine tenderness, uterine hyperactivity, and fetal death what is the diagnosis?

A

1) Placenta previa

2) Placental abruption

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20
Q

Placental abruption is the most common cause of __1__ in pregnancy.

It results from the release of __2__ from the disrupted placenta and subplacental decidua causing a consumptive coagulopathy.

A

1) DIC

2) Thromboplastin

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21
Q

Placental abruption can result in couvelaire uterus which is characterized by extravasation of blood into the uterus causing ____ of the serosa.

A

Red and purple discoloration

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22
Q

What implies complete separation of the uterine musculature through all of its layers?

A

Uterine rupture

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23
Q

What is the most common risk factor for uterine rupture?

A

Prior uterine incision such as from C-section or myomectomy

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24
Q

Uterine rupture is associated with sudden onset of ___ along with +/- vaginal bleeding.

A

Intense abdominal pain

25
Q

What must be done for future pregnancies due to previous uterine rupture?

A

Deliver via C-section

26
Q

What is a rare but important cause of third trimester bleeding?

It is often secondary to velamentous insertion of?

A

1) Rupture of fetal vessel

2) Umbilical cord

27
Q

Velamentous insertion of umbilical cord is characterized by the cord inserting at a distance away from the placenta and it’s vessels must traverse between the chorion and amnion without the protective __1__.

If unprotected vessels pass over the cervical os it is termed a __2__.

A

1) Wharton’s jelly

2) Vasa previa

28
Q

Postpartum Hemorrhages can be classified as primary which occurs within __1__.

Or classified as secondary with occurs within __2__.

A

1) First 24 hours

2) 24 hours to 12 weeks

29
Q

Primary postpartum hemorrhage is secondary to ____ 80% of the time.

A

Uterine atony

30
Q

Postpartum Hemorrhage is the leading cause of?

A

Maternal death

31
Q

Subinvolution of the uterus, sloughing of the eschar or retained products are the etiologies of?

A

Secondary postpartum hemorrhages

32
Q

The excessive blood loss seen with uterine atony most commonly results when the uterus ____ after delivery of placenta.

A

Fails to contract

33
Q

What is done in the management of uterine atony?

A

Bimanual massage of the uterus

34
Q

What is commonly given prophylactically after delivery of the infant or placenta in the management of uterine atony?

A

Oxytocin (Pitocin)

35
Q

Methylergonovine (Methergine) can be given in the management of uterine atony but is contraindicated in __1__ patients.

15- Methyl prostaglandin F2a (Hemabate) can be given in the management of uterine atony but is contraindicated in __2__ patients.

Dinoprostone (Prostin E2) can be given in the management of uterine atony but is contraindicated in __3__ patients.

A

1) HTN
2) Asthmatics
3) Hypotensive

36
Q

In the diagnosis of uterine atony, palpation will reveal a ___ uterus.

A

Boggy

37
Q

In the management of uterine atony, a 4 inch gauze layer back and forth from one cornu to the other using a sponge stick is known as?

A

Uterine packing

38
Q

If patient has stable vitals and persistent bleeding they may be a candidate for use of what interventional radiology in the management of uterine atony?

A

Arterial embolization

39
Q

Surgery in the management of uterine atony is the last resort and if patient desires future fertility the surgeon may try to?

If they are unstable then they must proceed with?

A

1) Ligate uterine arteries

2) Total abdominal hysterectomy

40
Q

What is the second most common cause of postpartum hemorrhage?

A

Trauma during delivery

41
Q

About 50% of patients with secondary postpartum hemorrhages have __1__.

Bleeding is secondary to inability of uterus to maintain a __2__ and involute normally around the placental tissue mass.

A

1) Retained placental fragments

2) Contraction

42
Q

Previous c-section, leiomyomas, prior D&C, and accessory (succenturiate) placenta lobe are all risk factors for?

A

Retained placenta

43
Q

What is characterized by the top of the fundus descending into the vagina and sometimes through the cervix?

If this occurs before placenta is delivered DO NOT remove placenta until?

A

1) Uterine inversion

2) Inversion is corrected

44
Q

What cause of postpartum hemorrhage is thought to be caused by infusion of amniotic fluid into maternal circulation and is characterized by respiratory distress, cyanosis, and cardiovascular collapse?

A

Amniotic fluid embolism

45
Q

What inherited coagulopathy with prolonged bleeding times can cause postpartum hemorrhage?

It is due to what deficiency?

A

1) von Willebrand’s disease

2) Factor VIII

46
Q

What coagulation disorder is a cause of postpartum hemorrhage and is characterized by platelets functioning abnormally and have a shorter life span?

A

Idiopathic thrombocytopenia

47
Q

Circulating antiplatelet antibodies of the ____ type can occasionally cross placenta resulting in fetal and neonatal thrombocytopenia.

A

IgG

48
Q

Fresh frozen plasma and Cryoprecipitate can increase ____ by 10 mg/dl.

Cryoprecipitate can be used to treat?

A

1) Fibrinogen

2) von Willebrand’s disease

49
Q

__1__ is characterized by women developing a febrile morbidity following delivery.

Most of the fevers are due to __2__.

A

1) Puerperal sepsis

2) Endometritis

50
Q

In the etiology of puerperal sepsis, after deliver the pH of the vagina becomes more ____.

A

Alkaline

51
Q

____ organisms cause about 70% of puerperal infections.

Most are cocci such as?

A

1) Anaerobic

2) Peptostreptococcus, Peptococcus, and Streptococcus

52
Q

What aerobic infection is the most common cause of puerperal sepsis?

A

E. coli

53
Q

Postpartum fever and increasing uterine tenderness on postpartum day 2 to 3 are the key clinical findings for?

A

Puerperal sepsis

54
Q

What broad-spectrum antibiotic regimens are effective first line drugs for the management of puerperal sepsis?

The major pathogen that is resistant to this combination is?

This pathogen is usually sensitive to?

A

1) Ampicillin and Gentamicin
2) Bacteroides fragilis
3) Clindamycin

55
Q

Fever and abdominal pain within 1 week after delivery or surgery along with patient appearing clinically ill (fever, abdominal pain, localized to the side of the affected vein) is diagnostic of which septic pelvic thrombophlebitis?

A

Ovarian vein thrombophlebitis

56
Q

Unlocalized fever in the first few days after delivery that is non responsive to antibiotics and the patient does not appear clinically ill is diagnostic of which septic pelvic thrombophlebitis?

A

Deep Septic Pelvic Vein Thrombophlebitis

57
Q

Because anticoagulation is thought to prevent further thrombosis, what should be given to treat septic pelvic thrombophlebitis?

A

Unfractionated Heparin or low molecular weight heparin

58
Q

Which septic pelvic thrombophlebitis may be seen radiographically?

A

Ovarian vein thrombophlebitis

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