Flashcards in Placental problems Witrak Deck (27):
What is placenta previa?
Presence of placental tissue over or just proximal (< 2cm) to the internal cervical os
When is placental previa suspected?
Painless vaginal bleeding in a women > 20wks gestation
(75% of cases)
Painless bleeding is the symptom in 75% of placental previa cases, what makes up the remaining 25%?
Vaginal bleeding + uterine contractions → simulates abruption (15%)
Reach term w/o bleeding (10%)
How is placental previa diagnosed?
What are the risk factors for placental previa?
Prior history of previa
Multiple gestation pregnancy
What is placental previa associated with?
Placenta accrete (in proportion to number of C-sections)
Amniotic fluid embolism
When is placental previa treated? How?
Treated for severe hemorrhage by doing a C-section
What is placental abruption?
Bleeding at the decidual/placental interface d/t partial or complete detachment
How does placental abruption present?
Maybe abnormal fetal heart tone pattern
How is placental abruption diagnosed?
What are some risk factors/associations of placental abruption?
Chronic uteroplacental hypoperfusion
What is the pathology of placental abruption?
What is it called when the placenta is morbidly adherent/stuck?
What causes placenta accrete?
Defective/thin decidua layer at implantation site
There are three types of placenta accrete. Which is when the villi are stuck to superficial myometrium (hardly penetrates)?
There are three types of placenta accrete. Which is when the villi penetrate INto the myometrium?
INcreta (14%)...like INto
There are three types of placenta accrete. Which is when the villi PEnetrate through the myometrium?
PErcreta (7%)...like PEnetrate
With which surgical procedure is there a huge correlation to placenta accrete?
How does placenta accrete present?
Severe hemorrhage when attempting manual placental separation
How is placenta accrete diagnosed?
What is Post-Partum Hemorrhage (PPH)?
Sufficient hemorrhage to cause hypovolemic/hypoxic symptoms
What causes PPH?
Uterine atony (80%)
Overdistention/prolonged labor, drug effects, infection
Less commonly coagulation defects (DIC)
How long PPH be delayed?
What can trigger DIC in pregnancy?
Retained dead fetus (> 4wks)
Amniotic fluid embolism
Acute fatty liver of pregnancy
Massive hemorrhage event (previa, accrete, uterine atony/rupture)
How is DIC diagnosed?
Increased d-dimer levels
How is DIC treated?
1:1:1 massive transfusion protocol + cryoprecipitate as needed
Removal of inciting factor