Obstetric Hemorrhage Flashcards Preview

OB/GYN > Obstetric Hemorrhage > Flashcards

Flashcards in Obstetric Hemorrhage Deck (69):
1

By the 30th week of pregnancy, what is the expansion in blood volume?

40%

2

What is the significance of the increase blood in pregnancy?

large blood losses can occur w/o clinical evidence

3

What Is the normal blood loss with a SVD? C/s?

-SVD = 500ml
-C/S = 1000ml

4

What is the initial change that is used to maintain bp with hemorrhage?

Increased TPR

5

After what percent of blood loss is there a fall in CO such that SVR can no longer maintain BP?

20%

6

How do BP and CO decrease in relation to one another?

in parallel to each other

7

What is placental abruption?

Premature separation of the normally implanted placenta from the uterus

8

What is the clinical triad of placental abruption?

-Painful Uterine bleeding
-Hypertonic uterus
-fetal distress/death

9

Inspection of the vagina with placental abruption shows what?

Adherent retroplacental clot with depression of the the underlying placental tissue

10

What is a grade I placental abruption?
(-vaginal bleeding
-Uterine s/sx
-maternal BP
-maternal fibrinogen
-FHT)?

-Slight vaginal bleeding
-Uterine irritability
-Unaffected BP
-normal fibrinogen
-FHT normal

11

What is a grade II placental abruption?
(-vaginal bleeding
-Uterine s/sx
-maternal BP
-maternal fibrinogen
-FHT)?

-Mild to moderate uterine bleeding
-Uterine irritable, tetanic, or frequent ctx
-BP maintained, but orthostatic
-Tachycardia
-Fibrinogen decreased
-FHT show distress

12

What is a grade III placental abruption?
(-vaginal bleeding
-Uterine s/sx
-maternal BP
-maternal fibrinogen
-FHT)?

-Moderate to severe bleeding
-Uterine tetanic and painful
-Hypotension
-Fetal death
-Fibrinogen less than 150
-Coag abnormalities

13

What percent of placental abruption occurs before the onset of labor?

80%

14

What is the etiology of placental abruption? (5)

-Cocaine use
-maternal smoking
-poor nutrition
-trauma
-maternal HTN

15

What is the hallmark presentation of placental abruption?

Painful bleeding in the 3rd trimester

16

True or false: placental abruption rarely occurs more than once

False-- significant rate of recurrence (5-17%)

17

What is the treatment for a grade I placental abruption?

-Observe

18

What is the treatment for a grade II or more placental abruption?

-Continuous fetal monitoring
-Tocolysis (?)
-Delivery
-volume resuscitation

19

What is placenta previa?

Implantation of the placenta over the cervical os

20

What are the three variations of placenta previa?

-Total
-Partial
-Marginal

21

What type of placenta previa is the worst? What fraction of previas are these?

Total

30% ish are these

22

What is the complication of partial placenta previa?

Dilation causes detachment

23

What is a marginal previa?

Placenta encroaches a bit onto the os

24

How do you differentiated between marginal and partial placenta previa?

US and the degree of cervical dilation and method of diagnosis

25

What is the leading cause of third-trimester hemorrhage?

Placenta previa

26

What is the classic presentation of placenta previa?

*painless* vaginal bleeding

27

What are the three major risk factors for placenta previa?

-Advanced maternal age
-Minority
-Previous C-section

28

Why are previous cesarean deliveries a risk for placenta previa?

implantation can get caught in the irregular scarred area

29

When are most placenta previas found, when they are? Why?

2nd trimester d/t anatomy scan

30

When is vaginal delivery appropriate for placenta previa? Why should be done for this?

if marginal previa

Do double set up

31

If you diagnose placenta previa a long time from delivery, what should you do?

Expectant management with avoidance of sexual intercourse d/t contraction induction

32

What are accreta, increta, and percreta?

-Accreta = attachment onto the myometrium
-Increta = invades the myometrium
-Percreta = penetrates the myometrium

33

What is the decidua basalis?

the area of endometrium between the implanted chorionic sac and the myometrium, which develops into the maternal part of the placenta

34

What is abnormal placentation?

formation of an abnormally firm attachment to the uterine wall with *loss of the deciruda basalis* and incomplete development of the fibrinoid layer

35

What is the incidence of abnormal placentation with previa without prior surgery? WIth precios c/s with multiple c/s?

W/o = 4%
with 1 = 10-35%
with multiple = 60-65%

36

How long does the bleeding last for with placenta previa? Placental abruption?

Previa = Stops within 2 hours

Abruption, Continuous bleeding

37

Which presents with painful bleeding: Placenta previa/abruption? Painless?

Painful = Abruption
Painless = Previa

38

What happens to FHT with placenta previa? Placental abruption?

Normal with previa
Variable with abruptio

39

Which commonly has coagulation defects: placenta previa or placental abruption?

Abruption has coagulation defects

Previa does not

40

What is vasa previa?

Fetal vessels traverse the membranes and cover the os

41

What is the classic presentation of vasa previa?

SROM, laceration of the fetal vessel, and rapid fetal death

42

What is the the fetal mortality rate with vasa previa?

more than 50%

43

Effective hemostasis after separation of the placenta is dependent on what?

The myometrium to compress the vessels

44

Failure of the myometrium to compress the myometrial vessels is usually attributed to what?

Myometrial dysfunction or retained POS

45

What are the risk factors for myometrial dysfunction? (3)

Overdistention of the uterus 2/2:
-Multiple gestations
-Polyhydramnios
-Fetal macrosomia

46

How do you prevent or minimize PP hemorrhage?

Establish IV access just prior to labor, and prep for possible blood transfusion

47

Why do you want to avoid excessive traction on the umbilical cord during delivery?

possibility of hemorrhage

48

How do you manage hemorrhage PP?

Continue oxytocin/prostaglandins

-Frequently palpate fundus and monitor VS

49

How is misoprostol administered to treat PP hemorrhage?

PR

50

1 unit of pRBC increase HCT and Hb by what? 1 unit of platelets?

-pRBCs = 3% and 1g
-Platelets = 5000-10000

51

What is a first degree vaginal laceration?

vaginal mucosa and perineal skin

52

What is a second degree vaginal laceration?

Also includes the muscles of the perineal body.

53

What is a third degree vaginal laceration?

Also include the anal sphincter

54

What is a fourth degree vaginal laceration?

Extends through rectal mucosa

55

What are the three major pelvic hematomas?

-Vulvar
-Vaginal
-Retroperitoneal

56

What is a vulvar hematoma? Are these painful or painless?

Laceration of vessel in superficial fascia of anterior or posterior pelvic triangle

Painful

57

What is the treatment for a vulvar hematoma?

Volume support
-incise and evacuate clost

58

What causes vaginal hematomas?

Results from trauma to soft tissues during delivery, causing blood to accumulate in the plane above the pelvic diaphragm

59

What are the s/sx of vaginal hematoma?

Severe rectal pain or feels like she still has to push

60

How do you treat vaginal hematomas?

Take to OR, I+D, pack

61

What causes a retroperitoneal hematoma?

Laceration of a vessel originating from the hypogastric artery, and can dissect up to the renal vasculature

62

How do you detect a retroperitoneal hematoma?

Uterus will be displaced d/t hematoma, and s/sx of shock

63

What is the treatment for a retroperitoneal hematoma?

-Surgical excision
-ligation of hypogastric vessels

64

True or false: A previous oxytocin-stimulated labor is a risk factor for the development of myometrial dysfunction

True

65

True or false: Prolonged or rapid labor is a risk factor for myometrial dysfunction

True

66

What are the two ethnicities that have an increased risk for postpartum hemorrhage?

Asians
Hispanics

67

Cryoprecipitate replaces which coagulation factors? What else?

8 and 12
Fibrinogen

68

Fresh frozen plasma replaces which coagulation factors?

5, 8, and antithrombin III

69

What is a succenturiate lobe? What is the significance of this?

-Accessory lobe of the placenta
-Increases the risk of leaving behind part of the placenta after delivery