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antepartum hemorrhag
OB/GYN
Question | Answer |
---|---|
What are the most common causes of maternal death? | -Hemorrhage -Embolism -Hypertensive disease -infections |
antepartum hemorrhage? | significant bleeding that occurs during the third trimester, or after 20/24 weeks gestation |
initial evaluation of bleeding patient includes? | -establish hemodynamic stability -2large bore IV/Central venous line -vitals/mental status -CBC/coag profile/4units crossmatch |
when should a pelvic exam be perfomed in a patient with antepartum hemorrhage? | after U/S has ruled out presence of placenta previa |
placenta previa? | an abnoramally implanted placenta |
two most common causes of antepartum hemorrhage? | -Placenta previa -placenta abruption |
classic presentation of placenta previa? | painless vaginal bleeding after mid-second trimester |
classic presentation of placenta abruption | painful contractions accompanying significant vaginal bleeding after mid-second trimester |
complete placenta previa | placenta completely covers the internal os of the uterine cervix |
partial placenta previa | placenta partially covers the internal os |
marginal placenta previa | placenta with edge extending to margin of internal os |
low-lying placenta | edge of the placenta is within 2cm of the internal cervical os |
incidence of placenta previa before 20 weeks gestation | 4-6% |
90% placenta previa resolve by third trimester due to? | upward placental migration |
factors predisposing to placenta previa | 1 multiparity 2 multiple gestation 3 increasing maternal age 4 prior placenta previa |
Management of placenta previa depends on? | GESTATIONAL AGE AMOUNT OF BLEEDING |
goal in management of placenta previa | obtain fetal lung maturity without compromising the health of the mother |
if the patient reaches 36 weeks? | assess lung maturity by amniocentesis deliver by C/S |
why should a patient with previa deliver vaginally? | lower uterine segment is poorly contractile>>increased postpartum bleeding |
what can exacerbate bleeding in previa/ | PLACENTA ACCRETA |
placental accreta/increta/percerta | abnormal attachment to: 1- uterine wall (no nitabuch's layer 2- placenta penetrates into myomet 3- placenta penetrates through myome |
Abruptio placenta | premature separation of a normally implanted placenta |
risk factors for placental abruption | -maternal hypertension -prior abruption -trauma -polyhydraminos w/rapid compression -PPROM -short umbilicus -cocaine/cigarette |
pathophyhsiology of placental separation | hmg into decidua basalis >>hematoma>> compression/destruction of placental tissue |
concealed hemg | blood dissect upward toward the fundus more dangerous than revealed |
revealed hmg | blood extends downward toward the cervix |
couvelaire uterus | bleeding into myometrium of the uterus, discolored uterine surface. |
complication seen more often with placental abruption than previa | -coagulopathy. 2ndry to hypofibrinogenemia -fetal to maternal hmg -DIC |
how is placental abruption dx? | clinically, U/s detects only 2% may coexist with placenta previa, so do U/S even if suspecting abruption |
management of abruption? | maternal hemodynamics and fetal monitoring, serial hematocrit, coag profile, delivery. |
should tocolytics be used in abruption? | NO. uterine tone is needed to control bleeding |
complications of abruption | fetal: hypoxia>death maternal: DIC/Hypovol> acute renal faliure/sheehan syndrome |
uterine rupture? | complete separation of the uterine musculature through all of its layers |
incidence of uterine rupture? | .5 % |
causes of uterine rupture? | -spontaneous -traumatic -prior uterine scar before labor/during labor/@ delivery |
Dx of uterine rupture | sudden onset intense abdominal pain w/some vaginal bleeding abnormal fetal heart rate pattern/fetus more easily palpated |
management of rupture? | immediate laparotomy debridment and closure or hysterectomy. |
dx of fetal bleeding? | Apt test. vaginal blood put into tube add water and KOH>> color stays red??fetal blood. |
when does fetal bleeding occur | vasa previa? umblical cord vessels inserted into the membrane with the vessels overlying internal os. |