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antepartum hemorrhag

OB/GYN

QuestionAnswer
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.
Created by: asabi3 on 2012-04-25



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