Hemorrhage And Sepsis - Moulton

Question 1

When do you deliver baby w/placenta previa?

Answer 1

36-37 weeks, do not want her to go into labor

Question 2

Crypercipitate has what effect?

Answer 2

Inc fibrinogen by 10 mg/dL

Question 4

Deep septic Vein thrombophlebitis fever?

Clinical presentation?

Diagnose how?

Answer 4

Unlocalized fever non-responsive to Abs in first few days

Do NOT appear clinical ill

No radiograph, dx of exclusion

Question 5

What surgical tx used for uterine hemorrhage?

Answer 5

O’Leary stitch - ligation of uterine a.

B-Lynch suture

Question 6

Tx septic pelvic thrombophlebitis?

Specifically tx ovarian vein thrombosis?

Answer 6

UF Heparin or LMW heparin

Anticoagulate 6 weeks, repeat imaging

Question 9

Most common reasons for placental abruption?

Most common cause of what?

Answer 9

Cocaine use
Car wreck
HTN

DIC

Question 11

How to treat puerperal sepsis?

What is the major Ab-resistant pathogen?

Answer 11

Ampicillin
Gentamicin
Clindamycin

Bacteroides fragilis

Question 12

Risk of uterine rupture w/low transverse uterine incision?

Classic vertical?

Answer 12

1%

4-7& –> must do c section

Question 13

Oxytocin CI in whom?

Dinoprostone (PGE2)?

Answer 13

Undiluted rapid IV infusion

Pt hypotensive

Question 14

FFP has what effect?

Answer 14

Inc. fibrinogen by 10 mg/dL

Question 18

Unprotected vessels that pass over the cervical os is called what?

Answer 18

Vasa previa - inc mortality rate

Question 19

Platelets have what effect?

Answer 19

Inc platelet count by 5-10,000

Question 22

What is associated w/copious bleeding and hypovolemic shock?

Answer 22

Uterine inversion

Question 24

Secondary hemorrhage occurs when?

Due to what?

Answer 24

24 hours to 12 weeks

Subinvolution of uterus, sloughing of the Escher or retained POC

Question 26

Invades the myometrium is what?

Answer 26

Placenta increta

Question 27

How to diagnose placenta previa?

Mean gestational age when bleeding occurs?

Answer 27

US

30 weeks

Question 28

Methylergonovine is CI in whom?

15-methyl PGF2a?

Answer 28

HTN pt

Asthma pt

Question 31

What is defined as temp > 100.4 (38) that occurs for more than 2 consecutive days during first 10 postpartum days?

Answer 31

Febrile morbidity - puerperal sepsis

Question 32

After delivery the pH becomes what?

Answer 32

More alkaline

Question 33

Primary hemorrhage occurs when?

Due to what?

Answer 33

W/in 24 hours

Uterine atony

Question 34

Ovarian Vein Thrombophlebitis fever present?

Cx presentation?

Dx how?

Answer 34

Fever and ABD pain w/1 week after delivery

Appear clinically ill

20% seen on radiograph

Question 35

Vaginal bleeding before 20 weeks and painless dilation indicates?

Answer 35

Cervical insufficiency

Question 36

Tx for uterine atony?

Answer 36

Bimanual massage
Oxytocin
Methylergonovine
15-Methyl PGF2
Dino/Mist

Question 37

What is assoc w/extravasation of blood into the uterus?

Answer 37

Couvelaire uterus

Question 41

Boggy uterus means what?

Answer 41

Uterine atony --> PPH

Question 42

Placenta previa is what? Presents how?

Answer 42

Implantation of placenta over cervical os (most common abnormality) Painless vaginal bleeding

Question 43

Postpartum hemorrhage (PPH) defined how after vaginal birth? C section?

Answer 43

> 500 cc > 1000 cc

Question 44

Packed red cells have what effect?

Answer 44

Inc Hct by 3%, Hb by 1 g/dL

Question 47

What is defined as premature separation of the normally implanted placenta?

Answer 47

Placental abruption

Question 48

Management of uterine rupture? If large?

Answer 48

Laparotomy and deliver baby Cesarean hysterectomy

Question 49

What presents as painful bleeding, uterine tenderness, uterine hyperactivity, and fetal distress/death?

Answer 49

Abruptio placenta

Question 51

3 types of placenta previa?

Answer 51

Marginal - does not cover os Partial Complete

Question 53

What is causing sudden onset of intense abdominal pain w/or w/out vaginal bleeding, abnormal FHR or palpation of fetal parts?

Answer 53

Uterine rupture

Question 56

What causes 3 trimester bleeding?

Answer 56

Fetal vessel rupture secondary to velamentous insertion of umbilical cord

Question 62

Thought the myometrium into the uterine serosa is what?

Answer 62

Placenta percreta

Question 67

Abnormal firm attachment to the superficial lining of the myometrium is what?

Answer 67

Placenta accreta