hemoorrgae

Question 1

1 post partum hemorrage

Answer 1

withn 24 hours of gving birth

Question 2

2 postpartum

Answer 2

24h - 6 weeks after giving birth

Question 3

causes of pph

Answer 3

1. atony - most commom
2. large placenta
3. retained placental products
4. genetial tract trauma
5. coagulation disorders
6. abnomal placneta such as acreta
7. uterine inversion (rare)
8. uterine rupture(rare)

Question 4

placenta acreta
placenta increta
placenta percreta

which is most common

Answer 4

acrete: too deep and firm - most common
increte: even deeper into the muscular wall
precrete: goes through the uterus and sometime to surroundign organs like bladder most serious

Question 5

PPH most common cause

Answer 5

atony

Question 6

risk factors for atony

Answer 6

advanced age 
CS delivery 
multiple pregnancies 
preeclampsia 
retained placental parts 
chorioamnionitis

Question 7

tx

Answer 7

first uterine massage
pharmacological : oxtyocin increased frequency and streght of contractions second is methergine works like oxy but is a potent constrictor whereas oxy is a dilator so wary in HTN , or prostaglandins (increase streght)

if these drugs do not work and massage now you have to go more invasive!

Question 8

invasive methods PPH

Answer 8

D&C if suspect retained products 
artery ligation 
artery embolisation 
hysterectomy 
intrauterine balloon tamponade

Question 9

what to do in case of accreta

Answer 9

if its known before pregnancy then you deliver via CS and remove the uterus

Question 10

how to diagnose acrtea

Answer 10

it doesnt really have symptoms but occacionally it can be diagnose on ultrasound

Question 11

easy way to remember causes of PPH

Answer 11

4 t's 
tone 
thrombin 
tissue - retained 
trauma- birht canal ijury

Question 12

secondary causes of pph

Answer 12

Endometritis (endometrial infection). This is often accompanied with offensive discharge and may be due to retained placental tissue leading to uterine atony.

Displacement of a retained blood clot

Poor healing of a perineal tear or genital tract trauma

Abnormal involution of the placental site

Choriocarcinoma (rare)

Question 13

def of low lying placenta

Answer 13

the placenta is within 2 cm of cervical os so isnt techinally covering it

Question 14

mcq 5 clinical forms of placenta previa

Answer 14

low lying 
marginal - closer to the opening than low lying 
complete 
incomplete 
isthmico cervical

Question 15

can u give birth naturally with previa

Answer 15

usually its CS but the only indication is if cervix is soft and effaced and dilated etc

Question 16

couvelaire uterus

Answer 16

there is blood in the myometrium forcing its way out into peritoneal cavity . This condition makes the uterus very tense and rigid. The uterus may adopt a bluish/purplish, mottled appearance due to extravasation of blood into uterine muscle.he myometrium becomes weakened and may rupture due to the increase in intrauterine pressure associated with uterine contractions. This may lead to a life-threatening obstetric emergency requiring urgent delivery of the fetus.