Keppler vaginal bleeding in pregnancy

Question 1

What are some pregnancy related reasons for first trimester bleeding?

Answer 1

1. Ectopic
2. Spontaneous abortion
3. Subchorionic bleeding

Question 2

What are other non-pregnancy related reasons for first trimester bleeding?

Answer 2

1. Bladder (UTI)
2. Hemorrhoids
3. Vaginitis
4. Cervical

Question 3

What are some things that increase your risk for ectopic pregnancy?

Answer 3

1. IUD
2. Tubal surgery
3. Excessive age
4. PID

Question 4

True or false: Beta HCG levels should double every 48 hours?

Answer 4

True

Question 5

What are some indications that its an ectopic pregnancy?

Answer 5

1. Beta HCG not rising
2. You see a mass near the ovaries that looks vascular cystic?
3. A heart beat near an ovary is never good

Question 6

If the pt is stable and has an ectopic pregnancy would you treat it medically or surgically?

Answer 6

Medically with Methotrexate

Question 7

What do you need to check weekly if treating an ectopic pregnancy medically with methotrexate?

Answer 7

need to check the BHCG weekly until it reaches zero

Question 8

If the pt has fluid in the pelvis and has an ectopic are the stable or unstable?

Answer 8

They are unstable and this will have to be treated surgically

Question 9

What is considered a spontaneous abortion?

Answer 9

IUP 0.5cm w/o Fetal cardiac activity (FCA)

Question 10

What percent of recognized pregnancies are spontaneous abortions

Answer 10

20%

Question 11

What is the diagnostic criteria for spontaneous abortion?

Answer 11

1. Empty gestational sac 2.5+cm, or unchanged
2. HCG above discriminatory zone without viable fetal pole
3. Previous viable fetus with no cardiac activity
4. Fetal pole > 7 weeks by Crown rump length (CRL) without cardiac activity

Question 12

What are the three management options for spontaneous abortion?

Answer 12

1. Expectant- just wait and see
2. Medical- Misoprostol
3. Surgical

Question 13

Spontaneous abortions can put the mother at risk of what?

Answer 13

1. infection (septic abortion)
2. Rare risk of DIC
3. Bleeding/transfusion

Question 14

What are some non-obstetric causes for second/third trimester bleeding?

Answer 14

1. Infection
2. Hemorrhoids
3. Trauma
4. Cervical

Question 15

What are some obstetric causes for second and third trimester bleeding?

Answer 15

1. Labor
2. Abruption
3. Placenta/ vasa previa

Question 16

What is the general management of second and third trimester bleeding?

Answer 16

1. Iv access
2. Fluids
3. Rapid transfusion protocol

Question 17

What is the main difference between placenta abruption vs previa?

Answer 17

abruption is PAINFUL

Question 18

What are some things that can cause a placenta abruption?

Answer 18

1. HTN
2. expose to nicotine, tobacco, amphetamines, caffeine
3. trauma
4. rupture of membrane
5. and of course prior history

Question 19

How do you diagnose placenta abruption?

Answer 19

1. Gross bleeding
2. check for uterine activity
3. is there pain
4. ultrasound? labs?

Question 20

True or false: with a placental abruption your only method of delivery is a c-section?

Answer 20

False- with placental abruption you can try to deliver the child vaginally

Question 21

What are some things that could cause placenta previa?

Answer 21

1. Advancing maternal age
2. prior uterine surgery
3. again happened before

Question 22

If some one gets placenta previa at 20 weeks should it go away by week 28?

Answer 22

yes

Question 23

True or false: you can stimulate the cervix of someone with placenta previa?

Answer 23

False- no cervical stimulation absolutely no sex

Question 24

True or false: the more C-sections you have the more likely you are to have placenta previa?

Answer 24

True

Question 25

What is vasa previa?

Answer 25

vasa previa is when membranes that contain fetal blood vessels connecting the umbilical cord and placenta overlie or are with 2cm of the internal cervical os

Question 26

Should you have a low or high index of suspicion for the vasa previa?

Answer 26

high index

Question 27

What causes postpartum hemorrhage?

Answer 27

1. Atony 2. Atony 3. Atony

Question 28

What is atony?

Answer 28

this is when the uterus has no tone and cant contract to slow down the bleeding

Question 29

What are some other reasons for postpartum hemorrhage?

Answer 29

1. Laceration 2. Retained placenta 3. Placenta accreta spectrum 4. Uterine rupture 5. DIC/Coagulopathies

Question 30

With postpartum hemorrhage would you exam the pt under anesthesia or awake?

Answer 30

under anesthesia

Question 31

What are some management option in the OR for postpartum hemorrhage?

Answer 31

1. Uterine curettage 2. Uterine tamponade 3. IR embolization 4. uterine artery ligation 5. B-lynch suture 6. Hysterectomy

Question 32

Because atony is the most common reason for postpartum hemorrhage, how would you treat this?

Answer 32

you would give uterotonics (pitocin, misoprostol things of this nature)

Question 33

which puts you at a higher risk of coagulopathies, pregnancy or BCPs?

Answer 33

pregnancy puts you at an 8x higher risk for VTE

Question 34

What is virchows tried?

Answer 34

1. venous stasis 2. hypercoaguable state 3. intervascular vessel wall damage

Question 35

What are some things that can cause a hypercoagulable state?

Answer 35

1. BCP 2. Pregnancy 3. Prothrombin gene mutation 4. Antithrombin III 5. Factor V leiden 6. Protein C or 5 deficiencies

Question 36

How would you evaluate someone for DVT/PE

Answer 36

1. Check genetic predisposition/history 2. Lower extremity doppler ultrasound 3. VQ/perfusion (rarely used) 4. CT PE (used frequently)

Question 37

Treatment for DVT/PE in preggos?

Answer 37

usually treated with LMWH those that are at a high risk will most likely be prophylaxed with LMWH throughout the pregnancy

Question 38

What are some causes of DIC in pregnancy?

Answer 38

1. Acute blood loss 2. HELLP/preeclampsia 3. Amniotic fluid embolism

Question 39

How do you manage DIC?

Answer 39

1. Massive transfusion protocol 2. Replace clotting factors 3. Control sources of bleeding