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obstetric - gynecol STEP 2 > placenta > Flashcards

placenta Flashcards

1
Q

Placenta abruption - definition? result?

A

premature seperation of the placenta from the uterus

–> tearing of the placental blood vessels and hemorrhaging into the separated space

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2
Q

Placenta abruption - this can occur … (when)

A

before / during / after labor

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3
Q

Placenta abruption - complications

A
  • if large separation with life threatening bleeding –> premature delivery, uterine tetany, DIC, hypovolemic shock (and sheehan syndrome), fetal distress (death or hypoxia)
  • small separation –> no clinical signs and symptoms
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4
Q

Placenta abruption - etiology and precipitating factors

A

unknown etiology. Factors:

  1. maternal hypertension (chronic, preeclampsia, eclampsia) 2. Prior placental abruption 3. cocaine
  2. external trauma 5. smoking during pregnancy
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5
Q

Placenta abruption - diagnostic test

A

Clinically

U/S (not required) to distinguish from previa

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6
Q

types of placental abruption

A
  1. concealed –> blood within uterine cavity (+ SERIOUS COMPLICATIONS)
  2. external –> blood drains through cervix
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7
Q

Placenta abruption - indications for cesarean delivery

A
  1. uncontrollable maternal hemorrhage
  2. rapidly expanding concealed hemorrhage
  3. fetal distress
  4. rapid placental separation
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8
Q

placental abruption - vaginal delivery indications

A
  1. placental separation is limited
  2. fetal heart tracing is assuring
  3. separation is extensive and fetus is dead
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9
Q

placenta abruption - clinical presentation

A 
sudden onset vaginal blededing (80%)
abd or back pain
high frequency, low intensity contractions
hypertonic, DISTENDED, tender uterus
fetal HR abnormalities
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10
Q

Placenta previa - definition

A

abnormal implantation of the placenta over the internal cerival os (3rd TRIMESTER) –> the cause of 20% of all prenatal hemorrhages

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11
Q

Risk factors for placenta previa

A
  1. previous cesarean deliveries
  2. previous uterine surgery
  3. multiple gestations
  4. previous placenta previa
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12
Q

pregnant woman in third trimester present with vaginal bleeding - next step?

A

transbdominal US

no digital vaginal exam before –> it may lead to separation between placenta + uterus resulting in severe hemorrhage

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13
Q

placenta previa presentation

A

painless vaginal bleeding after 20 weeks

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14
Q

placenta previa - diagnostic tests

A

tranabdominal followed by transvaginal sonogram

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15
Q

placenta previa - types

A

US identifies the types:

  1. complete: complete covering the internal cervix os
  2. partial: partial covering
  3. marginal: often touching the os
  4. vasa previa: fetal vessel over the os
  5. low lying: implanted in the lower segment of the uterus but NOT covering (more than o cm but less than 2 away
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16
Q

low lying placenta?

A

placenta that is implanted in the lower segment of the uterus but NOT covering the internal cervical os (more than o cm but less than 2 away)

17
Q

placenta previa - treatment / magement

A
  • treatment is done when there is large bleeding or drop of Hct. (consists of strict pelvic rest + nothing + intercourse).
  • There are several indications for immediate cesarean delivering
  • prepare for life threatening bleeding (type + screen blood, CBC, PT)
  • if preterm –> prepared with betamethasone
  • c- section at 36-37 wks
18
Q

indications for immediate cesarean delivering in placenta previa

A
  1. Unstoppable labor (cervix dilated more than 4 cm)
  2. severe hemorrhage
  3. fetal distress
19
Q

Placenta abruption vs previa (according to diagnosis)

A

previa –> painless vaginal bleeding

abruption –> painful vaginal bleeding

20
Q

vasa previa - mechanism

A

fetal vessels transverse the internal cervical os and are vulnerable to injury during amniotomy

21
Q

vasa previa - presentation

A

painless vaginal bleeding and feta HR abnormalities AFTER amniotomy

22
Q

Vasa previa - management

A

emergency C-section

23
Q

Vasa previa is frequently associated with

A

velamentous umbilical insertion

24
Q

velamentous umbilical insertion?

A

cord inserts in chorioamniotic membrane rather than placenta –> fetal vessels travel to placenta unprotected by Wharton jelly

25
Q

placenta invasion - types

A

abn adheres to the superficial uterine wallincreta attaches to myometriumpercreta_ invades into uterine serosa, bladder wall, or rectal wall

26
Q

placenta invasion - presentation / treatment

A

patients are usually asymptomatic, unless invasion into the bladder or rectum results in hematuria or rectal bleeding . Haemorrhage and shock if placenta cannot detach after delivery –> often hysterectomy

obstetric - gynecol STEP 2 (22 decks)

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