Bleeding in Pregnancy

Question 1

What is a placenta previa?

Answer 1

This is an abnormal implantation of the placenta over the internal os of the cervix.

Question 2

What are risk factors of a placenta previa?

Answer 2

Placental abruption, intrauterine growth restriction, and hemorrhage.

Question 3

What is a sign/symptom of a placenta previa?

Answer 3

Painless uterine bleeding

Question 4

What is a placental abruption?

Answer 4

This is detachment of a part or all of the placenta from its implantation site before delivery.

Question 5

How will the uterus palpate with a placental abruption?

Answer 5

Firm without in the absence of contractions.

Question 6

What is the definition of a placenta accreta?

Answer 6

This is where the placenta lacks decidua basalis (a maternal component of the placenta) so the placenta implants directly into the myometrium.

Question 7

What are two risks that a woman can face with a placenta accreta?

Answer 7

A blood transfusion or hysterectomy

Question 8

What is the definition of a vasa previa?

Answer 8

This a the result of a velamentous insertion of the umbilical cord. This is where the umbilical cord is implanted into the membranes rather than into the placenta. the umbilical cord is not surrounded by Wharton’s Jelly so they have no supportive tissue.

Question 9

What is the definition of a uterine rupture?

Answer 9

This is the separation of the uterine myometrium or previous uterine scar, with rupture of the membranes.

Question 10

What are signs/ symptoms of a uterine rupture?

Answer 10

Uterine hypertonus and tachysystole

Question 11

What are the three types of placenta previas?

Answer 11

1. Total/Complete: the cervical os is completely covered.
2. Marginal: this is where the placenta is within 2 cm of the cervical os.
3. Low-lying: the leading edge of the placenta is 2-2.5 cm away from the cervical os.

Question 12

What are risk factor for having a placenta previa?

Answer 12

AMA, uterine scaring, smoking, multiples, and previous c-section

Question 13

What are the three types of Cretas?

Answer 13

Accreta: placenta grows into the myometrium
Increta: further adherence into the myometrium
Percreta: invasion through uterine wall and outside

Question 14

What is a vasa previa?

Answer 14

This is where the umbilical cord is inserted into the membranes and the umbilical veins and arteries are unprotected on the membrane wall and the placenta is at the cervical opening.

Question 15

What is a velamentous cord insertion?

Answer 15

This is where there is no Wharton’s jelly protecting the umbilical cord

Question 16

What are classic findings of a placental abruption on the monitor?

Answer 16

Low amplitude, high frequency contractions

Question 17

What are warning signs from the patient of a placental abruption?

Answer 17

Sudden intense pain with bright red bleeding.

Question 18

What are risk factors for placental abruption?

Answer 18

Previous abruption, hypertension, trauma, infection, smoking, drugs, polyhydramnios, prolonged ROM, fibroids

Question 19

What are risk factors for having a uterine rupture?

Answer 19

previous fundal surgery, myomectomy, previous c-section, prior oxytocin use- prolonged

Question 20

What causes a uterine inversion?

Answer 20

excessive fundal pressure, excessive traction on the umbilical cord, uterine atony