UW abruptio placentae 02-18 (1)

Question 1

UW. table. definition?

Answer 1

placental detachment from the uterus before fetal delivery (premature detachment)

Question 2

UW. table. risk factors. 4

Answer 2

(Chronic) hypertension, preeclampsia
abdominal trauma (eg autoivykis)
prior abruptio placentae
cocaine and tabacco use

Question 3

UW. table. risk factors. CP?4

Answer 3

Sudden onset vaginal bleeding
abdominal or back pain
high frequency, low intensity contractions
rigid, tender uterus

OCCURS IN 3rd TRIMESTER (mehlman)

Question 4

UW. table. risk factors. Dx?2

Answer 4

Clinical
Ug: +/- retroplacental hematoma

Question 5

UW. table. risk factors. complications?2

Answer 5

fetal hypoxia, preterm labor, mortality
Maternal hemorrhage, DIC

Question 6

UW. what type of bleeding?

Answer 6

most have heavy bleeding, but can be minimal or no bleeding because blood is concealed within the intrauterine cavity.

Question 7

UW. type of pain? location?

Answer 7

focal pain (eg, back pain, suggesting posterior placental rupture),

Question 8

UW. uterus? measurements?

Answer 8

Abnormally distended uterus (eg, measuring 38 cm at 35 weeks gestation)

Question 9

UW. contractions?

Answer 9

high-frequency contractions due to increasing intrauterine pressure and volume.

Question 10

UW. As more of the placenta detaches, fetal hypoxia can occur, as evidenced by abnormalities on the fetal heart rate tracing (eg, late decelerations).

Answer 10

.

Question 11

UW. Common risk factor?

Answer 11

chronic hypertension

Question 12

UW. chronic hypertension.
regardless of well-controlled blood pressure, is associated with widespread endothelial dysfunction.

Answer 12

This dysfunction impairs normal development of the spiral arteries that supply blood to the fetus and placenta; the result is abnormally high-resistance spiral arteries that lead to low placental perfusion, ischemia, and possible infarction, all of which increase the risk of abruptio placentae.

Question 13

UW. In addition, chronic endothelial dysfunction (del HTN) increases vessel frailty and the risk of vessel rupture at the uteroplacental interface.
Other risk factors for abruptio placentae include tobacco or cocaine use (due to placental ischemia) and abdominal trauma.

Answer 13

.

Question 14

UW. Case: 30 weeks + motor vehicle => bleeding + BP 90/60, HR 126. fetal HR 140, no decelerations, contractions every 3 min.
IV fluids started. Next best step?

Answer 14

TRANSFUSE BLOOD PRODUCTS

abruptio placentae can cause hypovolemic shock from hemorrhage (ie, hemorrhagic shock).

Question 15

UW. motor vehicle. Hemorrhagic shock. Mx in general?

Answer 15

Rapid resuscitation with replacement of intravascular volume, transitioning from crystalloid to blood products as soon as possible

Question 16

UW. motor vehicle. Hemorrhagic shock management with fluid+ blood. What position change also included in Mx?

Answer 16

pregnant patients are placed in a left lateral decubitus position (if the spine is stable) to displace the uterus off the aortocaval vessels and maximize cardiac output.

Question 17

UW. motor vehicle. Hemorrhagic shock continues despite fluid + blood + lateral decubitus. NEXT STEP?

Answer 17

If hemorrhage or hemodynamic instability continues despite initial resuscitation efforts, massive transfusion protocol (MTP) should be activated.

MTP is the administration of packed red blood cells, platelets, and fresh frozen plasma in a 1:1:1 ratio to avoid coagulopathy from dilution of platelets and clotting factors.

Question 18

UW. pregnant patient with abdominal pain + contractions + vaginal bleeding following blunt abdominal trauma (eg, motor vehicle collision) likely has ….

Answer 18

abruptio placentae.

Question 19

UW. why abruptio can cause hemorrhage?

Answer 19

Due to the volume of blood supplied to the uterus, abruptio placentae can cause hypovolemic shock from hemorrhage (ie, hemorrhagic shock), as seen in this patient with hypotension, tachycardia, and cool extremities.

Question 20

UW. Should we add vasopresors in abruptio + hypovolemic shock?

Answer 20

Vasopressor therapy (eg, norepinephrine) is contraindicated in the setting of isolated hemorrhagic shock because peripheral vascular tone is already increased to compensate for decreased blood volume.

In addition, vasopressor use can decrease uterine blood flow and therefore impair fetal oxygenation.

Question 21

UW. when is emergency delivery apropriate in abruptio due to trauma?

Answer 21

Emergency cesarean delivery after maternal trauma may be indicated for imminent fetal compromise (ie, category 3 tracing). This patient has a category 2 tracing (due to minimal variability) but otherwise the fetal heart rate is normal with no variable or late decelerations; therefore, she does not require emergency delivery.

Question 22

UW. biophysical evaluation in trauma + abruptio?

Answer 22

A fetal biophysical profile evaluates for fetal acidosis and may be indicated for fetal heart rate tracings without accelerations. However, maternal stabilization is the priority over further fetal evaluation in this patient.

Question 23

UW. patients with ……. or ….. have incr. risk for abruptio because the sudden, uncontrolled loss of amniotic fluid causes rapid uterine decompression, which shears maternal placental vessels and causes placental hemorrhage and separation.

Answer 23

uterine overdistension (eg, twin gestation, severe polyhydramnios) are at increased risk for abruptio placentae

Question 24

UW. Therefore, patients with persistent bleeding and an abnormal fetal heart rate tracing (eg, bradycardia, minimal variability) require urgent delivery to prevent fetal demise and maternal complications (eg, hemorrhage, disseminated intravascular coagulation).

Answer 24

Kitam klausime tipo minimal variab. yr 2 tipo, todel nereikia, o decel. yra 3 tipo, todel jau reik urgent delivery