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Flashcards in vaginal bleeding Deck (116)
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31

Post-Partum Care

for devilry of the umbilical cord


Do not pull on the umbilical cord.

B/c it detaches and then the placenta stays up there. Can put you at risk for PPH

32

Postpartum Hemorrhage

atony of the uterus ( occurs when the uterus fails to contract after the delivery of the baby)

1. Greater than 500 cc blood.

2. Leading cause of obstetric death worldwide. In the US, second after VTE.

nipple stimulation will cause uterine contraction

33

Manual Interventions

Resuscitating PPH

Fundal massage (stimulates the uterus to contract down), explore for lacerations, manual uterine exploration for retained products

nipple stimulation will cause uterine contraction

34

medical interventions FOr PPH

Oxytocin, methylergonovine (ergot alkaloid), misoprostil ---> will cause vasoconstriction

Resuscitation with fluids and blood.


TXA (Tranexamic acid) now second-line.
1. Used for DUB and also used in PPH

makes you clot which isn't ideal

35

non pregnant cause of bleeding

i. Fibroids
vii. Infection
iii. Systemic disease
iv. Cancer
v. Dysfunctional uterine bleeding
vii. Look for symptomatic anemia.
viii. Consider evaluation for systemic illness.
perimenopause

36

fibroids

easy to detect on ULS

painful and heavy periods

37

contraception that can cause bleeding

a. Intrauterine device
i. Spotting and bleeding a known complication.
ii. Still check for pregnancy!

b. Hormonal therapies
i. Medroxyprogesterone
ii. Oral contraceptives
iii. Still check for pregnancy!

38

assessment needs to cover

a. Pregnancy status: negative
b. Hemoglobin level: not anemic
c. Status of the os: closed and no lesions
d. Size of the uterus: no fibroids
e. Skin: warm, dry, without bruising
f. Mucosa: no petechiae or bleeding
g. Discharge instructions: follow-up and return precautions.

39

Vaginal bleeding summary

Vaginal bleeding is an ectopic until you prove it is not!

Look for ABNORMAL VITAL SIGNS!
c. Screen for vaginal trauma and intimate partner violence.
d. Think about systemic disease.
e. Educate your patient to ensure safe follow-up.

40

screening for systemic disease in a female bleesing


CBC with smear, PT and PTT

Adolescents with menorrhagia: von Willebrand’s Disease

Secondary immune thrombocytopenias

SLE, antiphospholipid syndrome, thyroid disease

Viral associated thrombocytopenias:

HIV, Hep C, CMV

ITP: diagnosis of exclusion

41

when is estimating the gestational age inaccurate with fundal heigh and LMO

Multiple gestations

42

how else can you estimate gestation age?

ULS

43

how do you measure a BPD

Biparietal diameter

Measure perpendicular to the falx through that thalamus. Outer edge to inner edge of skull

44

pathogens in pyeo pregnancy

E.coli, Klebisiella, Group B strep.

increased risk in pregnancy

45

what diseases are we worried about in pregnancy

STI
PYELO
PNA

46

what does ALARA

ALARA: as low as reasonably achievable.

With respect to imaging

Risk highest in the first trimester and least in the third.

47

Higher rates of dissemination with this type of PNA in pregnancy

coccidyomycosis

48

Higher rates of morbidity and mortality; complications to the fetus with this type of pNA in pregnancy

varicella

49

High rates of respiratory failure with this type of PNA in pregnancyt

Influenza

50

what do you need to know about the increase risk of appy in pregnancy

Perforation rates increase with trimester.


risk of perf incraeases with trimester and increases risk to the fetus

imaginign ULS and MRI first

51

what test should be done to assess potential trauma to the fetus

Kleihauer–Betke

measures fetal hgb in mothers blood

52

new onset hypertension
excessive uterine size for dates
very elevated hCG levels
abnormal ULS
preeclampsia prior to 20 weeks

molar pregnancy

53

evaluation of a premature rupture of the membrane
PROM

iii. Nitrazine Paper: amniotic fluid has a pH of 6.5/7 or higher.

and ferning pattern on smear
Ferning: arborization of salt crystals in amniotic fluid.

54

when would a cervical exam be contraindicated

CONTRAINDICATED if you suspect placenta previa.

55

RF for Peripartum Cardiomyopathy

hypertension
preeclampsia
multiple gestations, advanced maternal age, African descent
use of prolonged tocolytics

56

sxs of preipartum cardiomyopathy

Peripartum Cardiomyopathy

57

causes of

preipartum cardiomyopathy

Causes include autimiimune, virally mediated
cytokine inflammatry repsonse
stress of pregnancy, genetics, nutrition, myocite apoptosis, elevated prolactin levels

58

approach to pregnant pt with dyspnea

Scrutinize the blood pressure, heart rate, and O2 sat.
Look for DVT.
Scan for PE if indicated.
Look for signs of heart failure.

59

Three medication for managing preeclampsia

: labetalol, nifedipine, hydralazine.

60

management of preterm labor

Tocolytics: Still given but not proven!

Calcium channel blockers now popular.
***Do not use more than one agent***
Corticosteroids: Proven! Give them!

Dexamethasone or betamethasone.
Fetal lung maturity.

Antibiotics: Proven, but only with ruptured membranes.
Increase the latency period in PPROM.