Postpartum Bleeding and Infection Flashcards

1
Q

Uterine atony risk factors

A

Precipitous labor
Multiparity
Twins
General anesthesia
Oxytocin use
Macrosomia
Hydramnios
Chorioamnionitis

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2
Q

Placenta previa risk factors

A

Prior C-section
Myomectomy
Maternal age >35
Previous D&C

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2
Q

What should you do if you discover placenta previa during 18-20 wga ultrasound?

A

Serial ultrasounds throughout pregnancy

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3
Q

Which uterotonic should not be used in patient with asthma?

A

Prostaglandin F2-alpha (carboprost tromethamine) - potent smooth muscle constrictor and bronchoconstrictor

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4
Q

Which uterotonic should not be used in patients with hypertension or pre-eclampsia?

A

Methylergonovine

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5
Q

What are the risk factors for uterine overdistension/uterine inversion?

A

Excessive traction on umbilical cord
Grand multiparity
Multiple gestation
Polyhydramnios
Morbidly adherent placenta
Macrosomia

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6
Q

Order of treatments for postpartum hemorrhage due to uterine atony

A

Uterotonics
B-Lynch stich
Hypogastric artery ligation
Cesarian hysterectomy

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7
Q

How should oxytocin be delivered?

A

Diluted with IV fluids - do not give as an IV push

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8
Q

When should uterine artery embolization be considered?

A

When uterine atony, retained placental products, and lacerations have been ruled out as sources of bleeding

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9
Q

What do US placental lakes finding suggest?

A

Morbidly adherent placenta/placenta accreta spectrum

Often seen with history of C/S

May require hysterectomy for uncontrolled bleeding

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10
Q

Delayed (48-72h) postpartum hemorrhage suggests what etiology?

A

Von Willebrand disease coagulopathy

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11
Q

Risk factors for placental abruption

A

HTN
Advanced maternal age
Cocaine
Alcohol

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12
Q

What is gold standard antibiotics following C/S?

A

Gentamicin (gram-negative) + clindamycin (anaerobes)

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13
Q

Postpartum endometritis is a clinical diagnosis, based on what signs and symptoms?

A

Fever +:
Uterine tenderness
Abnormal vaginal discharge or odor
Delay in rate of reduction of size of uterus

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14
Q

When should septic pelvic thrombophlebitis be suspected?

A

A diagnosis of exclusion, after abscess (via CT) has been ruled out

Antibiotics + anticoagulation

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15
Q

What RUQ infection does pregnancy put women at risk for?

A

Cholelithiasis and cholecystitis

16
Q

What is the most common cause of fever on postpartum day 1?

A

Lungs - mostly due to general anesthesia and aspiration pneumonia

17
Q

What is the order of interventions for postpartum uterine atony?

A

Uterine massage, high-dose oxytocin
Tranexamic acid (antifibrinolytic agent)
Carboprost tromethamine (Prostaglandin F2-alpha), methylergonovine

18
Q

vWF synthesis is increased by what hormones?

A

Estrogen and thyroid hormone

19
Q

What are the diagnostic means for vWD?

A

vWF antigen, vWF activity (ristocetin cofactor activity; ristocetin promotes platelet agglutination in presence of vWF), factor VIII levels

20
Q

Describe progression of lochia after delivery

A

Rubra (dark/bright red blood with small clots) –> serosa (serosanguinous (pink), brownish (old blood)) –> alba (white/yellow, creamy, light quantity), which is up to 8 weeks