Post partum hemorrhage, twins, cervical incompetence

Question 1

Define postpartum hemorrhage

Answer 1

Loss of 500+ cc during vaginal birth, 1000+ cc during C section
MCC is uterine atony (uterus does not contract hard enough to shrink= blood vessels stay open and keep bleeding)
can also occur 2/2 lacerations, uterine rupture, or coagulopathy

Question 2

How does postpartum hemorrhage present

Answer 2

weakness 
palpitations
confusion
SOB
syncope
-Tachycardia, Oliguria, low O2 sat, hypotension

Question 3

How do you treat postpartum hemorrhage

Answer 3

uterine massage
IV hydration to raise BP 
Oxytocin, misoprostol, methergine (contract uterus) 
blood transfusion 
surgery (D&C) if nothing else works

Question 4

MC twins are

Answer 4

Dizygotic (fraternal)

Question 5

The following factors increase chance for multiple gestation

Answer 5

fertility Tx 
AMA
Increasing parity 
FHx (from mom OR dad) 
Obese (BMI >30) 
Height (>5'4")

Question 6

How is a Dizygotic twin formed

Answer 6

Ovulation and fertilization of TWO oocytes

Dichorionic, Diamniotic

Question 7

How is a monozygotic twin formed

Answer 7

Ovulation and fertilization of ONE oocyte, but timind of egg division determines placenta
Monochorionic/Monoamniotic
OR
Monochorionic/Diamniotic

Question 8

How do you diagnose multiple gestation

Answer 8

US (definitive Dx!) best if in first trimester, >7 weeks (7-12 wks)
can’t ever use other methods to est. gestational age (like tape measure)
US is best for chorionicity and amniocity

Question 9

What signs on US tell you the type of twins you are having

Answer 9

Lamda sign: Dichorionic twins

T sign: Monochorionic twins

Question 10

Complications associate with multiple gestation include

Answer 10

preterm delivery (most delivered <37 weeks) 
Low birth weight 
gestational diabetes 
pregnancy induced HTN 
Pre-eclampsia 
postpartum hemorrhage 
higher C-section rate

Question 11

What is the most serious complication in multiple gestation

Answer 11

Twin Twin transfusion syndrome, only with MONOchorionic gestation
fetuses share one placenta and blood supply is not evenly distributed
One fetus demonstrates small size and amount of amniotic fluid

Question 12

What is cervical incompetence

Answer 12

cervical shortening, leading to preterm spontaneous delivery

Question 13

How do you diagnose cervical incompetence

Answer 13

US assessment of length in 2nd trimester (when baby becomes heavy enough to put pressure on the cervix)

Question 14

What can cause cervical incompetence

Answer 14

LEEP procedure!! from an abnormal PAP

Question 15

How do you manage cervical incompetence

Answer 15

Place a cervical cerclage (suture cervix shut until 37 weeks)
Remove at 37 weeks, or when membranes rupture