W11_07 Intrapartum care, abnormal labour, obstetrical emergencies 2

Question 1

what’s a succenturitae lobe?

Answer 1

an accessory lobe of the placenta;
note this can be a risk factor for vasa previa b/c of the connecting bridge

Question 2

note: it’s the lower uterus that grows the most in the 3rd trimester

Answer 2

if placenta is here, it can be sheared off and cause bleeding

Question 3

what’s placenta acreta?

Answer 3

villi Attach to the myometrium

Question 4

what’s placenta increta?

Answer 4

villi Invade into the myometrium

Question 5

what’s placenta percreta?

Answer 5

villi Penetrate through the myometrium (e.g. into bladder)

Question 6

what’s a sentinel bleed?

Answer 6

bleeding in the third trimester that stops spontaneously, and may indicate a placenta previa

Question 7

define primary postpartum hemorrhage

Answer 7

excessively bleeding 24h after delivery;
500mL loss after vaginal;
1000mL loss after c-section

Question 8

define secondary postpartum hemorrhage

Answer 8

bleeding 24h to 6 weeks postpartum

Question 9

what are causes of PPH? (4 Ts)

Answer 9

tone;
trauma;
tissue;
thrombin

Question 10

risk factors of poor tone, causing PPH?

Answer 10

overdistension of uterus;
uterine fatigue;
previous PPH;
infection;
anatomic distortion;
medications (nitroglycerin, anesthetics)

Question 11

what are the 4 signs of placental separation?

Answer 11

gush of blood;
cord lengthening;
uterus becomes globular;
uterus rises in abdomen

Question 12

what’s the most important part of PPH prevention?

Answer 12

prophylactic oxytocin before or after placental delivery

Question 13

what’s the most important and effective intervention of PPH?

Answer 13

bimanual massage - compress the uterus with both hands

Question 14

what are some uterotonics for medical PPH treatment?

Answer 14

oxytocin,
ergonavine (no for HTN or pre-eclampsia),
hemabate (no for asthmatics),
misoprostol

Question 15

what are some clotting agents used in PPH?

Answer 15

tranexamic acid (antifibrinolytic);
recombinant activated factor VII

Question 16

what’s a bakri balloon?

Answer 16

like a foley, but way bigger balloon and is inserted into uterus to tamponade during PPH

Question 17

what are some radiologic interventions of PPH?

Answer 17

uterine artery embolization w/catheter

Question 18

what are some surgical interventions of PPH?

Answer 18

compression sutures (B-lynch);
selective ligation of uterine vessels;
ligation of internal iliac;
hysterectomy

Question 19

what’s sheehan syndrome?

Answer 19

anterior pituitary becomes necrotic due to hypovolemia. Can cause lack of prolactin or amenorrhea, etc, after PPH