Obstetric hemorrhage

Question 1

what is normal blood loss with vaginal delivery?

Answer 1

500 mL

Question 2

what is normal blood loss in a C section?

Answer 2

1000 mL

Question 3

definition: placental abruption

Answer 3

• premature separation of normally implanted placenta from uterus

Question 4

what is seen on inspection for placental abruption?

Answer 4

adherent retroplacental clot with depression of underlying placental tissue

Question 5

what is the triad for placental abruption?

Answer 5

• PAINFUL uterine bleeding
• uterine hypertonus / hyperactivity
• fetal distress and/or fetal death

Question 6

what drug is associated with placental abruption?

Answer 6

cocaine

Question 7

what is a frequent cause of placental abruption besides cocaine use?

Answer 7

maternal HTN

Question 8

painful vaginal bleeding in 3rd trimester - diagnosis?

Answer 8

placental abruption

Question 9

definition: placenta previa

what are the three variations?

Answer 9

• implantation of placenta over cervical os

- total, partial, marginal

Question 10

what type of placenta previa poses the most serious maternal risk?

Answer 10

total (complete)

Question 11

what is the leading cause of third trimester bleeding?

Answer 11

placenta previa

Question 12

how does placenta previa present?

Answer 12

PAINLESS vaginal bleeding

Question 13

painless vaginal bleeding in 3rd trimester - diagnosis?

Answer 13

placenta previa

Question 14

what are the risk factors for placenta previa?

Answer 14

• advanced maternal age
• black and other minorities
• previous C section

Question 15

definition: placenta accreta

Answer 15

attachment to myometrium

Question 16

definition: placenta increta

Answer 16

invades myometrium

Question 17

definition: placenta percreta

Answer 17

penetrates myometrium

Question 18

what layer is lost in placenta accreta / increta / percreta?

Answer 18

decidua basalis

Question 19

definition: vasa previa

what is the presentation?

Answer 19

• fetal vessels traverse the membranes and cover the os

- presentation: SROM, laceration of fetal vessel, rapid fetal death

Question 20

effective hemostasis after separation of placenta is dependent on what uterine factor?

what if this factor fails?

Answer 20

• contraction of myometrium to compress vessels

- failure to contract is attributed to myometrial dysfunction or retained placental fragments

Question 21

what are risk factors for postpartum hemorrhage?

Answer 21

• history of PP hemorrhage
• episiotomy, especially mediolateral
• operative delivery
• asian or hispanic ethnicity

Question 22

vaginal laceration: 1st degree

Answer 22

• fourchette
• vaginal mucosa
• perineal skin

Question 23

vaginal laceration: 2nd degree

Answer 23

• fourchette
• vaginal mucosa
• perineal skin
• muscles of perineal body

Question 24

vaginal laceration: 3rd degree

Answer 24

• fourchette
• vaginal mucosa
• perineal skin
• muscles of perineal body
• anal sphincter

Question 25

vaginal laceration: 4th degree

Answer 25

- fourchette - vaginal mucosa - perineal skin - muscles of perineal body - anal sphincter - rectal mucosa

Question 26

how does a vulvar hematoma occur?

Answer 26

- laceration of vessel in superficial fascia of anterior or posterior pelvic triangle - subacute blood loss - pain

Question 27

how does a vaginal hematoma occur?

Answer 27

- trauma to soft tissues during delivery - blood accumulates in plane above pelvic diaphragm - complains on severe rectal pressure - large mass protruding into vagina patient still feels like she has to push

Question 28

how does a retroperitoneal hematoma occur?

Answer 28

- laceration of a vessel originating from hypogastric artery and can dissect up to renal vasculature - patient will show signs of shock