PPH

Question 1

can an ultrasound detect an abruption?

Answer 1

NO

Question 2

In the third trimester, much of the uterine growth takes place

Answer 2

in the lower uterine segment

Question 3

placenta acreta

Answer 3

penetration of placental tissue to the myometrium

Question 4

Placenta increta

Answer 4

penetration INTO the myometrium

Question 5

placenta Precreta

Answer 5

THROUGH the myometirum into bladder

Question 6

previous uterine surgery + placenta previa =

Answer 6

Placenta acreta until proven otherwise

Question 7

Sentinel bleed is

Answer 7

a third trimester bleed in a patient with previa that stops spontaneously

Question 8

Never examine a patient with a viable pregnancy presenting with vaginal bleeding until

Answer 8

PLacenta previa is ruled out

Question 9

Low-lying placentaq

Answer 9

within 2 cm of cervical oS

Question 10

vasa previa diagnosis is made by

Answer 10

Ultrasound

Question 11

non fatal effects of PPH

Answer 11

anemia
injury to pituitary
transfusion
coagulopathy
organ damage

Question 12

Primary PPH

Answer 12

excessive bleeding in first 24 hours after delivery

Question 13

Primary PPH - blood loss amounts

Answer 13

500mL of blood loss of vag delivery

1000 mL of blood loss after C-section

Question 14

Secondary PPH

Answer 14

bleeding from 24hrs to 6 weeks post partum

Question 15

Causes of PPH

Answer 15

Tone - uterine atony
Tissue - retained placenta/abnormal placenta/retained clot
Trauma - lacerations
Thrombin - coagulopathy/ ITP/HELLP/DIC

Question 16

Tone - normal vasculature diameter can

Answer 16

double by 20 weeks in pregnancy

Question 17

Uterine blood flow is ?% of cardiac output

Answer 17

20% !! LARGE

Question 18

Blood volumes increase by? % in pregnancy

Answer 18

45%

Question 19

Placenta normally delivers within

Answer 19

30 minutes of delivery

Question 20

4 signs of placental separation (Tissue)

Answer 20

1. Gush of blood
2. Cord lengthens
3. Uterus globular
4. Uterus rises in abdo

Question 21

Active management of PPH in 3rd stage of labor

Answer 21

1. Propylactic oxytocin before or after delivery MOST IMPORTANT PART
2. controlled traction on the cord

Question 22

Most common cause of PPH

Answer 22

Atony

Question 23

early shock might manifest as

Answer 23

tachycardia

orthostatic hypotension

Question 24

Single MOST important and effective intervention with PPH

Answer 24

Bimanual massage - unless a laceration of easily removed retained placenta

Question 25

Medical management of PPH

Answer 25

• oxytocin infusion
• ergonavine (C/I in pre-eclampsia and hTN)
• Hemabate (PG)
• Misoprostol (increase uterine contracility) - PR or sublingual

Question 26

Clotting aids for PPH

Answer 26

• tranexamic acid - antifibrinolytic - stabilize clots

- recombinant activated factor 7 = rarely used

Question 27

Mechanical compression PPH

Answer 27

• bimanual massage
  transabdominal compression of aorta
  bakri balloon