Third Tri & PP Bleeding

Question 1

Complete or total previa

Answer 1

Placenta completely covers the os

Question 2

Partial previa

Answer 2

placenta partially covers the internal os

Question 3

Marginal previa

Answer 3

Edge of placenta extends to margin of internal os

Question 4

Low lying placenta

Answer 4

Placenta lies in lower uterine segment, but does not extend to cervical os
Won’t attach to endometrial lining that is scarred

Question 5

Placenta abruptio

Answer 5

Premature separation of the normally implanted placenta from it’s attachment to uterus

Question 6

Uterine rupture

Answer 6

Complete separation of uterine musculature through all it’s layers

Question 7

Postpartum hemorrhage

Answer 7

Blood loss in excess of 500 mL for vaginal and 1000mL for c-section

Question 8

Placenta accreta

Answer 8

Placenta directly attached to myometrial wall

Absence of decidua basalis

Question 9

Placenta increta

Answer 9

Placenta invades myometrium

Question 10

Placenta percreta

Answer 10

Placenta penetrates myometrium to serosa or beyond

Question 11

Hemodynamic changes in preggers

Answer 11

Maternal blood vol increases (40%)
Plasma vol increased
Erythrocyte vol increased 
2,3 DPG increased 
Maternal blood pressure decreased 
HR, SV, CO, increased
Systemic vascular resistance decreased

Question 12

Top three most frequent causes of maternal death in US

Answer 12

Embolism
HTN Disease
Obstetrical hemorrhage

Question 13

Common causes of antepartum bleeding

Answer 13

Placenta previa

Placenta abruptio

Question 14

In antepartum hemorrhage, do not check the cervix unless what has been ruled out?

Answer 14

Placenta previa

Question 15

Most accurate means of determining cause of antepartum bleeding

Answer 15

Ultrasound

Picks up all previas, misses 50% of abruptions

Question 16

Preterm premature rupture of membranes (PPROM)

Answer 16

Water breaks before 37 weeks

Question 17

Premature rupture of membranes (PROM)

Answer 17

Water breaks but no contractions yet

Question 18

Dx of placenta previa

Answer 18

Classic presentation is painless, bright red bleeding

Question 19

What should you never forget if the mother is Rh neg?

Answer 19

RHOGAM

Question 20

Kleihauer Betke

Answer 20

Gives percentage of fetal blood to know how much rhogam to give

Question 21

Risk factors for placenta abruptio

Answer 21

Maternal HTN
COcaine abuse, especially crack
Trauma
Smoking
Polyhydraminos and multiple gestation
Previous abruption

Question 22

What is the most common cause of DIC in preggers?

Answer 22

Placenta abruptio

Question 23

MOA of placenta abruptio

Answer 23

Hemorrhage into decidua basalis with formation of hematoma
Separation of decidua from basal plate perpetuates itself and causes further separation as well as compression and destruction of tissue

Question 24

Couvelaire Uterus

Answer 24

Blueish purple discoloration to uterus caused by blood dissecting into myometrium

Question 25

Dx of placenta abruptio

Answer 25

Hallmark is painful vaginal bleeding in association with uterine tenderness, hyperactivity, and increased tone Blood is usually dark red US not useful Uterus is firm, like a contraction that's not going away

Question 26

Management of placenta abruptio

Answer 26

Stabilize mother

Question 27

Uterine rupture

Answer 27

Complete separation of uterine musculature through all of it's layers Fetus usually extruded in abdomen

Question 28

Dx of uterine rupture

Answer 28

Sudden onset of intense abdominal pain and vaginal bleeding

Question 29

Management of uterine rupture

Answer 29

Immediate laparotomy | Usually TAH is performed (TOC)

Question 30

Postpartum hemorrhage

Answer 30

Uterus fails to contract around myometrial spiral arterioles and decidual veins at attachment site after placental separation

Question 31

#1 cause of postpartum hemorrhage

Answer 31

Uterine atony - won't contract down; floppy, soft, and can have massive bleeding

Question 32

Management of postpartum hemorrhage

Answer 32

IV Pitocin

Question 33

Second most common cause of postpartum hemorrhage

Answer 33

Genital tract trauma

Question 34

Retained placenta

Answer 34

Fragments/pieces of placenta that did not come out Accreta, increta, and percretas Dx - exploration Tx - manual removal or D&C

Question 35

Uterine inversion

Answer 35

Turning inside out of uterus Usually iatrogenic Pt can go into profound vasovagal shock IT'S IN YO FACE, BITCH

Question 36

Management of uterine inversion

Answer 36

Immediate IV vol. expansion Halothane anesthesia or terbutaline to relax uterus Replace with fist and give immediate pitocin Possible surgical suspension

Question 37

Which coagulation disorder has an 80% mortality DIC?

Answer 37

Amniotic fluid embolism