Obstetric Hemorrhage (Moulton) Flashcards
In the initial evaluation of antepartum hemorrhage, you want to type and crossmatch for ___ units of blood.
4
What will One unit (250-300cc) of PRBC raise by 3% and by 1g/dL
1) Hct by 3%
2) Hgb by 1g/dL
In the initial evaluation of antepartum hemorrhage, you want to avoid digital exam until ____ has been ruled out by US.
Placenta previa
In the initial evaluation of antepartum hemorrhage, a sterile speculum exam is used to look for?
A digital exam is used to assess?
1) Genital lacerations or cervical lesions (cancer, polyps)
2) Cervical dilation
Vaginal bleeding with these issues occurs when?
- Abortions
- Ectopics
- Cervical/vaginal etiology (cancer, trauma, polyps),
- Subchorionic hemorrhage/retroplacental clot
- Cervical insufficiency
Before 20 weeks
1) Vaginal bleeding with what part of genital tract do these issues occur?
- Placental Abruption
- Placenta Previa
- Uterine rupture
- Vasa previa
2) They result in vaginal bleeding when?
1) Upper genital tract
2) After 20 weeks
1) Vaginal bleeding with what part of genital tract do these issues occur?
- Cervical polyps
- infections, trauma
- cancer
- vulvar varicosities
- blood dyscrasia
2) They result in vaginal bleeding when?
1) Lower genital tract
2) After 20 weeks (antepartum hemorrhage)
1) Placenta previa is defined as the implantation of the placenta over the?
2) 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) C-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
1) 90% of placenta previa will resolve by what?
2) What is diagnosis of Placenta previa through?
Placental migration
2) US
1) What is characterized by abnormal firm attachment to the superficial lining of the myometrium.
2) What is characterized by invasion into myometrium.
3) What 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)
What is defined as premature separation of the normally implanted placenta?
Placental abruption
Placental abruption is the most common cause of which 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 (causing thrombin to be released)
Placental abruption can result in what kind of uterus?
2) This is caused by extravasation of blood into the uterus causing what to occur to the serosa?
1) Couvelaire Uterus
2) Red and purple discoloration
1) What implies complete separation of the uterine musculature through all of its layers?
2) What is the most common risk factor?
1) Uterine rupture
2) 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
Rupture of fetal vessel
1) What trimester bleeding?
2) What causes this?
1) Third
2) Velamentous insertion of Umbilical cord
Velamentous insertion of umbilical cord is characterized by the cord not inserting into the placenta and instead the vessels move between chorion and amnion without the protective what?
If unprotected vessels pass over the cervical os it is termed a __2__.
1) Wharton’s jelly
2) Vasa previa
1) Primary Postpartum Hemorrhages is when?
2) Secondary Postpartum Hemorrhage is when?
1) First 24 hours
2) 24 hours to 12 weeks
Treatments
1) Retained Placenta
2) Uterine Inversion
3) Uterine Atony
1) Manual Removal
2) Manual Replace uterus
3) B
The excessive blood loss seen with uterine atony most commonly results when the uterus ____ after delivery of placenta
What can be done to manage the uterine atony?
What confirms diagnosis of Uterine Atony with palpation?
1) Fails to contract
2) Bimanual massage of uterus
3) Boggy Uterus
What is commonly given prophylactically after delivery of the infant or placenta in the management of uterine atony?
Oxytocin (Pitocin)
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?
Uterine packing
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?
Arterial embolization
Surgery in the management of uterine atony is the last resort and if patient desires future fertility the surgeon may try to?
If it is unstable then they must proceed with?
1) Ligate uterine arteries
2) Total abdominal hysterectomy
Uterine Atony Treatments
1) Bimanual massage
2) Interventional Radiology
3) Oxytocin
4) Uterine Packing
5) Surgery
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?
1) Uterine inversion
2) Inversion is corrected
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?
Amniotic fluid embolism
What inherited coagulopathy with prolonged bleeding times can cause postpartum hemorrhage?
It is due to what deficiency?
1) von Willebrand’s disease
2) Factor VIII
What coagulation disorder is a cause of postpartum hemorrhage and is characterized by platelets functioning abnormally and have a shorter life span?
Idiopathic thrombocytopenia
Circulating antiplatelet antibodies of the ____ type can occasionally cross placenta resulting in fetal and neonatal thrombocytopenia.
IgG
1) Fresh frozen plasma and Cryoprecipitate can increase what by 10 mg/dl.
2) Cryoprecipitate can be used to treat?
1) Fibrinogen
2) von Willebrand’s disease
What is characterized by women developing a febrile morbidity following delivery.
Most of the fevers are due to what?
1) Puerperal sepsis
2) Endometritis
In the etiology of puerperal sepsis, after deliver the pH of the vagina becomes more what?
Alkaline
What kind of organisms mostly cause puerperal infections.
1) Anaerobic cocci
What aerobic infection is the most common cause of puerperal sepsis?
E. coli
Postpartum fever and increasing uterine tenderness on postpartum day 2 to 3 are the key clinical findings for what?
Puerperal sepsis
What broad-spectrum antibiotic regimens are effective first line drugs for the management of puerperal sepsis?
Ampicillin and Gentamicin (AG)
Ovarian Vein Thrombophlebitis Characteristics?
1) Appear How
2) Seen where?
3) What kind of Pain?
1) Clinically ill
2) Seen radiographically
3) Abdominal pain
Deep Septic Pelvic Vein Thrombophlebitis? Characteristics
1) What kind of fever?
2) What is it not?
3) Seen where?
1) Unlocalized
2) NOT clinically ill
3) Nowhere
Septic Pelvic Thrombophlebitis Treatment?
Heparin
