Obstetric Hemorrhage and Peurperal Sepsis

Question 1

What are common causes of vaginal bleeding at < 20 wks gestation

Answer 1

Abortion
Ectopic
Cervical/Vaginal issue
Cervical insufficiency
Retroplacental clot
Subchorionic hemorrhage

Question 2

What are the 3 most common causes of bleeding > 20 wks gestation

Answer 2

Placenta abruption
Placenta previa
Uterine rupture

Question 3

Def = separation of normally implanted placenta

Answer 3

Placenta abruption

Question 4

Sx’s = painful vaginal bleeding, uterine tenderness, fetal distress

Answer 4

Placenta abruption

Question 5

What is the most common cause of DIC in pregnancy

Answer 5

Placenta abruption

Question 6

Def = extravasation of blood into the uterus causing red/purple discoloration under serosa

Answer 6

Couvelaire uterus

Question 7

How do you deliver when there is a placenta abruption

Answer 7

Vaginally if both are stable

Question 8

Def = implantation of the placenta over the cervical os

Answer 8

Placenta previa

Question 9

What is the most common type of abnormal placentation

Answer 9

Placenta previa

Question 10

Sx’s = painless vaginal bleeding

Answer 10

Placenta previa

Question 11

What is the Tx for placenta previa

Answer 11

Bed rest if not profuse bleeding

C-section of > 36 wks

Question 12

What is the Tx for a uterine rupture

Answer 12

Immediate laparotomy and delivery

Question 13

Def = firm attachment of the placenta to the superficial lining of the myometrium

Answer 13

Placenta accreta

Question 14

Def = placenta invades into the myometrium

Answer 14

Placenta increta

Question 15

Def = placenta invades into the uterine serosa

Answer 15

Placenta precreta

Question 16

Def = fetal blood vessels covering the uterine os

Answer 16

Vasa previa

Question 17

What is the likely cause of 3rd trimester fetal bleeding

Answer 17

Velamentous cord rupture

Question 18

What is the criteria for primary vs secondary PPH

Answer 18

Primary = < 24 hrs PP
Secondary = 24 hrs - 12 wks PP

Question 19

What are the 4 main causes of primary PPH

Answer 19

Uterine atony
Retained placenta
Coagulopathies
Uterine inversion

Question 20

What are the Tx options for uterine atony

Answer 20

Bimanual massage
Pitocin
Uterine packing

Question 21

What is the Tx option for retained placenta

Answer 21

Manual removal

Question 22

If a uterine inversion occurs with the placenta still attached, what should you do with the placenta

Answer 22

Leave it attached until the uterus is replaced

Question 23

What are the 4 common causes of secondary PPH

Answer 23

Subinvolution of placental site
Retained products of conception
Infection
Coagulation defects

Question 24

What is the leading cause of maternal death worldwide

Answer 24

PH

Question 25

What are the 1st and 2nd most common causes of PPH

Answer 25

``` 1st = uterine atony 2nd = genital tract trauma ```

Question 26

What are the Sx's of Virchow's triad

Answer 26

Endothelial damage Venous stasis Hypercoagulable state

Question 27

What is the difference between Ovarian Vein Thrombophlebitis and Deep Septic Pelvic Vein Thrombophlebitis

Answer 27

Ovarian Vein Thrombophlebitis --> pt appears ill w/ fever and ab pain

Question 28

What is the Tx for Septic pelvic thrombophlebitis

Answer 28

Unfractionated/LMW Heparin