Obstetric Hemorrhage (Moulton) Flashcards
In the initial evaluation of antepartum hemorrhage, you want to avoid digital exam until ____ has been ruled out by US.
Placenta previa
Abortions, ectopics, cervical/vaginal etiology (cancer, trauma, polyps), subchorionic hemorrhage/retroplacental clot, and cervical insufficiency can all present with vaginal bleeding at what time?
Before 20 weeks
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?
1) Upper genital tract
2) After 20 weeks
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?
1) Lower genital tract
2) After 20 weeks
What is the most common type of abnormal placentation and accounts for about 20% of all cases of antepartum hemorrhages?
Placenta previa
Placenta previa is defined as the implantation of the placenta over the?
It presents classically as?
1) Cervical os
2) Painless vaginal bleeding
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?
1) 35 y/o
2) Multiparity
3) Cocaine and smoking
4) Cesarean section
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.
1) Marginal
2) Partial
3) Complete
With placenta previa the mean gestational age bleeding that occurs is at ___ weeks.
30 weeks
90% of placenta previa will resolve by 32-35 weeks by a phenomenon known as ____.
Placental migration
__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?
1) Placenta accreta (Most common)
2) Placenta increta
2) Placenta percreta (Least common)
Previous cesarean section and placenta previa increases the incidence of?
Placenta accreta
What is defined as premature separation of the normally implanted placenta?
Placental abruption
Placental abruption is the most common cause of __1__ trimester bleeding.
It classically presents as __2__ bleeding.
1) Third
2) Painful
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?
1) Maternal HTN
2) Cocaine use
3) Physical trauma (MVA and physical abuse)
4) Polyhydramnios
5) Multiparity
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?
1) Placenta previa
2) Placental abruption
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.
1) DIC
2) Thromboplastin
Placental abruption can result in couvelaire uterus which is characterized by extravasation of blood into the uterus causing ____ of the serosa.
Red and purple discoloration
What implies complete separation of the uterine musculature through all of its layers?
Uterine rupture
What is the most common risk factor for uterine rupture?
Prior uterine incision such as from C-section or myomectomy
Uterine rupture is associated with sudden onset of ___ along with +/- vaginal bleeding.
Intense abdominal pain
What must be done for future pregnancies due to previous uterine rupture?
Deliver via C-section
What is a rare but important cause of third trimester bleeding?
It is often secondary to velamentous insertion of?
1) Rupture of fetal vessel
2) Umbilical cord
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__.
1) Wharton’s jelly
2) Vasa previa
