Obstetric Hemorrhage and Puerperal Sepsis

Question 1

What do we want to avoid until placenta previa has been ruled out?

Answer 1

-digital exam

Question 2

What kind of speculum do we use for hemorrage?

Answer 2

-sterile spectum

Question 3

What does that sinusoidal wave mean?

Answer 3

-severe fetal anemia

Question 4

If the hemorrhage is before 20 weeks, what do we think of?

Answer 4

-abortion or ectopic…stuff like that

Question 5

bleeding after 20 weeks?

Answer 5

• placental abruption
• placenta previa
• infection
• etc…

Question 6

What is the most common type of abnormal placentation?

Answer 6

placenta previa

Question 7

How does placenta previa classically present?

Answer 7

-painless vaginal bleeding

Question 8

What does marginal, partial , and complete placenta previous mean?

Answer 8

-just how much is covering the os

Question 9

how is placenta previa diagnosed?

Answer 9

• U/S

- repeat at 30 weeks because it will migrate 90% of the time

Question 10

Placenta accreta?

Answer 10

• abnormal firm attachment to the superficial lining of the myometrium
• most common

Question 11

palcenta increta

Answer 11

-invades myometrium

Question 12

placenta percreta?

Answer 12

• through the myometrium into uterine serosa

- least common

Question 13

What is the most common cause of third trimester bleed and how does it present?

Answer 13

• Placental Abruption!

- PAINFUL bleeding

Question 14

What is the most common cause of DIC in pregnancy?

Answer 14

-placental abruption

Question 15

In general, when managing these hemorrhagic patients in the hospital, what kind of diet are they on?

Answer 15

• NPO
• we are probs going to have to open them up
• type and cross 4 units of blood

Question 16

What is the most common risk factor for uterine rupture?

Answer 16

-prior uterine incision

Question 17

how does uterine rupture present?

Answer 17

• sudden onset of intense abdominal pain

- regression of presenting part of fetus

Question 18

What is the other rare but important cause of third trimester bleeding?

Answer 18

• velamentous insertion of the umbilical cord
• cord inserts away from palcenta and has to travel across a lot of stuff
• vasa previa if over the cervical os

Question 19

definition of postpartum hemorrhage following vaginal and cesarean section?

Answer 19

• vaginal: 500cc

- C section: 1000cc

Question 20

most common cause of primary postpartum hemorrhage?

Answer 20

• uterine atony

- secondary happens later and happens with subinvolution of the uterus…

Question 21

When do more than half of all maternal deaths occur?

Answer 21

-within 24 hrs of delivery

Question 22

What drug can we give them if there is uterine atony?

Answer 22

-oxytocin (pitocin)

Question 23

if there is uterine inversion, when should we remove the placenta?

Answer 23

-after the inversion is corrected

Question 24

What is febrile morbidity?

Answer 24

• temp> 100.4 or higher that occurs for more than 2 consecutive days during the first 10 postpartum days
• most fevers are due to endometritis…. from organsims in the vagina

Question 25

What kind of organisms cause 70% of peurperal sepsis?

Answer 25

-anaerobic cocci

Question 26

clinical features of peurperal sepsis

Answer 26

• postpartum fever and increasing uterine tenderness on postpartum day 2-3 are key***
• for diagnosis, extrapelvic causes of fever should be excluded

Question 27

What drugs do we give a lady with puerperal sepsis?

Answer 27

• ones that fight anaerobic coverage

- ampicillin and gentamicin

Question 28

What is the major pathogen that is resistant to that drug combo?

Answer 28

• bacteroides fragilis

- run that bitch over with clindamycin

Question 29

What is Virchow’s triad?

Answer 29

• endothelial damage
• venous stasis
• hypercoagulable state of pregnancy

Question 30

main way we can tell ovarian vein thrombophlebitis from deep septic pelvic vein thrombphlebitis

Answer 30

• ovarian vein: appear clinically ill

- Deep septic pelvic vein: do NOT appear clinically ill