Uw uterus: rupture, vasa, abruptio 02-18 (2)

Question 1

UTERINE RUPTURE. in what patients?

Answer 1

Occurs in patients with prior history of uterine surgery

Question 2

UTERINE RUPTURE. CP?

Answer 2

2. Pain presentation:
   a. Focal and intense, which is relieved by rupture
   b. Diffuse pain after the rupture

Question 3

UTERINE RUPTURE. Signs of imminent rupture?

Answer 3

a. Hyperventilation
b. Agitation
c. Tachycardia
d. Bleeding (can be vaginal or intra-abdominal)

Question 4

UTERINE RUPTURE. pathognomonic for rupture?

Answer 4

Loss of fetal station is pathognomonic for rupture

Question 5

UTERINE RUPTURE. Dx? 3 cia kas jauciama/matoma su fetal

Answer 5

6. Diagnosis
   a. Fetal limbs palpable on abdominal exam
   b. Fetal heart tracings are abnormal (eg, fetal tachycardia, recurrent decelerations)
   c. Disordered contractions occur because ruptured myometrial fibers cannot contract in unison, leading to progressively decreasing contraction amplitude (ie, staircase sign on
   tocodynamometry)

Question 6

UTERINE RUPTURE. table. risk factors?

Answer 6

Prior uterine surgery (eg cesarian delivery, myomectomy)

Induction of labor/prolonged labor

Congenital uterine anomalies

Fetal macrosomia

Question 7

UTERINE RUPTURE. table. CP?

Answer 7

Vaginal bleeding
Intraabdominal bleeding (hypotension, tachycardia)
Fetal heart decelerations
Loss of fetal station
Palpable fetal parts on abdominal examnination
loss on intrauterine pressure

Question 8

UTERINE RUPTURE. table. Tx?

Answer 8

Laparotomy for delivery and uterine repair

Question 9

yra uterine rupture deceleracijos visokios.

Answer 9

.

Question 10

vasa previa. table. definition?

Answer 10

fetal vessels on overlying the cervix

Question 11

vasa previa. table. risk factors, 4?

Answer 11

placenta previa
multiple gestations
in vitro fertilization
succenturiate placental lobe

Question 12

vasa previa. table. CP?

Answer 12

painless vaginal bleeding with ROM or contractions
FHR abnormalities (bradycardia, sinusoidal pattern)
Fetal exsanguination and demise

Question 13

vasa previa. table. mx?

Answer 13

emergency cesarean delivery

Question 14

vasa previa. notes. when Dx?

Answer 14

vasa previa is diagnosed on fetal anatomy ultrasound at 18-20 weeks

Question 15

vasa previa. notes. mx?

Answer 15

it is managed with C-section at 34-35 weeks gestation (ie prior to spontaneous labor)

Question 16

Placental abruption. table. risk factors. 4

Answer 16

maternal hypertension or preeclampsia/eclampsia
abdominal trauma
prior placental abruption
cocaine/tobacco use

Question 17

Placental abruption. table. CP? 4

Answer 17

sudden-onset vaginal bleeding (80 proc.)
abdominal or back pan
high-frequency, low intensity contractions
hypertonic, tender uterus

Question 18

Placental abruption. table. Dx? 3

Answer 18

Primarily by clinical presentation
UG (not required for Dx) to rule out placenta previa. May show retroplacental hematoma

Question 19

Placental abruption. irgi deceleracijos.

Answer 19

.

Question 20

UW. vasa previa. what about normally vessels?

Answer 20

Normally, fetal vessels travel in the umbilical cord surrounded by thick, gelatinous tissue (ie, Wharton jelly) that protects them.

Question 21

UW. vasa previa. what is abberant?

Answer 21

Vasa previa is an aberrant condition in which the fetal vessels overlie the cervix, surrounded only by thin fetal membranes, making them prone to tear with rupture of membranes or contractions.

Question 22

UW. when is typically diagnosed vasa previa?

Answer 22

on fetal anatomy ultrasound at 18-20 weeks

Question 23

UW. vasa previa Dx on 18-20w UG. What is Mx?

Answer 23

managed with planned cesarean delivery at 34-35 weeks gestation (ie, prior to spontaneous labor).

Question 24

UW. vasa previa.
Because total fetal blood volume is low (eg, ~250 mL or 1 cup), even minimal fetal bleeding can lead to rapid exsanguination and fetal demise. Therefore, these patients require third-trimester inpatient management to monitor for acute changes that require immediate delivery.

Answer 24

.

Question 25

UW. vasa previa. IT IS OBSTETRIC EMERGENCY = requires immediate delivery

Answer 25

.

Question 26

UW. vasa previa. if Dx at 18-20w., planned delivery at 34-35 w, before spontaneous. These patients need inpatient management. Eg pt is inpatient. Happens ROM + blood-tinged vaginal fluid and fetal bradycardia. Dx? Mx?

Answer 26

vasa previa, need emergency CESAREAN delivery vaginal delivery can cause further fetal vessel tearing and fetal compromise, induction of labor is contraindicated

Question 27

Uw. in vasa previa = S/C!!!!! planned or emergency

Answer 27

vaginal delivery can cause further fetal vessel tearing and fetal compromise, induction of labor is contraindicated

Question 28

UW. uterine rupture. Case: pt 38w + atvyko del prasidejusio gimdymo, station 0, cervix 6, 50 effaced. po 2 h - restless, pain, station -3, cervix same, observed decelerations. Hx of S/c. Dx?

Answer 28

Uterine rupture uterine rupture, a disruption of the uterine wall typically associated with contractions.

Question 29

UW. uterine rupture. typically in patients with what Hx?

Answer 29

prior uterine surgery (eg, cesarean delivery, myomectomy) because weakened uterine scar tissue can separate with the force of contractions.

Question 30

UW. uterine rupture. why bleeding?

Answer 30

develop massive bleeding (ie, intraabdominal, vaginal) due to the highly vascular pregnant uterus.

Question 31

UW. uterine rupture. why fetus losses station?

Answer 31

the sudden decrease in intrauterine pressure and partial fetal delivery into the maternal abdomen can result in loss of fetal station (eg, 0 to −3 station).

Question 32

UW. uterine rupture. What is palpabled on abdomen?

Answer 32

Fetal parts may also become palpable abdominally (ie, an irregular protuberance).

Question 33

UW. uterine rupture. when evaluate fetal HR, what is observed? why?

Answer 33

abnormal fetal heart rate tracing, including recurrent variable and late decelerations caused by umbilical cord compression and reduced uteroplacental blood flow, respectively.

Question 34

UW. uterine rupture. recurrent variable, why?

Answer 34

umbilical cord compression

Question 35

UW. uterine rupture. late decelerations, why?

Answer 35

reduced uteroplacental blood flow

Question 36

UW. uterine rupture. what is done to prevent maternal and fetal compromise?

Answer 36

includes emergency laparotomy and cesarean delivery

Question 37

UW. uterine rupture vs abruptio placentae? station

Answer 37

in abruptio placentae no loss of fetal station.

Question 38

UW. uterine rupture vs normal labor?station

Answer 38

fetal part descends (eg, 0 to +2 station) with advancing dilation.

Question 39

UW. uterine rupture vs vasa previa? station

Answer 39

no changes in station in vasa previa

Question 40

UW. uterine rupture. What type of S?C incr. risk?

Answer 40

classical (vertical) cesarean delivery not safe vaginal delivery elective cesarean delivery at 36-37 weeks gestation.

Question 41

UW. uterine rupture. What type of S?C no risk?

Answer 41

low transverse (horizontal uterine incision) safe vaginal delivery

Question 42

UW. uterine rupture. Expectant management for a vaginal delivery is generally contraindicated in patients with prior classical cesarean delivery or extensive myomectomy

Answer 42

.

Question 43

UW. uterine rupture dalis. buvo lentele uterine surgical Hx and vaginal birth. Surg. - low transverse S/c delivery (horizontal incision). Trial of labor contraindicated?

Answer 43

NO!!!! you can deliver vaginaly

Question 44

UW. uterine rupture dalis. buvo lentele uterine surgical Hx and vaginal birth. Surg. - classical S/c delivery (vertical incision). Trial of labor contraindicated?

Answer 44

YES!! risk of uterine rupture is delivered vaginaly

Question 45

UW. uterine rupture dalis. buvo lentele uterine surgical Hx and vaginal birth. Surg. - abdominal myomectomy with uterine CAVITY ENTRY. Trial of labor contraindicated?

Answer 45

YES!!! RISK OF UTERINE RUPTURE

Question 46

UW. uterine rupture dalis. buvo lentele uterine surgical Hx and vaginal birth. Surg. - abdominal myomectomy withOUT uterine CAVITY ENTRY. Trial of labor contraindicated?

Answer 46

NO!!! you can deliver vaginaly

Question 47

UW. uterine rupture. what age incr. risk?

Answer 47

Maternal age ≥35 may increase the risk of uterine rupture. This patient is age 19.

Question 48

UW. uterine rupture. vs abruptio placenta. buvo case 38w + tabaco + cocaine + pain + bleeding + fetal brady + IRREGULAR abdominal mass

Answer 48

in abruptio NO IRREGULAR abdominal mass!!!!!