Glines bleeding

Question 1

What is Nitabuch’s layer?

Answer 1

another term for decidua basalis? Absence of this layer may lead to weird placental attachements i.e. accreta

Question 2

What are the trends in childbirth death rate and cerebral palsy?

Answer 2

death rates at childbirth have significantly decreased, cerebral palsy has not

Question 3

Define the 3 types of placenta previas

Answer 3

complete = completely covers the os, incomplete = partially covers os, marginal previa = margin of placenta encroaches on margin of os

Question 4

How is a low lying placenta different from a placenta previa?

Answer 4

low lying placenta is a placenta that forms low in the uterus but does not cover or touch the os

Question 5

What placental issue is there an increased risk for in a woman using crack cocaine?

Answer 5

placental abruption

Question 6

What is a complete separation of uterine musculature through all layers, what previous procedure puts one at increased risk for this?

Answer 6

uterine rupture, prior casearian

Question 7

Is more blood lost in vaginal delivery or casarean?

Answer 7

casarean loses 1000 whereas vaginal only 500 ml

Question 8

When the vessels of the umbilical cord insert between the layers of the amnion and chorion but away from the placenta, this is called ________

Answer 8

velamentous cord insertion

Question 9

What is vasa previa?

Answer 9

When there is velamentous cord insertion but they pass over the os and predispose to rupture

Question 10

Aside from the aorta, what artery in a pregnant woman is particularly dangerous to rupture in a trauma situation?

Answer 10

uterine artery, it has a much higher blood flow than a non pregnant woman’s uterine artery

Question 11

What happens to total peripheral resistance in pregancy?

Answer 11

decreases

Question 12

What are the 2 most common causes of antepartum bleeding?

Answer 12

placenta previa and placenta abruptio

Question 13

When doing a physical exam, you must rule out this to before checking uterine tenderness?

Answer 13

placenta previa

Question 14

What is the most accurate means of determining the cause of bleeding

Answer 14

ultrasound

Question 15

What % of placental abruptions does ultrasound miss?

Answer 15

50%

Question 16

What accounts for 20% of all antepartum bleeding?

Answer 16

placenta previa

Question 17

In which type of placenta previa may you still be able to do a vaginal delivery?

Answer 17

a marginal one because the head of the fetus may tamponade off the margin of the placenta near the os without compromising fetal blood flow entirely

Question 18

T/F advanced maternal age is a risk factor for placenta previa

Answer 18

true

Question 19

What other placental anomaly is commonly present with placenta previa?

Answer 19

placenta accreta

Question 20

What is the classic presentation of placenta previa?

Answer 20

painless bright red blood

Question 21

How do you diagnose placenta previa with US? What if inconclusive?

Answer 21

Transabdominal is 95% effective whereas transvaginal is 100% but increases bleeding risk; if inconclusive do a “double set up exam”

Question 22

The fetus is ________- weeks old if the fundus reaches the umbilicus

Answer 22

20

Question 23

Which illicit drug puts women at risk for abruptio placentae?

Answer 23

crack cocaine

Question 24

Why is polyhyramnios associated with abruptio placentae?

Answer 24

because of the rapid decompression that occurs when the water breaks, this causes shearing of the membranes

Question 25

If a mother had a placental abruption but delivered the baby and when trying to breast feed she could not lactate, then what might you think had occurred?

Answer 25

She may have had Sheehan's syndrome due to the hemorrhage from the abruption

Question 26

What term describes the bluish-purple color to the uterus from blood dissecting into the myometrium from an abruption?

Answer 26

couvelaire uterus

Question 27

What is the classic presentation of placental abruption?

Answer 27

painful vaginal bleeding, uterine tenderness, hyperactivity, and increased tone

Question 28

T/F ultrasound is the gold standard for Dx of placental abruption

Answer 28

false it is not very effective and placental abruption is a clinical Dx

Question 29

How does the appearance of blood from placenta previa differ from that of abruption?

Answer 29

previa = bright red; abruption = dark red

Question 30

What is the mgmt of placental abruption?

Answer 30

stabilize the mother and attempt a vaginal birth

Question 31

Define uterine rupture

Answer 31

complete separation of the uterus through all of its layers. Possibly, with extrusion of the fetus into the abdomen!

Question 32

Which type of incision for a C-section carries with it the lowest risk for future uterine rupture?

Answer 32

low transverse (vertical has greater risk)

Question 33

What is a metroplasty? What effect does it have on future uterine rupture?

Answer 33

this is when they fix a septum in the uterus i.e. from defective paramesonephric development, this increases the risk of uterine rupture

Question 34

What is the usual mgmt of uterine rupture?

Answer 34

total abdominal hysterectomy (removal of uterus and cervix)

Question 35

What should you do if a woman has a uterine rupture and still wants more kids?

Answer 35

attempt local debridement and primary closure

Question 36

Describe the pathophysiology of postpartum hemorrhage

Answer 36

after placental separation, the uterus does not contract down on the spiral arterioles

Question 37

What is a very common cause of post-partum hemorrhage?

Answer 37

uterine atony

Question 38

How can the Tx of pre-ecclampsia lead to uterine atony?

Answer 38

magnesium sulfate is a smooth muscle relaxant

Question 39

What are some treatment options for uterine atony (post partum hemorrhage)?

Answer 39

IV pitocin, massage, methergine, PGF2 alpha, cytotec

Question 40

How do you diagnose genital tract trauma?

Answer 40

exploration

Question 41

What is the treatment for retained placenta?

Answer 41

D/C or manual removal; if it is a placenta accreta you may need to do a hysterectomy

Question 42

What is the most common cause of uterine inversion? What is the major complication for the patient?

Answer 42

iatrogenic from pulling too hard on the cord; the patient can go into vasovagal shock

Question 43

What is the mgmt of uterine inversion?

Answer 43

immediate IV volume expansion, halothane anesthesia or terbutaline to relax uterus, replace with your fist and give immediate pitocin