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22 Cards in this Set
- Front
- Back
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The triad in abruptio placenta |
Abruptio placenta is the most common cause of: 1. Late trimester painful bleeding 2. Normal placental implantation 3. DIC in obstetrics |
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Risk factors for abruptio placenta |
- Previous abruption - Hypertension - Maternal blunt trauma - Cocaine - Couvelaire uterus: 'bruised' uterus (looks bruised cuz intense contractions resulted in blood extravasation in the midst of uterine myofibers (diagnosed during CS tho!) |
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Management of abruptio placenta |
- Maternal or fetal jeopardy: Emergency CS - Term, in labor, mom & fetus stable: Vaginal delivery - Preterm, UCs subsided, mom & fetus stable: Conservative, admit to hospital and follow; if improves, discharge |
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If you have transverse lie in the third trimester, what should you consider? |
- A fetal anomaly - A uterine anomaly - Placenta previa |
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The triad of placenta previa |
1. Late trimester bleeding 2. Low segment placental implantation 3. Painless |
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What's the mechanism of placental 'migration' (trophotropism)? |
Differential atrophy and hypertrophy because there is more blood supply coming from the lateral uterine well than from the lower portion |
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Prevalence of placenta previa at 16 weeks and 40 weeks |
At 16 weeks: up to 20% At 40 weeks: 0.5% |
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What's the pathophysiology of bleeding in placenta previa? |
Avulsion of anchoring villi from stretching of lower urine segment during effacement that occurs late part of pregnancy |
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Classification of placenta previa |
- Low-lying (marginal) - Partial - Total-central Bleeding is maternal |
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Risk factors for placenta previa |
- Previous history - Multiple gestation - ART (artificial reproductive technique) - increase by up to a factor of 5 |
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Management of placenta previa |
- Maternal or fetal jeopardy: Emergency CS - Preterm, stable mom & fetus: Conservative, in-hospital - Marginal placenta, 2cm from os: Vaginal delivery - Term, stable mom & fetus: Scheduled CS |
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When do you get placenta accreta, increta, percreta? |
If placenta previa occurs over a previous uterine scar, the villi may invade beyond Nitabuch layer, resulting in placenta accreta
*Nitabuch layer is a layer of fibrinoid tissue that separates the superficial portion of the desidua basalis from its deeper portion |
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How to you differentiate placenta accreta, increta, and percreta from one another |
Villi invade: - Deep basalis layer in placenta accreta (75-78%) - Partial myometrium in placenta increta (17%) - Serosa/bladder in placenta percreta (5%). If bladder is involved, the pt may present with hematuria |
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Vasa previa incidence |
1 in 3000 deliveries; very rare |
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The triad of vasa previa |
1. Rupture of membranes 2. Painless vaginal bleeding (bright red) 3. Fetal bradycardia; stable/normal maternal vitals |
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Pathophysiology of vasa previa |
- Bleeding is painless and is of fetal blood (vessels involved are fetal vessels traversing fetal membranes) - Placental implantation is normal |
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Risk factors for vasa previa |
- Velamentous cord insertion (vessels branch before the umbilical cord attaches to placental disk) - Accessory placental lobe - Multiple gestation |
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Management of vasa previa |
Crash CS!! Hypovolemia usually kills the fetus |
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Uterine Rupture |
- Painful bleeding - Normal placental implantation (not related to uterine rupture) - Due to complete laceration of uterine wall |
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Diagnostic tetrad of uterine rupture |
1. Painful late trimester bleeding 2. Lost fetal heart tracing 3. Loss of station (fetal head) 4. Inability to identify uterine contractions |
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Risk factors for uterine rupture |
- Classic CS - Previous myomectomy - Excessive oxytocin (rare) |
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Management of uterine rupture |
- Take fetus out, which is usually dead - Uterine repair - Hysterectomy if intractable bleeding |
