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STEP 2 OBGYN > Uw uterus: rupture, vasa, abruptio 02-18 (2) > Flashcards

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

1
Q

UTERINE RUPTURE. in what patients?

A

Occurs in patients with prior history of uterine surgery

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2
Q

UTERINE RUPTURE. CP?

A
  1. Pain presentation:
    a. Focal and intense, which is relieved by rupture
    b. Diffuse pain after the rupture
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3
Q

UTERINE RUPTURE. Signs of imminent rupture?

A

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

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4
Q

UTERINE RUPTURE. pathognomonic for rupture?

A

Loss of fetal station is pathognomonic for rupture

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5
Q

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

A
  1. 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)
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6
Q

UTERINE RUPTURE. table. risk factors?

A

Prior uterine surgery (eg cesarian delivery, myomectomy)

Induction of labor/prolonged labor

Congenital uterine anomalies

Fetal macrosomia

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7
Q

UTERINE RUPTURE. table. CP?

A

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

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8
Q

UTERINE RUPTURE. table. Tx?

A

Laparotomy for delivery and uterine repair

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9
Q

yra uterine rupture deceleracijos visokios.

A

.

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10
Q

vasa previa. table. definition?

A

fetal vessels on overlying the cervix

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11
Q

vasa previa. table. risk factors, 4?

A

placenta previa
multiple gestations
in vitro fertilization
succenturiate placental lobe

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12
Q

vasa previa. table. CP?

A

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

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13
Q

vasa previa. table. mx?

A

emergency cesarean delivery

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14
Q

vasa previa. notes. when Dx?

A

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

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15
Q

vasa previa. notes. mx?

A

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

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16
Q

Placental abruption. table. risk factors. 4

A

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

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17
Q

Placental abruption. table. CP? 4

A

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

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18
Q

Placental abruption. table. Dx? 3

A

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

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19
Q

Placental abruption. irgi deceleracijos.

A

.

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20
Q

UW. vasa previa. what about normally vessels?

A

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

21
Q

UW. vasa previa. what is abberant?

A

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.

22
Q

UW. when is typically diagnosed vasa previa?

A

on fetal anatomy ultrasound at 18-20 weeks

23
Q

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

A

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

24
Q

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.

25
Q

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

26
Q

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?

A

vasa previa, need emergency CESAREAN delivery

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

27
Q

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

A

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

28
Q

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?

A

Uterine rupture

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

29
Q

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

A

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

30
Q

UW. uterine rupture. why bleeding?

A

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

31
Q

UW. uterine rupture. why fetus losses station?

A

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).

32
Q

UW. uterine rupture. What is palpabled on abdomen?

A

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

33
Q

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

A

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

34
Q

UW. uterine rupture. recurrent variable, why?

A

umbilical cord compression

35
Q

UW. uterine rupture. late decelerations, why?

A

reduced uteroplacental blood flow

36
Q

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

A

includes emergency laparotomy and cesarean delivery

37
Q

UW. uterine rupture vs abruptio placentae? station

A

in abruptio placentae no loss of fetal station.

38
Q

UW. uterine rupture vs normal labor?station

A

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

39
Q

UW. uterine rupture vs vasa previa? station

A

no changes in station in vasa previa

40
Q

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

A

classical (vertical) cesarean delivery

not safe vaginal delivery
elective cesarean delivery at 36-37 weeks gestation.

41
Q

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

A

low transverse (horizontal uterine incision)

safe vaginal delivery

42
Q

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

43
Q

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

A

NO!!!! you can deliver vaginaly

44
Q

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

A

YES!! risk of uterine rupture is delivered vaginaly

45
Q

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

A

YES!!! RISK OF UTERINE RUPTURE

46
Q

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

A

NO!!! you can deliver vaginaly

47
Q

UW. uterine rupture. what age incr. risk?

A

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

48
Q

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

A

in abruptio NO IRREGULAR abdominal mass!!!!!

STEP 2 OBGYN (58 decks)

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