Postpartum Hemorrhage- Exam Questions with Verified Solutions Latest Version () Already Passed

Postpartum Hemorrhage- Exam Questions with Verified Solutions Latest Version () Already Passed Average Blood loss with Cesarean delivary - Answers -~1000 Average Blood loss with Vaginal delivary - Answers -~500 What is the definition of postpartum hemorrhage (PPH) - Answers -10% drop in Hct, S/s of hypovolemia, need for transfusion What should you suspect for postpartum hemorrhage with bleeding from any sight other then the vagina - Answers -Coagulopathy Risk factors for Postpartum Hemorrhage*** - Answers -Prolonged/Augmented/Rapid labor. Hx of postpartum hemorrhage, episiotomy, preeclampsia, Asian or hispanic ethnic, Chorioamnionitis Majority of Postpartum hemorrhage is caused by - Answers -Uterine atony MOA Methylergonovine maleate and route of admin*** - Answers -Potent uterotonic agent that can cause uterine contractions within several minutes. ALWAYS given intramuscularly, bc of rapid IV can cause dangerous HTN Contraindicaitons for Methylergonovine - Answers -Cardiac, Pulmonary, liver or renal diseases and HTN Route of administration for 15-methyl prostaglandin F for PPH - Answers -IV or Myometrium Medication that is contraindicated for a pt with asthma for the tx of PPH - Answers -Prostaglandin drugs: PGF 2 alpha Route of adminstration for Dinoprostone for PPH - Answers -Rectal suppository Note: One non-drug tx for PPH is the do an aggressive bimanual intrauterine massage (Balled up fist in the vagina and suprapubic compression of the uterus) - Answers ... Define Placenta accreta - Answers -Abnormal adherence of the placenta to the superficial lining of the uterus Define Placenta increta - Answers -Abnormal adherence of the placenta into the uterine muscle Define Placenta Percreta - Answers -Abnormal adherence of the placenta that involves the complete invasion *through* the thickness of the uterine muscle What are the risk factors for retained placenta - Answers -Previous C Section, uterine leiomyomata, prior uterine curettage, and accessory (succenturiate) placental lobe How do you diagnose retained placenta - Answers -Look at the placenta for abruptly ending surface vessels or abscent cotyledons, also look for excessive bleeding after birth How do you treat retained placenta - Answers -Manual extraction of the remaining placenta via finger manipulation or currettage. Note: Careful to not become overly aggressive with currettage to avoid Asherman syndrome What is Nitabuch's layer - Answers -Layber that is missing with placenta accreta; It forms the layer where the placenta should not penetrate through and into the uterus. The lack of this barrier present indicates Retained placenta on placenta inspection bc it has grown too far into the uterus What is the poor man's coagulation profile - Answers -Tape the blood to the wall. It should clot outside the body This patient developed acute respiratory distress with cyanosis, then CV collapse, then hemorrhage, then coma, then death. Peripheral smear shows a schistocyte. What is the likely cause - Answers -Amniotic fluid PE Your patient is attempting a TOLAC with sudden increase in abdominal pain and you note brisk vaginal bleeding. The fetal heart rate tracing demonstrates loss of variability then bradycardia. The fetus was at +2 station and now is at -2 station, what happened - Answers -Uterine Rupture Most common cause of uterine rupture - Answers -Previous C-Section What is the most common finding with Uterine Rupture - Answers -Non-reassuring fetal heart beats. The pathologic finding will be a *true* fetal loss of station (Goes from positive to negative), but the most common cause is overestimating the fetal station