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31 Cards in this Set
- Front
- Back
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3rd trimester bleeding is any bleeding from ___th week
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20
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5 obstetric causes of 3rd trimester bleeding
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bloody show
placenta previa abruptio placentae vasa previa uterine rupture |
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5 RFs for placenta previa (PP)
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previous PP
multiparity increased age multiple gestation uterine anomalies |
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4 uterine anomalies which cause PP
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leiomyoma
myomectomy previous C/S scar D&C |
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3 kinds of PP
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total
partial marginal |
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marginal PP means placenta is within ___ of ___
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2 cm
internal os |
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PP is painful/painless
abdomen is tender/nontender uterus is hard/soft fetal presentation is normal/abnormal FHR is normal/abnormal shock/anemia do/don't correspond with apparent loss coagulopathy is common/rare |
painless
nontender soft abnormal normal do rare |
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abruption is painful/painless
abdomen is tender/nontender uterus is hard/soft fetal presentation is normal/abnormal FHR is normal/abnormal shock/anemia do/don't correspond with apparent loss coagulopathy is common/rare |
painful
tender hard normal abnormal don't common |
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when bleeding is present, ___ cannot be done until ___ is done by ___
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digital PV exam
PP is ruled out US |
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5 possible fetal complications of PP
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PPROM
prematurity malpresentation hypoxia IUGR |
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___ is a maternal complication of PP associated with ___
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placenta accreta
previous uterine surgery |
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US can be used to dx ___ but not ___
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PP
abruption |
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1st step in managing 3rd trimester bleed is ___
check for maternal ___ |
abcs
hemodynamic stability |
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if mother is hemodynamically stable,
do ___ otherwise do ___ |
begin fetal monitoring
fluid resuscitation for mother |
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if maternal fluid resuscitation is successful, do ___
otherwise do ___ |
begin fetal monitoring
begin urgent delivery procedure |
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first step in urgent delivery procedure is ___
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US to locate placenta
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in urgent delivery, if placenta is over internal os, do ___
otherwise check ___ |
C/S
whether delivery is remote |
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in urgent delivery, if no PP and delivery is not remove, do ___
otherwise do ___ |
instrumental delivery
C/S |
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if mother is hemodynamically stable and NRFHR present, do ___
otherwise do ___ |
intrauterine fetal resuscitation
US to locate placenta |
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if intrauterine fetal resuscitation succeeds, do ___
otherwise do ___ |
US to locate placenta
urgent delivery |
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in non-urgent setting, if placenta previa is present, do C/S if any of ___
otherwise do ___ |
hemodynamically unstable
NRFHR EGA>=36w expectant management |
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in non-urgent setting, if placenta previa is NOT present, deliver if any of ___
otherwise do ___ |
hemodynamically unstable
NRFHR EGA>=36w expectant management |
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in non-urgent setting, if EGA<34 do ___
also, do ___ no matter what |
give betamethasone
manage anti-D if necessary |
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5 labs for 3rd trimester bleed
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CBC
INR PLT fibrinogen cross/match |
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be concerned if fibrinogen is high/low
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low
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8 RFs for abruption
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previous abruption
HTN smoking alcohol cocaine multiparity PPROM uterine anomaly |
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5 maternal complications of abruption
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DIC
ARF hemorrhagic shock Sheehan's syn amniotic fluid embolus |
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2 tests for vasa previa rupture
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apt
wright |
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apt test principle
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fetal supernatant turns pink with NaOH
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wright test principle
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fetal blood has nucleated RBCs
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vasa previa tx
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emergency C/S
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