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20 Cards in this Set
- Front
- Back
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How much blood is lost in vaginal delivery?
C/S? |
500ml
1000ml |
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6 Causes of Antepartum Hemorrhage
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Placenta Previa
Placental Abruption Vasa Previa Ectopic Pregnancy Miscarriage (Midtrimester abortion) Gestational Trophoblastic Neoplasia |
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How does mother prepare for blood loss during delivery?
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Blood volume and CO expansion
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Def'n placenta previa
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Abnormal location of the placenta at or near the internal cervical os
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What are the three (four) types of PP?
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Total
Partial Marginal (Low lying placenta -- possibility of SVD) |
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Causes / Associations / Frequency
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1/250 deliveries
- Multiparity Previous uterine surgery (e.g. C/ S, myomectomy) - Previous placenta accreta, increta, percreta |
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Signs and Symptoms of PP
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- Painless bleeding at or after end of 2nd trimester
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How do you investigate?
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do NOT do a vaginal exam
U/S, or if none available consider double -set up where exam is done in OR and C/S can be done if needed |
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Where is placenta normally in 1st trimester?
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Can be previa. Repeat ultrasounds later (3rd trim) may show migration
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What can exacerbate PP?
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Intercourse / intense exercise
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Management PP
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Depending on GA, do a C/S when necessary
CANNOT deliver placenta before baby |
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Abruptio Placenta Def'n
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Premature separation of normally implanted placenta
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Causes AP
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Trauma
Recurrence Hypertension Multiple Gestation Uterine Anomaly Fibroids Substances (cocaine -- contractions) Idiopathic |
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Dx AP
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Clinical
+ / - bleeding Pain Shock DIC Renal failure FETAL DISTRESS (unlike PP) |
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Management AP
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Stabilize mother
Deliver if fetal distress (vaginally if possible) |
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DIC Def'n
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A manifestation of another disorder; a syndrome of a generalized coagulation and fibrinolysis
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DIC - Causes
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AP
Fetal death in utero Pregnancy Induced Hypertension Post Partum Hemorrhage |
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Management DIC
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Supportive Care
(fluid, blood, cryoprecipitate, FFP, PLTs) Tx underlying cause |
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Antepartum Hemorrhage: Rare Causes / Red Herrings
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Vasa Previa
Non-obstetrical: e.g. cervical SCC |
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What is Vasa Previa?
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Blood vessels in membranes lie over cervical os ; rupture of membrane may cause fetal distress
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