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)