OBAb: Obstetrical Hemorrhage

Question 1

Cite possible causes of obstetric hemorrhage

Answer 1

1. Uterine atony
2. Genital tract lacerations
3. Retained products of conception
4. Coagulopathy (thrombin)

Question 2

____ is the single most important cause of maternal death worldwide

Answer 2

obstetrical hemorrhage

Question 3

____ mL estimated blood loss should alter the obstetrician

Answer 3

More than 500mL

Question 4

____ % volume decrease in the postpartum hematocrit is a clinically significant blood loss with vaginal delivery.

Answer 4

6%

Question 5

Causes of obstetrical hemorrhage antepartum

Answer 5

1. Placenta Previa

2. Abruptio placenta

Question 6

____ refers to the premature separation of a normally implanted placenta

Answer 6

Abruptio placenta

Question 7

What are the risk factors of abruptio placenta?

Answer 7

1. Prior abruption
2. Thrombophilias
3. PROM
4. pre-eclampsia
5. Multifetal gestation
6. Hydramnios
7. Chronic hypertension
8. Cigaretter smoking
9. Increased age and parity
10. uterine myoma
11. Cocaine use

Question 8

What are the components of virchow’s triad in abruptio placenta?

Answer 8

1. Vaginal bleeding after 20 weeks
2. Increased uterine tone
3. Abdominal pain

Question 9

What is the characteristic EFM tracing associated with abruptio

Answer 9

1. Recurrent late or variable decelerations
2. reduced variability
3. Bradycardia
4. Sinusoidal pattern

Question 10

How will you now that there is coagulation defect in clot observation test?

Answer 10

1. Clot does not form within 6 minutes

2. Forms and lyses within 30 minutes

Question 11

___ uterus also refers to uteroplacental apoplexy

Answer 11

Couvelaire uterus

Question 12

What is the most common cause of DIC in pregnancy?

Answer 12

Abruptio placenta

Question 13

What are the of CS in abruption placenta?

Answer 13

1. Fetal compromise
2. Severe uterine hypertonus
3. Life-threatening vaginal bleeding or DIC
4. Vaginal delivery is no iminent

Question 14

[Abruptio placeta]

preterm >24 weeks, stable mother, reassuring fetal status

Management?

Answer 14

1. Conservative management (tocolyze)

2. Deliver 37 to 38 weeks

Question 15

[Abruptio placeta]

preterm >24 weeks, unstable mother, non-reassuring fetal status

Management?

Answer 15

1. Deliver

2. Do not tocolyze

Question 16

____ placenta implanted in the lower uterine segment of the uterus, presenting ahead of the leading pole of fetus

Answer 16

Placenta previa

Classic presentation: painless vaginal bleeding

Question 17

A low-lying placenta is defined as placental edge within ____

Answer 17

2cm from the os

Marginalis - approaching the border of the os

Question 18

What are the common risk factors of placenta previa?

Answer 18

1. Maternal age >35
2. Multiparity
3. Prior uterine surgery
4. Recurrent abortions
5. Smoking

Question 19

When can you do a vaginal delivery in patients with placenta previa?

Answer 19

> 35 weeks

1. Placental edge 2cm away from os
2. Placental edge within 0-20 mm from os (depends)

Question 20

What are the indications for CS in patients with placenta previa

Answer 20

1. Any degree of overlap after 35 weeks

2. Elective CS in asymptomatic women is not recommended

Question 21

When will you do elective CS for patients with placenta previa

Answer 21

1. <37 weeks

Question 22

When will you do elective CS for patients with placenta accreta

Answer 22

<36 weeks

Question 23

What are the risk factors for massive bleeding during CS via previa?

Answer 23

1. advanced maternal age
2. previous CS
3. Presence of sponge-like US findings in the cervix

Question 24

___ refers to placental villi are attached to the myometrium

Answer 24

Placenta accreta

Attached = Accreta

Question 25

___ refers to placental villi invading the myometrium

Answer 25

Placeta increta INvade = INcreta

Question 26

___ refers to placental villi that penetrate through the myometrium and to ir through the serosa

Answer 26

placenta percreta PEnetrate = PErcreta

Question 27

[Type of accreta] all lobules attached

Answer 27

Total accreta

Question 28

[Type of accreta] several cotyledons are attached

Answer 28

Partial accreta

Question 29

[Type of accreta] single lobule abnormally attached

Answer 29

Focal accreta

Question 30

What are the 2 most important risk factors of placeta accreta?

Answer 30

1. Previa | 2. Prior CS delivery

Question 31

Imperfect development of this layer can lead to the firm adherence of placental villi to the myometrium

Answer 31

nitabuch layer

Question 32

[Cause of DIC: Extrinsic or Intrinsic pathway] Rapid process of DIC Associated with abruptio placenta, amniotic fluid embolism, retained dead fetus, saline-induction abortion

Answer 32

Extrinsic

Question 33

[Cause of DIC: Extrinsic or Intrinsic pathway] Slow process associated with septic abortion, chorioamniotinis

Answer 33

Intrinsic