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Flashcards in Placental problems Witrak Deck (27)
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1
Q

What is placenta previa?

A

Presence of placental tissue over or just proximal (< 2cm) to the internal cervical os

2
Q

When is placental previa suspected?

A

Painless vaginal bleeding in a women > 20wks gestation

75% of cases

3
Q

Painless bleeding is the symptom in 75% of placental previa cases, what makes up the remaining 25%?

A

Vaginal bleeding + uterine contractions → simulates abruption (15%)

Reach term w/o bleeding (10%)

4
Q

How is placental previa diagnosed?

A

Transvaginal ultrasound

5
Q

What are the risk factors for placental previa?

A

Prior history of previa
Prior C-section
Multiple gestation pregnancy

6
Q

What is placental previa associated with?

A
Placenta accrete (in proportion to number of C-sections)
Amniotic fluid embolism
7
Q

When is placental previa treated? How?

A

Treated for severe hemorrhage by doing a C-section

8
Q

What is placental abruption?

A

Bleeding at the decidual/placental interface d/t partial or complete detachment

9
Q

How does placental abruption present?

A

Vaginal bleeding
Abdominal pain
Uterine contractions
Maybe abnormal fetal heart tone pattern

10
Q

How is placental abruption diagnosed?

A

Ultrasound…suboptimal sensitivity

11
Q

What are some risk factors/associations of placental abruption?

A
Trauma (small%)
Uterine anomalies
Smoking/cocaine use
Chronic uteroplacental hypoperfusion
Sever preeclampsia/HTN
12
Q

What is the pathology of placental abruption?

A

Retroplacental hematoma

Focal infarction

13
Q

What is it called when the placenta is morbidly adherent/stuck?

A

Placenta accrete

14
Q

What causes placenta accrete?

A

Defective/thin decidua layer at implantation site

15
Q

There are three types of placenta accrete. Which is when the villi are stuck to superficial myometrium (hardly penetrates)?

A

Accreta (79%)

16
Q

There are three types of placenta accrete. Which is when the villi penetrate INto the myometrium?

A

INcreta (14%)…like INto

17
Q

There are three types of placenta accrete. Which is when the villi PEnetrate through the myometrium?

A

PErcreta (7%)…like PEnetrate

18
Q

With which surgical procedure is there a huge correlation to placenta accrete?

A

C-sections

19
Q

How does placenta accrete present?

A

Severe hemorrhage when attempting manual placental separation

20
Q

How is placenta accrete diagnosed?

A

Ultrasound

21
Q

What is Post-Partum Hemorrhage (PPH)?

A

Sufficient hemorrhage to cause hypovolemic/hypoxic symptoms

22
Q

What causes PPH?

A
Uterine atony (80%)
Retained placenta
Overdistention/prolonged labor, drug effects, infection

Less commonly coagulation defects (DIC)

23
Q

How long PPH be delayed?

A

24hr–12wks

24
Q

What can trigger DIC in pregnancy?

A
Severe preeclampsia/abruption
Retained dead fetus (> 4wks)
Septic abortion
Amniotic fluid embolism
Acute fatty liver of pregnancy
Massive hemorrhage event (previa, accrete, uterine atony/rupture)
25
Q

How is DIC diagnosed?

A

Prolonged PT/PTT
Thrombocytopenia
Low fibrinogen
Increased d-dimer levels

26
Q

How is DIC treated?

A

1:1:1 massive transfusion protocol + cryoprecipitate as needed
Removal of inciting factor

27
Q

What does an unprovoked DVT or PE in pregnancy suggest?

A

Underlying inherited thrombotic disorder (>50%)