Third Trimester Bleeding

Question 1

If a patient presents with spotting or bleeding accompanied with contractions or cramping this could indicate

Answer 1

cervical dilation and labor

Question 2

two concerning reasons for bleeding in the 2nd and 3rd trimester

Answer 2

placenta previa

placental abruption

Question 3

complication of pregnancy which placenta lies over the cervix instead of along one of the uterine walls → diagnosed during routine ultrasound but can present with vaginal bleeding

Answer 3

placenta previa

Question 4

this occurs when placenta begins to separate from the wall of the uterus prematurely (prior to delivery) → may cause painful contractions

Answer 4

placental abruption

Question 5

the 3 main vessels of the placenta and what cushions them?

Answer 5

2 arteries and 1 vein

Wharton’s Jelly

Question 6

what does the placenta provide the fetus?

Answer 6

nutrients, water, oxygen

way to excrete waste

Question 7

How does placental weight compare to fetal weight?

Answer 7

approximately one seventh the fetal weight

Question 8

what is the mean amniotic fluid at term?

Answer 8

500 ml

Question 9

The placenta has immunological properties and produces what?

Answer 9

steroid hormones, estrogen, progesterone, growth factors, pituitary like hormones and proteins

Question 10

mechanisms that substances transverse the placental membrane

Answer 10

passive diffusion
facilitated diffusion
active transport
endocytosis and exocytosis

Question 11

what kind of substances readily diffuse through the trophoblastic membrane?

Answer 11

highly lipid soluble

Question 12

How are respiratory gases (oxygen and carbon dioxide) transported between maternal and fetal circulation?

Answer 12

partial pressure gradient between the 2

Question 13

glucose transfer from mother to fetus rates will ___ as maternal glucose concentration increases

Answer 13

decreases

Question 14

painful bleeding + rigid abdomen

Answer 14

abruptio placenta

Question 15

plainless bleeding

Answer 15

placenta previa

Question 16

Ddx for painless bleeding in 3rd trimester

Answer 16

placenta previa

vasa previa

Question 17

Ddx for painful bleeding in the 3rd trimester

Answer 17

placenta abruption
uterine rupture
labor

Question 18

causes of abruptio placenta

Answer 18

hypertension
cocaine use
trauma
multiparity

Question 19

Method used to diagnose abruptio placenta

Answer 19

pelvic ultrasound

Question 20

treatment for abruptio placenta

Answer 20

hospitalize for hemodynamic management → C-section

Question 21

complications of abruptio placenta

Answer 21

dessimated intravascular coagulation

Question 22

infarcts in the maternal surface of the placenta that occur when there is separation of the placenta from the uterus

Answer 22

placental infarcts

Question 23

premature aging of the placenta due to maternal complications, poor nutrition, smoking may cause what on the placenta?

Answer 23

calcifications

Question 24

implantation on or close to the cervical os either total or partial or marginal

Answer 24

placenta previa

Question 25

How do you differentiate partial or marginal placenta previa?

Answer 25

dilation of cervix and method of diagnosis

Question 26

leading cause of 3rd trimester bleeding

Answer 26

placenta previa

Question 27

encroachment of placenta on margins of the cervical os

Answer 27

marginal placenta previa

Question 28

risk factors for placenta previa

Answer 28

advanced maternal age, multiparity, smoker and cocaine use in pregnancy, male sex, hx of C-section, prior abortions and uterine surgery, hx of placenta previa

Question 29

90% of placenta previa found in 2nd trimster resolve by the 3rd → changes in architecture secondary to differential growth of lower uterine segment during 2nd and 3rd trimester may account for

Answer 29

placental migration

Question 30

this occurs when chorionic villi attach to the myometrium rather than limited to the decidua basalis

Answer 30

acreta

Question 31

this occurs when the chorionic villi invade the myometrium

Answer 31

increta

Question 32

this occurs when chorionic villi invade through the myometrium to the level of the serosa or beyond it

Answer 32

precreta

Question 33

rupture of fetal vessel that transverse the membranes in the lower uterine segment/cervical os → painless vaginal bleeding

Answer 33

vasa previa

Question 34

treatment for vasa previa

Answer 34

immediate C section

Question 35

umbilical cord inserts into the fetal memrabens (choriamniotic membranes) then travels within the membrane to the placenta (between the amnion and chorion) → exposed vessels lack Wharton's jelly and are vulnurable to rupture

Answer 35

velementous insertion

Question 36

not every pregnancy with velamentous cord insertion results in vasa previa, only those where …

Answer 36

blood vessels are near the cervix