OB HEMORRHAGES Flashcards by Jamaira Belmes

Postpartum Hemorrhage

Cumulative blood loss > 1000 mL accompanied by signs and symptoms of HYPOVOLEMIA

NSD > 500 mL
CS > 1000 mL

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4 Ts

Tone
Trauma
Tissue
Thrombin

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Bleeding during pregnancy

Antepartum Hemorrhage

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Frequent causes of Postpartum Hemorrhage

uterine atony with placental site bleeding

genital tract trauma

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Most frequent cause of obstetrical hemorrhage

Uterine Atony

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Antimicrobial prophylaxis after manual removal of placenta

Ampicillin or Cefazolin

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Uterotonic agents – UTERINE CONTRACTION

Oxytocin
Ergot Derivative - Methylergonovine (Methergine), Ergonovine
Carboprost
Prostaglandin E2 - Dinoprostone
Misoprostol - Cytotec

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Degrees of Uterine Inversion

1st Degree

Inverted fundus extends to but not through the cervix

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Degrees of Uterine Inversion

2nd Degree

Inverted fundus extends through the cervix but remains within the vagina

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Degrees of Uterine Inversion

3rd Degree

Inverted fundus extends outside the vagina

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Degrees of Uterine Inversion

Total Inversion

Vagina and uterus are inverted

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Occurs more commonly in patients with previous caesarian delivery (classical CS)

Uterine Rupture

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Risk Factors for Uterine Rupture

Prior uterine surgery/uterine scar
Injudicious use of oxytocin
Grand multiparity
Marked uterine distension
Abnormal fetal lie
Large fetus
External version
Trauma

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Treatment of choice when intractable uterine bleeding occurs or when the uterine rupture sites are multiple, longitudinal or low lying

HYSTERECTOMY

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Premature separation of the placenta from the uterine wall

Placental Abruption

vaginal bleeding (3rd trimester)
sudden onset abdominal pain
uterine tenderness

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Maternal sequelae of placental abruption

DIC
shock
transfusion
hysterectomy
renal failure
death

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Fetal complications of placental abruption

nonreassuring fetal status
growth restriction
death

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Neonatal outcomes

death
preterm delivery
growth restriction

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Risk factors for placental abruption

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prior abruption
increased age and parity
preeclampsia
chronic HPN
chorioamnionitis
preterm ruptured membranes
multifetal gestation
low birthweight
hydramnios
cigarette smoking
single umbilical artery
cocaine use
uterine leiomyoma

Placental abruption

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hypovolemic shock
consumptive coagulopathy
Couvelaire uterus
end organ injury
Sheehan syndrome

Classic sign of placental abruption that can be seen at the time of cesarean delivery

life threatening condition

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Couvelaire uterus

bluish purple myometrium

Abnormally implanted placenta

Placenta goes before the fetus into the birth canal

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Placenta Previa

Describe the apparent movement of the placenta AWAY from the INTERNAL OS

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Placental migration

Internal os is covered partially or completely by placenta

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PLACENTA PREVIA

complete/totalis
partial/partialis
marginalis
low-lying

Implantation in the lower uterine segment placental edge does not cover the internal os but lies within a 2 cm wide perimeter around the os

Low Lying Placenta

The most characteristic event with placenta previa

PAINLESS BLEEDING

Predisposing factors for placenta previa

``` prior CS and uterine surgery multiparity multiple gestation erythroblastosis smoking hx of placenta previa increasing maternal age ```

Fetal complications associated with Placenta previa

``` preterm delivery and its complications preterm premature rupture of membranes intrauterine growth restriction malpresentation vasa previa congenital abnormalities ```

Recommended delivery in placenta previa

b/w 34 and 37 weeks

Abnormal placental adherence to the myometrium

partial or total absence of decidua basalis imperfect devt of fibrinoid or Nitabuch layer

Frequent and serious complication associated with placenta previa

morbidly adherent placentas

Villi are attached to the myometrium

Placenta ACCRETA Total placenta accreta Focal placenta accreta

Villi INVADE the myometrium

Placenta INCRETA

Villi that PENETRATE through the myometrium and to or through the serosa

Placenta PERCRETA

Confirmation of a percreta or increta almost always mandates

Hysterectomy

2nd MC severe maternal morbidity indicator

Disseminated Intravascular Coagulation (DIC)

Classic triad of amniotic fluid embolism

abrupt hemodynamic respiratory compromise DIC

For treatment of hypovolemia from catastrophic hemorrhage

Compatible Whole Blood

Massive Transfusion Protocol

Cryoprecipitate Fresh frozen plasma Packed RBCs Platelets

EFM tracing associated with abruptio

recurrent late or variable decelerations reduced variability bradycardia sinusoidal pattern

Complications of Placental Abruptio

``` Perinatal mortality (25-30%) Hemorrhage Couvelaire uterus (Uteroplacental apoplexy) Acute renal failure (23 %) DIC ```

Risk Factors for massive bleeding during CS with previa

advanced maternal age previous CS (+) sponge like US findings in the cervix

Widespread systemic activation of coagulation --> thrombotic obstruction of small and midsize vessels --> tissue ischemia and bleeding from consumption of platelets and coagulation factors

Disseminated Intravascular Coagulation (DIC)

Intrinsic pathway (Endothelial damage)

septic abortion | chorioamnionitis

Extrinsic pathway (massive tissue injury)

abruptio placenta amniotic fluid embolism retained dead fetus saline induced abortion

Risk factors of DIC

``` pregnancy abruptio placenta preeclampsia/eclampsia intrauterine fetal demise (> 1 mo) septic abortion amniotic fluid embolism ```

OB HEMORRHAGES Flashcards

(46 cards)