Obstetrical Antepartum Hemorrhage Flashcards
What is placental abruption?
Partial or complete separation of the placenta from the uterus before delivery of the fetus
What pre-existing conditions can lead to obstetrical antepartum hemorrhage?
Chronic HTN Pregnancy induced HTN Pre-eclampsia Cocaine use Smoking Advanced age
Presentation of placental abruption:
vaginal bleeding of dark, clotted blood
uterine tenderness
fetal bradycardia
Associated complications with placental abruption:
Risk of DIC
Fetal demise secondary to hypoxia
Hemorrhage and shock
What’s your plan of mgmt for placental abruption?
Large bore IV access Baseline blood samples (crit, cogs, type and cross) Fetal heart rate monitoring supplemental oxygen foley catheter left uterine displacement deliver fetus and placenta Correct vlood volume and coags with blood components (FFP, Cryo, platelets, PRBCs)
Can you do NA in placental abruption patients?
What are you going to do in the OR?
Yes. As long as coags are good and they are heodynamically staable
IV ketamine 1 mg/kg for induction or etomidate (pt likely hypovolemic)
A line/ CvP if needed -prop would do a line-no cvp unless bad
What is placenta previa?
Placenta is either overlying or enchroaching on cervical os. Painless, bright red bleeding.
Who is at increased risk for placenta previa?
Increased risk for placenta previa:
- multiparous women
- Previous C section
- Advanced maternal age
- previous uterine surgery or previous placenta previa
My homegirL PREVIA had a PREVIOUS C SECTION. She OLD, GOT 3 KIDS, and one is named PREVIA
Mgmt of placenta previa
Also in OR
Diagnosed by US Avoid vaginal exam Tocolysis: -Mag sulfate -terbutaline Blood transfusions as needed
Send labs
large bore access
2 Units PRBCs in OR
IF it goes to OR, regional is recommended unless contraindicated, but if pt is hemodynamically ustable, general anesthesia should be considered.
How can anesthesia be maintained in the preggos?
50% nitrous oxide, 50% oxygen, and a low concentration of volatile anesthetic. IN pts with fetal distress, avoid nitrous.
What is uterine rupture?
Complete non surgical disruption of all uterine layers in a gravid uterus-resulting in fetal distress and/or maternal hemorrhage
What puts people at risk for uterine rupture?
previous c sections (more sections=more risk)
VBAC. Of note, patients with a prior classical cesarean section should NOT be offered a VBAC
Trauma
Advanced maternal age
multiparity
How will you know if someone has uterine rupture?
Maternal hypotension, constant abdominal pain, change in uterine shape
Anesthesia for uterine rupture
if hemodynamically stable, can use the epidural ALREADY IN PLACE (if not already in place, do GA) And even if already in place, explain to the pt that it is likely she will still need GA. Actually after wasting time typing all of this, i have decided that i will just do GA
What is vasa previa?
Some of fetal umbilical cord blood vessels run across or very close to cervical os. The bleeding is fetal
Mother shouldn’t get hypotensive
