Lecture 4 - Maternal Hemorrhage Flashcards Preview

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Flashcards in Lecture 4 - Maternal Hemorrhage Deck (32)
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1
Q

What are the three antepartum hemorrhages:

A
  • Placenta previa
  • Abruptio Placentae
  • Uterine rupture
2
Q

What is the most common presentation of placenta previa?

A

-Vaginal bleeding

3
Q

What is a complete previa;

A

-When cervical is entirely covered by placenta

4
Q

T/F: All patient with vaginal bleeding are considered to have a placenta previa until proven negative by ultrasound.

A

TRUE

5
Q

Patients with a history of previous C-section and a current placenta previa are at very high risk of placenta _______

A

Accreta

6
Q

T/F: A regional anesthetic is appropriate in placenta previa if patient is euvolemic, bleeding is not severe or ongoing and patient is stable.

A

TRUE

7
Q

What two medication are considered to be used on induction if emergency C-section is evident and patient is hemodynamically unstable?

A
  • Ketamine

- Etomidate

8
Q

What is Placenta accreta:

A

-Abnormally deep attachment of the placenta through the endometrium and into the myometrium.

9
Q

What are the stages of placenta accreta:

A
  • Accreta: does not penetrate entire thickness of myometrium
  • Increata: invades further into myometrium
  • Percreta: completely through myometrium, into serosa, and potentially outside of uterus, with invasion into surrounding structures
10
Q

Placenta accreat is suspected if the placenta has not been delivered within __ minutes of the fetuw delivery.

A

30

11
Q

What is the treatment of Placenta accreta:

A
  • Planned c-section
  • abdominal hysterectomy
  • Uterus sparing approaches
12
Q

What is Abruptio placentae:

A
  • Premature separation of the normal placenta

- Most common cause of intrapartumm fetal death

13
Q

What are the risk factors of abruptio placentae:

A
  • Hypertension
  • Trauma
  • Cocaine use
  • Structural uterine abnormality
  • Multiparity
  • Alcohol use
14
Q

T/F: Mild to moderate abruption may be managed with vaginal delivery but severe abruption mandate emergency C-section.

A

TRUE

15
Q

T/F: In abruptio placentae bleeding may remain concealed in the uterus resulting in underestimated blood loss.

A

TRUE

16
Q

Uterine Rupture is most ________ seen in patients with prior classical C-section although there is an elevated risk even in patient with prior low _________ C-section if attempting vaginal birth after C-section.

A
  • commonly

- Transverse

17
Q

Other risk factors for Uterine Rupture would be:

A
  • History of myomectomy
  • Prolonged labor with oxytocin infusion
  • Enlarged uterus
18
Q

What is the most common presentation of uterine rupture:

A

-Sudden profound fetal distress with continuous severe abdominal pain.

19
Q

T/F: An epidural will mask the pain of a uterine rupture.

A

FALSE

20
Q

At what blood loss do you consider postpartum hemorrhage:

A

EBL of 500 cc

21
Q

What is the causes of postpartum hemorrhage:

A

Uterine atony

  • Twins
  • Ployhydraminios
22
Q

What is the treatment of uterine atony:

A
  • Oxytocin 20-30 unit in 1 liter IV fluid
  • Methylergonovine 0.2 mg IM
  • Prostaglandin 0.25 mg IM
23
Q

Can you give prostaglandin to an asthmatic?

A

No, will cause bronchospasm

24
Q

T/F: If patient is hypovolemic a neuraxial block is still the best choice over a general anesthetic.

A

FALSE

25
Q

What is another name for amniotic fluid embolism:

A

Anaphylactoid syndrom of pregnancy

26
Q

What is the mortality rate of amniotic fluid embolism:

A

85%

27
Q

Mechanism of ___________ fluid embolism is thought to involve entry of amniotic fluid into maternal ___________ through breaks in ___________ membrane. this probably happens _____ but reaction are rare.

A

-amniotic
circulation
uteroplacental
a lot

28
Q

What is the typical presentation in amniotic fluid embolism:

A
  • Sudden tachypnea
  • cyanosis
  • shock
  • generalized bleeding
29
Q

What is the pathophysiology of amniotic fluid embolism:

A
  • Acute pulmonary embolism
  • DIC
  • uterine atony
30
Q

When can amniotic fluid embolism occur:

A
  • Labor
  • delivery
  • C-section
  • postpartum
31
Q

Why are chest compression worthless if baby is still in utero:

A
  • Aortocaval compression

- Lateral chest compression are do not work

32
Q

How is a diagnoses made of amniotic fluid embolism in the maternal circulation?

A

Often times an autopsy