Obstetric Hemorrhage (Moulton)

Question 1

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

Answer 1

Placenta previa

Question 2

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

Answer 2

Before 20 weeks

Question 3

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?

Answer 3

1) Upper genital tract

2) After 20 weeks

Question 4

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?

Answer 4

1) Lower genital tract

2) After 20 weeks

Question 5

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

Answer 5

Placenta previa

Question 6

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

It presents classically as?

Answer 6

1) Cervical os

2) Painless vaginal bleeding

Question 7

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?

Answer 7

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

Question 8

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.

Answer 8

1) Marginal
2) Partial
3) Complete

Question 9

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

Answer 9

30 weeks

Question 10

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

Answer 10

Placental migration

Question 11

__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?

Answer 11

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

Question 12

Previous cesarean section and placenta previa increases the incidence of?

Answer 12

Placenta accreta

Question 13

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

Answer 13

Placental abruption

Question 14

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

It classically presents as __2__ bleeding.

Answer 14

1) Third

2) Painful

Question 15

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?

Answer 15

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

Question 16

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?

Answer 16

1) Placenta previa

2) Placental abruption

Question 17

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.

Answer 17

1) DIC

2) Thromboplastin

Question 18

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

Answer 18

Red and purple discoloration

Question 19

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

Answer 19

Uterine rupture

Question 20

What is the most common risk factor for uterine rupture?

Answer 20

Prior uterine incision such as from C-section or myomectomy

Question 21

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

Answer 21

Intense abdominal pain

Question 22

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

Answer 22

Deliver via C-section

Question 23

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

It is often secondary to velamentous insertion of?

Answer 23

1) Rupture of fetal vessel

2) Umbilical cord

Question 24

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__.

Answer 24

1) Wharton’s jelly

2) Vasa previa

Question 25

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?

Answer 25

Ovarian vein thrombophlebitis

Question 26

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?

Answer 26

Deep Septic Pelvic Vein Thrombophlebitis

Question 27

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

Answer 27

Unfractionated Heparin or low molecular weight heparin

Question 28

Which septic pelvic thrombophlebitis may be seen radiographically?

Answer 28

Ovarian vein thrombophlebitis