Obgyn 5-0

Front 1

1. Placenta Previa?

Back 1

a. Abnormal implantation of the placenta over the internal cervical os.

Front 2

2. Complete previa?

Back 2

a. When the placenta completely covers the internal os.

Front 3

3. Partial previa?

Back 3

a. When the placenta covers a portion of the internal os.

Front 4

4. Marginal previa?

Back 4

a. When the edge of the placenta reaches the margin of the os.

Front 5

5. Vasa previa?

Back 5

a. A fetal vessel which lies over the cervix.

Front 6

6. Bleeding from placenta previa?

Back 6

a. Results from disruption in the placental attachment during normal development and thinning of the lower uterine segment during the 3rd trimester.
b. Profuse haemorrhage and shock can occur.

Front 7

7. Note placenta previa may be complicated by placenta accreta (placenta previa accreta).

Back 7

7. Note placenta previa may be complicated by placenta accreta (placenta previa accreta).

Front 8

8. Placenta accreta?

Back 8

a. Defined as abnormal invasion of the placenta into the uterine wall.
b. An accreta is defined as the superficial invasion of the placenta into the uterine myometrium.
c. Causes an inability of the placenta to properly separate from the uterine wall after delivery of the fetus.
d. Can result in profuse haemorrhage and shock.

Front 9

9. Increta?

Back 9

a. Occurs when the placenta invades the myometrium.

Front 10

10. Percreta?

Back 10

a. Occurs when the placenta invades through the myometrium.

Front 11

11. What do 2/3 of women w/both a placenta previa and an associated accreta require?

Back 11

a. A hysterectomy at the time of delivery (puerperal hysterectomy)

Front 12

12. How do pts w/placenta previa classically present?

Back 12

a. Sudden and profuse PAINLESS Vaginal Bleeding. Usually after 28 weeks gestation.

Front 13

13. Diagnosis of placenta previa?

Back 13

a. U/S->95% sensitivity.

Front 14

14. Velamentous placenta?

Back 14

a. Occurs when the blood vessels insert between the amnion and chorion, away from the margin of the placenta. This leaves the vessels largely unprotected and vulnerable to compression or injury.

Front 15

15. Succenturiate placenta?

Back 15

a. An extra lobe of the placenta that is implanted at some distance away from the rest of the placenta.
b. Fetal vessels may course between the two lobes, possibly over the cervix, leaving these blood vessels unprotected and at risk for rupture.

Front 16

16. Can you do a vaginal exam or transvaginal U/S with placenta previa?

Back 16

a. No, both are contraindicated in known placenta previa.

Front 17

17. Placental abruption (abruptio placentae)?

Back 17

a. Premature separation of the normally implanted placenta from the uterine wall, resulting in haemorrhage between the uterine wall and the placenta.

Front 18

18. Concealed haemorrhage?

Back 18

a. In 20% of placental separations, bleeding is confined w/in the uterine cavity and is referred to as concealed haemorrhage.

Front 19

19. External haemorrhage?

Back 19

a. 80% of cases
b. The blood dissects downward toward the cervix, resulting in a revealed or external haemorrhage.
c. Bc there is an egress for the blood, they are less likely to result in larger retroperitoneal clots, which are associated w/fetal demise.

Front 20

20. Most common factor associated w/increased incidence of abruption?

Back 20

a. Hypertension, whether chronic, preeclampsia, or maternal ingestion of cocaine or meth.

Front 21

21. Classic presentation of placental abruption?

Back 21

a. 3rd trimester vaginal bleeding associated w/severe abdominal pain and/or frequent, strong contractions.

Front 22

22. Presentation of placental abruption on PE?

Back 22

a. Will often have vaginal bleeding and a firm, tender uterus.
b. On tocometer, small frequent contractions are usually seen as well as tetanic contractions.

Front 23

23. Diagnosis of placental abruption?

Back 23

a. Primarily clinical.
b. Only 2% are picked up by U/S (evidenced by retroperitoneal clot).

Front 24

24. Tx of placental abruption?

Back 24

a. The potential for rapid deterioration (e.g., haemorrhage, DIC, fetal hypoxia) necessitates delivery in some cases of placental abruption.
b. Most are small and non-catastrophic.

Front 25

25. Preferred delivery for placental abruption?

Back 25

a. Vaginal as long as bleeding is controlled and there are no signs of fetal distress.

Front 26

26. Uterine rupture?

Back 26

a. Represents a potential obstetric catastrophe and can lead to both maternal and fetal death.
b. Most complete uterine ruptures occur during the course of labour.
c. Over 90% are associated w/a prior uterine scar.

Front 27

27. Presentation of uterine rupture?

Back 27

a. Highly variable.
b. Sudden onset of intense abdominal pain.
c. Vaginal bleeding, if present, may range from spotting to severe haemorrhage.
d. Nonreassuring fetal testing, abnormal abdominal contour, cessation of uterine contractions, disappearance of fetal heart tones, and regression of the presenting part are other signs of uterine rupture

Front 28

28. Treatment of uterine rupture?

Back 28

a. Immediate laparotomy and delivery of the fetus.
b. If feasible, the rupture site should be repaired and haemostasis obtained.
c. Pts are usually discouraged to attempt future pregnancies given the high risk of recurrent rupture.

Front 29

29. Fetal vessel rupture?

Back 29

a. Most pregnancies complicated by rupture of a fetal vessel are due to velamentous cord insertion where the blood vessels insert between the amnion and chorion away from the placenta instead of inserting directly into the chorionic plate.

Front 30

30. Vasa previa?

Back 30

a. When the vessels cross over the internal cervical os. Can happen with velamentous cord insertion.

Front 31

31. Succenturiate placenta?

Back 31

a. Unprotected fetal vessels and vasa previa may occur w/a succenturiate placenta or accessory placental lobe.
b. In This case, the bulk of the placenta is implanted in one portion of the uterine wall, but a small lobe of the placenta is implanted in another location.

Front 32

32. Clinical manifestations of fetal vessel rupture?

Back 32

a. Vaginal bleeding associated w/sinusoidal variation of the FHR indicative of fetal anaemia.

Front 33

33. How can fetal vessel rupture be diagnosed at time of vaginal bleeding?

Back 33

a. Apt test or examination of the blood for nucleated (fetal) RBCs.

Front 34

34. Tx of fetal vessel rupture?

Back 34

a. Emergent C-section.