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ENRP Exam 1 > Obstetric Hemorrhage and Sepsis > Flashcards

Obstetric Hemorrhage and Sepsis Flashcards

1
Q

What is the immediate course of action for a patient who is bleeding profusely after delivery

A
  • Get the appropriate team
  • 2 Large bore IV
  • Draw labs (CBC/Coag, Serial H/H, Type and cross)
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2
Q

how much will one unit of blood increase Hct and Hgb?

A

3% hct

1g/dL hgb

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3
Q

What do you need to rule out before a digital exam in heavy postpartum bleeding?

A

Rule out placenta previa

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4
Q

name common causes of vaginal bleeding prior to 20 weeks

A

Abortions
Ectopics
Cervical/vaginal path
Cervical insufficiency

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5
Q

Name causes of vaginal bleeding after 20 weeks in the upper gential tract

A

Placental Abruption
Placenta Previa
Uterine Rupture
Vasa Previa

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6
Q

Name causes of vaginal bleeding after 20 weeks in the lower genital tract

A 
Blood show labor
Cervical polyps
Infections
Trauma
Cancer
Vulvar varicosities 
Blood dyscrasia
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7
Q

what is the most common type of abnormal placentation

A

Placenta Previa

accounts for 20% of all antepartum hemorrhages

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8
Q

How does placenta previa present

A

Painless vaginal bleeding
20% will have associated contractions
Mean gestational age: 30 weeks

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9
Q

What are some risk factors for placenta previa

A 
>35 y/o
Multiparity
Cocaine/smoking
Prior Previa
C-section
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10
Q

What are the three classifications of Placenta previa

A

Marginal
Partial
Complete

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11
Q

What percent of previas will resolve by weeks 32-35?

A

90%

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12
Q

What is the main goal of managing placenta previa

A

keep baby gestating as long as possible.

Only deliver if fetal lung maturity confirmed or imminent threat

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13
Q

What are the three types of abnormal placental implantation

A

Placenta Accreta - superficial lining of myometrium
Placenta Increta - invades myometrium
Placenta precreta - through the myometrium into uterine serosa

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14
Q

what is placental abruption

A

premature separation of the normally implanted placenta

most common cause of 3rd trimester bleeding

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15
Q

How does placental abruption present

A

Painful bleeding, uterine tenderness, uterine hyperactivity

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16
Q

What is the most common risk factor for placental abruption

A

maternal HTN

17
Q

What is a dangerous pathology associated with placental abruption

A

DIC, most common cause of DIC in pregnancy

18
Q

what is couvelaire uterus

A

in placental abruption, extravasation of blood in the uterus, causing red & purple discoloration of the serosa

19
Q

What are risk factors associated with uterine rupture

A

Prior uterine incision
Trauma
Multiparity

20
Q

Velamentous insertion of the umbilical cord is responsible for what

A

fetal bleeding -> third trimester bleeding

21
Q

A woman presents for a check up. randomly she begins to bleed and the fetal heart rate skyrockets then begins to slow below normal. What occurred and what is the next step

A

Some sort of fetal bleeding

must proceed to delivery

22
Q

What is the most common cause of primary postpartum hemorrhage

A

uterine atony

23
Q

what are risk factors for uterine atony

A

enlargement of uterus
abnormal labor
conditions interfere with contractions of uterus

24
Q

how do you manage uterine atony clincally

A 
bimanual massage of the uterus 
Start oxytocin, and other pharmacological factors 
Uterine packing
Interventional radiology
Surgical Measure/hysterectomy
25
Q

What are the two options for surgical management of atonic uterine hemorrhage

A

O leary stitch - ligation of uterine artery

B-lynch suture

26
Q

How do you manage retained placenta

A

Reach up in there and grab it!

if you are gonna use D&C need US to not perforate

27
Q

what is an amniotic fluid embolism

A

Rare incorporation of amnion into maternal circulation ->consumptive coagulopathy

28
Q

What causes puerperal sepsis

A

changes in vaginal pH during delivery.

29
Q

What are key clinical features of puerperal sepsis

A

Postpartum fever and uterine tenderness day 2-3

make sure you r/o extra uterine causes of fever

30
Q

Differentiate ovarian and deep septic thrombophlebitis

A

Ovarian is fever and local pain in abdomen

deep septic us non localized fever unresponsive to abx and dont appear clinically ill

both are treated with heparin

ENRP Exam 1 (20 decks)

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