Third Tri & PP Bleeding Flashcards
Complete or total previa
Placenta completely covers the os
Partial previa
placenta partially covers the internal os
Marginal previa
Edge of placenta extends to margin of internal os
Low lying placenta
Placenta lies in lower uterine segment, but does not extend to cervical os
Won’t attach to endometrial lining that is scarred
Placenta abruptio
Premature separation of the normally implanted placenta from it’s attachment to uterus
Uterine rupture
Complete separation of uterine musculature through all it’s layers
Postpartum hemorrhage
Blood loss in excess of 500 mL for vaginal and 1000mL for c-section
Placenta accreta
Placenta directly attached to myometrial wall
Absence of decidua basalis
Placenta increta
Placenta invades myometrium
Placenta percreta
Placenta penetrates myometrium to serosa or beyond
Hemodynamic changes in preggers
Maternal blood vol increases (40%) Plasma vol increased Erythrocyte vol increased 2,3 DPG increased Maternal blood pressure decreased HR, SV, CO, increased Systemic vascular resistance decreased
Top three most frequent causes of maternal death in US
Embolism
HTN Disease
Obstetrical hemorrhage
Common causes of antepartum bleeding
Placenta previa
Placenta abruptio
In antepartum hemorrhage, do not check the cervix unless what has been ruled out?
Placenta previa
Most accurate means of determining cause of antepartum bleeding
Ultrasound
Picks up all previas, misses 50% of abruptions
Preterm premature rupture of membranes (PPROM)
Water breaks before 37 weeks
Premature rupture of membranes (PROM)
Water breaks but no contractions yet
Dx of placenta previa
Classic presentation is painless, bright red bleeding
What should you never forget if the mother is Rh neg?
RHOGAM
Kleihauer Betke
Gives percentage of fetal blood to know how much rhogam to give
Risk factors for placenta abruptio
Maternal HTN COcaine abuse, especially crack Trauma Smoking Polyhydraminos and multiple gestation Previous abruption
What is the most common cause of DIC in preggers?
Placenta abruptio
MOA of placenta abruptio
Hemorrhage into decidua basalis with formation of hematoma
Separation of decidua from basal plate perpetuates itself and causes further separation as well as compression and destruction of tissue
Couvelaire Uterus
Blueish purple discoloration to uterus caused by blood dissecting into myometrium
Dx of placenta abruptio
Hallmark is painful vaginal bleeding in association with uterine tenderness, hyperactivity, and increased tone
Blood is usually dark red
US not useful
Uterus is firm, like a contraction that’s not going away
Management of placenta abruptio
Stabilize mother
Uterine rupture
Complete separation of uterine musculature through all of it’s layers
Fetus usually extruded in abdomen
Dx of uterine rupture
Sudden onset of intense abdominal pain and vaginal bleeding
Management of uterine rupture
Immediate laparotomy
Usually TAH is performed (TOC)
Postpartum hemorrhage
Uterus fails to contract around myometrial spiral arterioles and decidual veins at attachment site after placental separation
1 cause of postpartum hemorrhage
Uterine atony - won’t contract down; floppy, soft, and can have massive bleeding
Management of postpartum hemorrhage
IV Pitocin
Second most common cause of postpartum hemorrhage
Genital tract trauma
Retained placenta
Fragments/pieces of placenta that did not come out
Accreta, increta, and percretas
Dx - exploration
Tx - manual removal or D&C
Uterine inversion
Turning inside out of uterus
Usually iatrogenic
Pt can go into profound vasovagal shock
IT’S IN YO FACE, BITCH
Management of uterine inversion
Immediate IV vol. expansion
Halothane anesthesia or terbutaline to relax uterus
Replace with fist and give immediate pitocin
Possible surgical suspension
Which coagulation disorder has an 80% mortality DIC?
Amniotic fluid embolism
