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18 Cards in this Set
- Front
- Back
What are some causes of first trimester vaginal bleeding?
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- miscarriage: chromosome abnormalities, progesterone deficiency
- ectopic pregnancy |
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Types of miscarriages.
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- blighted ovum: empty embryonic sac
- threatened miscarriage: any bleeding during early pregnancy - inevitable abortion: fetal heart stopped and cervix open - complete abortion - incomplete abortion - missed abortion |
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How do you figure out how much Rhogam you need to give for bleeds during pregnancy?
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Based on amount of fetal red blood cells
- 300mcg per 15 cc fetal blood cells (deternined by Kleihauer-Betke test) |
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What is the formula to determine fetal blood volume in Kleihauer-Betke test?
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maternal blood volume (5L) X maternal Hct X % fetal cells
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Maternla or fetal hemaglobin?
- resistent to acid solution |
fetal hemaglobin
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What is Rosette test?
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detects presemce of RH+ fetal blood in maternal circulation
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What are some causes of 2nd trimester bleeding?
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- placenta previa
- placental abruption - preterm labor - previability: cervical incompetence - recent coitus - cervical polyps, cancer |
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What are different grades of placenta previa?
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- low lying placenta
- marginal placenta previa - partial placenta previa - complete placenta previa |
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Risk factors for placenta previa.
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- prior c-sections and uterine surgeries
- multiparity - multiple gestation - smoking - h/o placenta previa - increased maternal age |
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What is this?
- "sentinel bleed" after 28wk gestation - sudden profuse painless vaginal bleeding |
placenta previa
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How to diagnose placenta previa?
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- u/s: transabdominal, translabial
- vaginal exam and u/s contraindicated |
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How to manage placenta previa?
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- strict bed rest
- c section if unstoppable labor, fetal distress, or life threatening bleed |
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How to manage this case?
- placenta previa with accreta |
- hysterectomy at the time of delivery (puerperal hysterectomy)
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Definitions of these terms:
- placenta accreta - placenta increta - placenta percreta - vasa previa |
- placenta accreta: placenta invades superficial uterine wall
- placenta increta: placenta invades myometrium - placenta percreta: placenta invades uterine serosa - vasa previa: fetal vessels course over cervix |
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What are some complications of placenta previa?
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- hemorrhage
- preterm delivery - PPROM - IUGR - comgenital malformation - risk pf puerperal hysterectomy |
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How to diagnose placenta accreta?
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- MRI is the best imaging choice
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How to manage placenta accreta?
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- surgical planning
- catheter placement, pre-op for embolization if necessary - expect to transfuse |
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What is placental abruption?
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- premature separation of normally implanted placenta from the uterine wall resulting in hemorrhage between uterine wall and placenta
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