What is vaginal bleeding any time after 20 weeks of gestation
100
What is the first question you should ask a triage pt presenting with antepartum hemorrhage?
What is any complications with pregnancy or known placenta issues?
also acceptable is history of current bleeding.
100
Pt presents at 34 wks with complaint of vaginal bleeding, what is the your first step?
What is history and vitals
100
What percentage of pregnancies will experience antepartum hemorrhage?
What is 2-5%
200
List the three most common identifiable causes of antepartum hemorrhage:
What is placental abruption, placental previa and lower genital tract lesion
200
Image 2
What is placenta previa
200
Pt has recently been dx with placenta previa during her second pregnancy. Her first was delivered by PLTCS, what dx should be ruled in or out?
What is abnormal placentation (accretia/increta/percreta)
complicates 1:2500 births
200
Once maternal status and fetal heart tones are established, how do you assess bleeding status in order to determine next step?
What is visualize pt perineum; if minimal bleeding and above is stable you proceed with US to determine placenta location, if unstable or questionable or us not available then SSE.
Do NOT do SVE prior to two above
200
During the 3rd trimester, the uterus receives what percentage of the mothers cardiac output?
What is 20%
300
Define placenta previa
What is placenta covering the internal cervical os at TERM
300
Image 3
What is low lying placenta
300
List 4 RF for placenta previa (there were 8 listed)
What is h/o prior previa, h/o cesarean section, h/o uterine surgery, >35 yo, mutliparity, mutligestation, smoking/cocaine use, conceived by IVF
300
What labs are helpful in further assessment of maternal and fetal status during antepartum hemorrhage?
What is CBC, type and match, coagulation studies (PT, INR, fibrinogen), Kleihauer-Betke
300
At 35 wks gestation, how far from the internal OS should the leading edge of a placenta be to safely offer vaginal delivery?
What is 10-20mm
400
Define placental abruption:
What is premature separation of a normally implanted placenta
400
Image 4
What is vaso-previa
400
What is the key presentation difference between those with antepartum hemorrhage from previa vs abruption
What is pain, uterine tone, fetal status compared to amount of blood loss observed.
400
What are the 2 main treatment objectives for women with active bleeding who are hemodynamically unstable?
What is fluid replacement (2 lg bore iv w/ crytalloids/blood) and delivery
400
What is the gold standard of dx of placenta previa? How accurate is it?
What is TVUS, 99% accuracy
500
Cause of most placental abruptions....
What is idiopathic
500
Pt presents w/ c/o decreased fetal movement and severe abdominal pain, FHT strip looks like this (image 5), what is your interpretation and dx?
What is sinusoidal, due to fetal anemia, concealed abruption.
500
Risk factors shared between placenta previa and placental abruption, List two
What is smoking, AMA, multiparity, multiple gestation
500
Abrupt onset of intrapartum hemorrhage with almost immediate non-reassuring fetal heart tones; what is your dx?
What is rupture of vaso previa
blood being lost is fetal not maternal, 60% mortality rate
500
Pt with history of prior abruption has what percent change of repeat abruption with subsequent pregnancies?