Obstetric Hemorrhage Flashcards Preview

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Flashcards in Obstetric Hemorrhage Deck (69)
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1
Q

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

A

40%

2
Q

What is the significance of the increase blood in pregnancy?

A

large blood losses can occur w/o clinical evidence

3
Q

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

A
  • SVD = 500ml

- C/S = 1000ml

4
Q

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

A

Increased TPR

5
Q

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

A

20%

6
Q

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

A

in parallel to each other

7
Q

What is placental abruption?

A

Premature separation of the normally implanted placenta from the uterus

8
Q

What is the clinical triad of placental abruption?

A
  • Painful Uterine bleeding
  • Hypertonic uterus
  • fetal distress/death
9
Q

Inspection of the vagina with placental abruption shows what?

A

Adherent retroplacental clot with depression of the the underlying placental tissue

10
Q
What is a grade I placental abruption? 
(-vaginal bleeding
-Uterine s/sx
-maternal BP
-maternal fibrinogen
-FHT)?
A
  • Slight vaginal bleeding
  • Uterine irritability
  • Unaffected BP
  • normal fibrinogen
  • FHT normal
11
Q
What is a grade II placental abruption? 
(-vaginal bleeding
-Uterine s/sx
-maternal BP
-maternal fibrinogen
-FHT)?
A
  • Mild to moderate uterine bleeding
  • Uterine irritable, tetanic, or frequent ctx
  • BP maintained, but orthostatic
  • Tachycardia
  • Fibrinogen decreased
  • FHT show distress
12
Q
What is a grade III placental abruption?
(-vaginal bleeding
-Uterine s/sx
-maternal BP
-maternal fibrinogen
-FHT)?
A
  • Moderate to severe bleeding
  • Uterine tetanic and painful
  • Hypotension
  • Fetal death
  • Fibrinogen less than 150
  • Coag abnormalities
13
Q

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

A

80%

14
Q

What is the etiology of placental abruption? (5)

A
  • Cocaine use
  • maternal smoking
  • poor nutrition
  • trauma
  • maternal HTN
15
Q

What is the hallmark presentation of placental abruption?

A

Painful bleeding in the 3rd trimester

16
Q

True or false: placental abruption rarely occurs more than once

A

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

17
Q

What is the treatment for a grade I placental abruption?

A

-Observe

18
Q

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

A
  • Continuous fetal monitoring
  • Tocolysis (?)
  • Delivery
  • volume resuscitation
19
Q

What is placenta previa?

A

Implantation of the placenta over the cervical os

20
Q

What are the three variations of placenta previa?

A
  • Total
  • Partial
  • Marginal
21
Q

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

A

Total

30% ish are these

22
Q

What is the complication of partial placenta previa?

A

Dilation causes detachment

23
Q

What is a marginal previa?

A

Placenta encroaches a bit onto the os

24
Q

How do you differentiated between marginal and partial placenta previa?

A

US and the degree of cervical dilation and method of diagnosis

25
Q

What is the leading cause of third-trimester hemorrhage?

A

Placenta previa

26
Q

What is the classic presentation of placenta previa?

A

painless vaginal bleeding

27
Q

What are the three major risk factors for placenta previa?

A
  • Advanced maternal age
  • Minority
  • Previous C-section
28
Q

Why are previous cesarean deliveries a risk for placenta previa?

A

implantation can get caught in the irregular scarred area

29
Q

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

A

2nd trimester d/t anatomy scan

30
Q

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

A

if marginal previa

Do double set up

31
Q

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

A

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

32
Q

What are accreta, increta, and percreta?

A
  • Accreta = attachment onto the myometrium
  • Increta = invades the myometrium
  • Percreta = penetrates the myometrium
33
Q

What is the decidua basalis?

A

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

34
Q

What is abnormal placentation?

A

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

35
Q

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

A

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

36
Q

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

A

Previa = Stops within 2 hours

Abruption, Continuous bleeding

37
Q

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

A
Painful = Abruption
Painless = Previa
38
Q

What happens to FHT with placenta previa? Placental abruption?

A

Normal with previa

Variable with abruptio

39
Q

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

A

Abruption has coagulation defects

Previa does not

40
Q

What is vasa previa?

A

Fetal vessels traverse the membranes and cover the os

41
Q

What is the classic presentation of vasa previa?

A

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

42
Q

What is the the fetal mortality rate with vasa previa?

A

more than 50%

43
Q

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

A

The myometrium to compress the vessels

44
Q

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

A

Myometrial dysfunction or retained POS

45
Q

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

A

Overdistention of the uterus 2/2:

  • Multiple gestations
  • Polyhydramnios
  • Fetal macrosomia
46
Q

How do you prevent or minimize PP hemorrhage?

A

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

47
Q

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

A

possibility of hemorrhage

48
Q

How do you manage hemorrhage PP?

A

Continue oxytocin/prostaglandins

-Frequently palpate fundus and monitor VS

49
Q

How is misoprostol administered to treat PP hemorrhage?

A

PR

50
Q

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

A
  • pRBCs = 3% and 1g

- Platelets = 5000-10000

51
Q

What is a first degree vaginal laceration?

A

vaginal mucosa and perineal skin

52
Q

What is a second degree vaginal laceration?

A

Also includes the muscles of the perineal body.

53
Q

What is a third degree vaginal laceration?

A

Also include the anal sphincter

54
Q

What is a fourth degree vaginal laceration?

A

Extends through rectal mucosa

55
Q

What are the three major pelvic hematomas?

A
  • Vulvar
  • Vaginal
  • Retroperitoneal
56
Q

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

A

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

Painful

57
Q

What is the treatment for a vulvar hematoma?

A

Volume support

-incise and evacuate clost

58
Q

What causes vaginal hematomas?

A

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

59
Q

What are the s/sx of vaginal hematoma?

A

Severe rectal pain or feels like she still has to push

60
Q

How do you treat vaginal hematomas?

A

Take to OR, I+D, pack

61
Q

What causes a retroperitoneal hematoma?

A

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

62
Q

How do you detect a retroperitoneal hematoma?

A

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

63
Q

What is the treatment for a retroperitoneal hematoma?

A
  • Surgical excision

- ligation of hypogastric vessels

64
Q

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

A

True

65
Q

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

A

True

66
Q

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

A

Asians

Hispanics

67
Q

Cryoprecipitate replaces which coagulation factors? What else?

A

8 and 12

Fibrinogen

68
Q

Fresh frozen plasma replaces which coagulation factors?

A

5, 8, and antithrombin III

69
Q

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

A
  • Accessory lobe of the placenta

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