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LMCC Study - OBGYN > Obstetrical hemorrhage > Flashcards

Obstetrical hemorrhage Flashcards

1
Q

With antepartum vaginal bleeding you should never do a vaginal exam until you first rule out this condition.
How do you rule it out?

A
  • Placenta Previa

- Rule out by transvaginal ultrasound

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2
Q

What is a threatened miscarriage?

A
  • Vaginal bleeding associated with intrauterine pregnancy up to 24 weeks gestation
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3
Q

What is antepartum hemorrhage?

A
  • Vaginal bleeding associated with intrauterine pregnancy from 24 weeks gestation until the onset of labour
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4
Q

What is intrapartum hemorrhage?

A
  • Vaginal bleeding associated with intrauterine pregnancy from onset of labour until the end of the second stage of labour
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5
Q

What is postpartum hemorrhage?

A
  • Vaginal bleeding associated with intrauterine pregnancy from the third stage of labour until the end of puerperium (6 wks after delivery)
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6
Q

What is placenta accreta?

A
  • The placenta invade the myometrium and cannot be readily separated from the uterus following delivery
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7
Q

If the placenta covers part of or all of the cervical os is this minor or major placenta previa?

A

Major

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8
Q

What is a placental abruption?

A

retroplacental hemorrhage (between placenta and uterus)

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9
Q

What frequently co-occurs with placental abruption?

A

Placental separation (minor degree of)

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10
Q

Bleeding from placenta previa is it typically painful or painless?

A

Painless

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11
Q

What is vasa previa?

A

Babies blood vessels run over or near the cervical os putting them at risk of rupture

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12
Q

What is a primary post partum hemorrhage?

A
  • Blood loss of 500mL or more within 24 hours of delivery
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13
Q

What is a secondary post partum hemorrhage?

A
  • Any significant blood loss between 24 hours and 6 weeks after birth.
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14
Q

What is the most common cause of vaginal bleeding in the third trimester?

A
  • Bloody show

> the shedding of the cervical mucous plug

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15
Q

What is the definition of an antepartum hemorrhage?

A
  • Vaginal bleeding from 20 weeks until term
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16
Q

What are the risk factors for placenta privia?

A
  • History of previous (4-8% recur)
  • Multiparity
  • Multiple gestation
  • Increased maternal age
  • Uterine tumour or anomalies (fibroids)
  • Uterine scarring (c/s, d&c..)
17
Q

What are the risk factors for abrupto placentae?

A
  • Previous abruption (5-16% recur)
  • Maternal HTN or vascular disease
  • Smoking, EtOH, COCAINE
  • Multiparity, increased age
  • Maternal trauma
  • Uterine tumour (Fibroid) or anomalies
18
Q

What is placenta increta?

A

Placenta invades INto the myometrium

19
Q

What is placenta percreta?

A

Placenta passes THROUGH the myometrium

20
Q

When differentiating between placenta privia and placental abruption, shock/anemia that is out of proportion to the apparent blood loss would suggest which cause?

A
  • Placental abruption
  • 20% are internal or conceiled and the blood dissects upward
  • Most cases are a mixed type where some blood dissects towards cervix and some towards fetus
21
Q

How is placental abruption diagnosed?

A
  • Clinical diagnosis

- U/S is not a sensitive test for it (15%)

22
Q

How do you manage a placenta previa under 37 weeks? after stable

A
  • Rhogam if Rh neg
  • Admit
  • limit activity, nothing into the vagina
  • Corticosteroids for fetal lung development
  • L/S ratio to assess fetal lung development (>2:1 can deliver)
  • Deliver when mature or when hemorrhage dictates
23
Q

How do you manage a placental abruption under 37 weeks? after stable

A
  • Rhogam if Rh neg
  • Serial Hct to assess for concealed bleeding
  • Deliver when fetus mature of when hemorrhage dictates
24
Q

You are trying to differentiate between placenta previa and vasa priva. The baby is in distress, which diagnosis does this steer you toward?

A

Vasa privia

  • In placenta privia the baby is usually ok, in distress with vasa
  • 50% perinatal mortality with vasa privia, increases to 75% if membranes rupture (most die from exangination)
25
Q

What is the apt test? How do you interpret the results?

A
  • Alkali denaturation test
  • Uses NaOH to differentiate maternal blood from fetal blood
  • Fetal hemoglobin is resistant to alkali denaturation and appears pink, maternal is not and appears yellow
26
Q

How do you manage vasa privia?

A
  • Emergency C-section

- The bleeding is from the fetus who has a small blood volume so small loss can result in death

LMCC Study - OBGYN (21 decks)

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