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Flashcards in Placental problems Witrak Deck (27):
1

What is placenta previa?

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

2

When is placental previa suspected?

Painless vaginal bleeding in a women > 20wks gestation

(75% of cases)

3

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%)

4

How is placental previa diagnosed?

Transvaginal ultrasound

5

What are the risk factors for placental previa?

Prior history of previa
Prior C-section
Multiple gestation pregnancy

6

What is placental previa associated with?

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

7

When is placental previa treated? How?

Treated for severe hemorrhage by doing a C-section

8

What is placental abruption?

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

9

How does placental abruption present?

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

10

How is placental abruption diagnosed?

Ultrasound...suboptimal sensitivity

11

What are some risk factors/associations of placental abruption?

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

12

What is the pathology of placental abruption?

Retroplacental hematoma
Focal infarction

13

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

Placenta accrete

14

What causes placenta accrete?

Defective/thin decidua layer at implantation site

15

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

Accreta (79%)

16

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

INcreta (14%)...like INto

17

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

PErcreta (7%)...like PEnetrate

18

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

C-sections

19

How does placenta accrete present?

Severe hemorrhage when attempting manual placental separation

20

How is placenta accrete diagnosed?

Ultrasound

21

What is Post-Partum Hemorrhage (PPH)?

Sufficient hemorrhage to cause hypovolemic/hypoxic symptoms

22

What causes PPH?

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

Less commonly coagulation defects (DIC)

23

How long PPH be delayed?

24hr--12wks

24

What can trigger DIC in pregnancy?

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

How is DIC diagnosed?

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

26

How is DIC treated?

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

27

What does an unprovoked DVT or PE in pregnancy suggest?

Underlying inherited thrombotic disorder (>50%)