Placental problems Witrak

Question 1

What is placenta previa?

Answer 1

Presence of placental tissue over or just proximal (< 2cm) to the internal cervical os

Question 2

When is placental previa suspected?

Answer 2

Painless vaginal bleeding in a women > 20wks gestation

75% of cases

Question 3

Painless bleeding is the symptom in 75% of placental previa cases, what makes up the remaining 25%?

Answer 3

Vaginal bleeding + uterine contractions → simulates abruption (15%)

Reach term w/o bleeding (10%)

Question 4

How is placental previa diagnosed?

Answer 4

Transvaginal ultrasound

Question 5

What are the risk factors for placental previa?

Answer 5

Prior history of previa
Prior C-section
Multiple gestation pregnancy

Question 6

What is placental previa associated with?

Answer 6

Placenta accrete (in proportion to number of C-sections)
Amniotic fluid embolism

Question 7

When is placental previa treated? How?

Answer 7

Treated for severe hemorrhage by doing a C-section

Question 8

What is placental abruption?

Answer 8

Bleeding at the decidual/placental interface d/t partial or complete detachment

Question 9

How does placental abruption present?

Answer 9

Vaginal bleeding
Abdominal pain
Uterine contractions
Maybe abnormal fetal heart tone pattern

Question 10

How is placental abruption diagnosed?

Answer 10

Ultrasound…suboptimal sensitivity

Question 11

What are some risk factors/associations of placental abruption?

Answer 11

Trauma (small%)
Uterine anomalies
Smoking/cocaine use
Chronic uteroplacental hypoperfusion
Sever preeclampsia/HTN

Question 12

What is the pathology of placental abruption?

Answer 12

Retroplacental hematoma

Focal infarction

Question 13

What is it called when the placenta is morbidly adherent/stuck?

Answer 13

Placenta accrete

Question 14

What causes placenta accrete?

Answer 14

Defective/thin decidua layer at implantation site

Question 15

There are three types of placenta accrete. Which is when the villi are stuck to superficial myometrium (hardly penetrates)?

Answer 15

Accreta (79%)

Question 16

There are three types of placenta accrete. Which is when the villi penetrate INto the myometrium?

Answer 16

INcreta (14%)…like INto

Question 17

There are three types of placenta accrete. Which is when the villi PEnetrate through the myometrium?

Answer 17

PErcreta (7%)…like PEnetrate

Question 18

With which surgical procedure is there a huge correlation to placenta accrete?

Answer 18

C-sections

Question 19

How does placenta accrete present?

Answer 19

Severe hemorrhage when attempting manual placental separation

Question 20

How is placenta accrete diagnosed?

Answer 20

Ultrasound

Question 21

What is Post-Partum Hemorrhage (PPH)?

Answer 21

Sufficient hemorrhage to cause hypovolemic/hypoxic symptoms

Question 22

What causes PPH?

Answer 22

Uterine atony (80%)
Retained placenta
Overdistention/prolonged labor, drug effects, infection

Less commonly coagulation defects (DIC)

Question 23

How long PPH be delayed?

Answer 23

24hr–12wks

Question 24

What can trigger DIC in pregnancy?

Answer 24

Severe preeclampsia/abruption
Retained dead fetus (> 4wks)
Septic abortion
Amniotic fluid embolism
Acute fatty liver of pregnancy
Massive hemorrhage event (previa, accrete, uterine atony/rupture)

Question 25

How is DIC diagnosed?

Answer 25

Prolonged PT/PTT
Thrombocytopenia
Low fibrinogen
Increased d-dimer levels

Question 26

How is DIC treated?

Answer 26

1:1:1 massive transfusion protocol + cryoprecipitate as needed
Removal of inciting factor

Question 27

What does an unprovoked DVT or PE in pregnancy suggest?

Answer 27

Underlying inherited thrombotic disorder (>50%)