What is Nitabuch's layer?
another term for decidua basalis? Absence of this layer may lead to weird placental attachements i.e. accreta
What are the trends in childbirth death rate and cerebral palsy?
death rates at childbirth have significantly decreased, cerebral palsy has not
Define the 3 types of placenta previas
complete = completely covers the os, incomplete = partially covers os, marginal previa = margin of placenta encroaches on margin of os
How is a low lying placenta different from a placenta previa?
low lying placenta is a placenta that forms low in the uterus but does not cover or touch the os
What placental issue is there an increased risk for in a woman using crack cocaine?
What is a complete separation of uterine musculature through all layers, what previous procedure puts one at increased risk for this?
uterine rupture, prior casearian
Is more blood lost in vaginal delivery or casarean?
casarean loses 1000 whereas vaginal only 500 ml
When the vessels of the umbilical cord insert between the layers of the amnion and chorion but away from the placenta, this is called ________
velamentous cord insertion
What is vasa previa?
When there is velamentous cord insertion but they pass over the os and predispose to rupture
Aside from the aorta, what artery in a pregnant woman is particularly dangerous to rupture in a trauma situation?
uterine artery, it has a much higher blood flow than a non pregnant woman's uterine artery
What happens to total peripheral resistance in pregancy?
What are the 2 most common causes of antepartum bleeding?
placenta previa and placenta abruptio
When doing a physical exam, you must rule out this to before checking uterine tenderness?
What is the most accurate means of determining the cause of bleeding
What % of placental abruptions does ultrasound miss?
What accounts for 20% of all antepartum bleeding?
In which type of placenta previa may you still be able to do a vaginal delivery?
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
T/F advanced maternal age is a risk factor for placenta previa
What other placental anomaly is commonly present with placenta previa?
What is the classic presentation of placenta previa?
painless bright red blood
How do you diagnose placenta previa with US? What if inconclusive?
Transabdominal is 95% effective whereas transvaginal is 100% but increases bleeding risk; if inconclusive do a "double set up exam"
The fetus is ________- weeks old if the fundus reaches the umbilicus
Which illicit drug puts women at risk for abruptio placentae?
Why is polyhyramnios associated with abruptio placentae?
because of the rapid decompression that occurs when the water breaks, this causes shearing of the membranes
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?
She may have had Sheehan's syndrome due to the hemorrhage from the abruption
What term describes the bluish-purple color to the uterus from blood dissecting into the myometrium from an abruption?
What is the classic presentation of placental abruption?
painful vaginal bleeding, uterine tenderness, hyperactivity, and increased tone
T/F ultrasound is the gold standard for Dx of placental abruption
false it is not very effective and placental abruption is a clinical Dx
How does the appearance of blood from placenta previa differ from that of abruption?
previa = bright red; abruption = dark red
What is the mgmt of placental abruption?
stabilize the mother and attempt a vaginal birth
Define uterine rupture
complete separation of the uterus through all of its layers. Possibly, with extrusion of the fetus into the abdomen!
Which type of incision for a C-section carries with it the lowest risk for future uterine rupture?
low transverse (vertical has greater risk)
What is a metroplasty? What effect does it have on future uterine rupture?
this is when they fix a septum in the uterus i.e. from defective paramesonephric development, this increases the risk of uterine rupture
What is the usual mgmt of uterine rupture?
total abdominal hysterectomy (removal of uterus and cervix)
What should you do if a woman has a uterine rupture and still wants more kids?
attempt local debridement and primary closure
Describe the pathophysiology of postpartum hemorrhage
after placental separation, the uterus does not contract down on the spiral arterioles
What is a very common cause of post-partum hemorrhage?
How can the Tx of pre-ecclampsia lead to uterine atony?
magnesium sulfate is a smooth muscle relaxant
What are some treatment options for uterine atony (post partum hemorrhage)?
IV pitocin, massage, methergine, PGF2 alpha, cytotec
How do you diagnose genital tract trauma?
What is the treatment for retained placenta?
D/C or manual removal; if it is a placenta accreta you may need to do a hysterectomy
What is the most common cause of uterine inversion? What is the major complication for the patient?
iatrogenic from pulling too hard on the cord; the patient can go into vasovagal shock
What is the mgmt of uterine inversion?
immediate IV volume expansion, halothane anesthesia or terbutaline to relax uterus, replace with your fist and give immediate pitocin