Term
| source of most third TM bleeding: |
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Definition
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Term
| 4 of the most common causes for third trimester bleeding: |
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Definition
1. spoting post coital
2. preterm labor
3. placenta previa
4. abruptio placentae |
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Term
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Definition
| abnormal location of the placenta over or near the cervical Os |
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Term
| previous C-section increases the risk by 4x for this abnormality: |
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Definition
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Term
| 3 types of placenta previa: |
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Definition
1. complete - total Os covered
2. partial - edge of placenta over Os
3. marginal - placenta lies near Os |
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Term
| how is placenta previa dx? |
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Definition
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Term
| describe the autocorrection of placenta previa from the 2nd to third trimester: |
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Definition
| 5% of pregnancies are positive for placenta previa but only a few of these are positive into the third trimester; as the uterus grows the placenta moves upward and away from the Os. |
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Term
| placenta previa presentation: |
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Definition
| sudden, plainless, maternal bleeding, with the avg gestation being around 29-30wks - may be assoc w labor |
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Term
| placenta previa management: |
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Definition
1. pelvic rest; nothing enters the vagina
2. follow up serial ultrasounds
3. bed rest |
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Term
| management of placenta previa continues unitl: |
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Definition
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Term
| condition most likely with placenta previa and previous C sections: |
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Definition
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Term
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Definition
| occurs when the placenta attaches too deep within the uterine wall |
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Term
| placenta accreta is dx with: |
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Definition
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Term
| what percent of placenta previas also involve placenta accreta? |
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Definition
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Term
| types of placenta accreta: |
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Definition
1. placenta accreta: doees not penetrate the uterine muscle (75%)
2. Placenta Increta: penetrates into the uterine muscle but not serosa
3. placenta percreta: penetrates through the muscle and serosa and can attach to another organ |
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Term
|
Definition
| premature separation of the normally implanted placenta |
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Term
| is previa a normal implantation of the placenta? |
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Definition
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Term
| abruptio placenta presentation: |
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Definition
| abdominal pain w a variable amount of bleeding |
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Term
| 5 major risk factors for abruptio placenta: |
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Definition
1. Maternal HTN
2. Previous abruption
3. cocaine
4. trauma
5. tobacco |
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Term
|
Definition
1. xfuse if indicated
2. vaginal delivery preferred
3. home management possible if bleeding stops and no coagulpathies |
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Term
| uterine rupture most often occurs in these patients: |
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Definition
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Term
| which C section scar is most at risk for uterine rupture? |
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Definition
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Term
| 6 conditions assoc w uterine rupture: |
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Definition
1. induced labor
2. uterine abnormalities
3. placenta increta/percreta
4. grand multiparity
5. obstructed labor
6. previous perforation |
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Term
| uterine rupture presentation: |
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Definition
1. S/Sx highly variable
2. Sudden intense Abd Pain
3. bleeding/shock
4. loss of station: can't tell where the baby is |
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Term
| management of uterine rupture: |
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Definition
1. immediate laparotomy: abd incision
2. removal of fetus and placenta
3. repair of uterine defect or histerectomy |
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Term
| which of the complications listed may require histerectomies? |
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Definition
| placenta accreta & uterine rupture |
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Term
| which condition has painless bleeding? |
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Definition
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Term
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Definition
| unprotected FETAL blood vessels from the placenta or cord cross the entrance to the birth canal |
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Term
| rate of infant mortality in undx vasa previa: |
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Definition
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Term
| can vasa previa babies be delivered avginally? |
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Definition
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Term
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Definition
velamentous: involving the umbilical cord
Normal cord insertion w vessels running exposed btwn bilobed placenta |
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Term
| when are the exposed vessels of the cord or placenta not considered vasa previa: |
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Definition
| if the exposed vessels are not crossing the cervical opening |
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Term
| 3 major risk factors for vasa previa: |
|
Definition
1. low lying placenta
2. multi-lobed placenta
3. velamentous cord insertion |
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Term
| recommendations for screening in vasa previa: |
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Definition
| women with risk factors should have transvaginal color doppler US |
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Term
| management of vasa previa: |
|
Definition
1. reduced phys activity or bed rest
2. no sex
3. admit for third trimester
4. steroid injection to increase FLM
5. elective C section @ 35-36wks |
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