placenta

Question 1

Placenta abruption - definition? result?

Answer 1

premature seperation of the placenta from the uterus

–> tearing of the placental blood vessels and hemorrhaging into the separated space

Question 2

Placenta abruption - this can occur … (when)

Answer 2

before / during / after labor

Question 3

Placenta abruption - complications

Answer 3

• if large separation with life threatening bleeding –> premature delivery, uterine tetany, DIC, hypovolemic shock (and sheehan syndrome), fetal distress (death or hypoxia)
• small separation –> no clinical signs and symptoms

Question 4

Placenta abruption - etiology and precipitating factors

Answer 4

unknown etiology. Factors:

1. maternal hypertension (chronic, preeclampsia, eclampsia) 2. Prior placental abruption 3. cocaine
2. external trauma 5. smoking during pregnancy

Question 5

Placenta abruption - diagnostic test

Answer 5

Clinically

U/S (not required) to distinguish from previa

Question 6

types of placental abruption

Answer 6

1. concealed –> blood within uterine cavity (+ SERIOUS COMPLICATIONS)
2. external –> blood drains through cervix

Question 7

Placenta abruption - indications for cesarean delivery

Answer 7

1. uncontrollable maternal hemorrhage
2. rapidly expanding concealed hemorrhage
3. fetal distress
4. rapid placental separation

Question 8

placental abruption - vaginal delivery indications

Answer 8

1. placental separation is limited
2. fetal heart tracing is assuring
3. separation is extensive and fetus is dead

Question 9

placenta abruption - clinical presentation

Answer 9

sudden onset vaginal blededing (80%)
abd or back pain
high frequency, low intensity contractions
hypertonic, DISTENDED, tender uterus
fetal HR abnormalities

Question 10

Placenta previa - definition

Answer 10

abnormal implantation of the placenta over the internal cerival os (3rd TRIMESTER) –> the cause of 20% of all prenatal hemorrhages

Question 11

Risk factors for placenta previa

Answer 11

1. previous cesarean deliveries
2. previous uterine surgery
3. multiple gestations
4. previous placenta previa

Question 12

pregnant woman in third trimester present with vaginal bleeding - next step?

Answer 12

transbdominal US

no digital vaginal exam before –> it may lead to separation between placenta + uterus resulting in severe hemorrhage

Question 13

placenta previa presentation

Answer 13

painless vaginal bleeding after 20 weeks

Question 14

placenta previa - diagnostic tests

Answer 14

tranabdominal followed by transvaginal sonogram

Question 15

placenta previa - types

Answer 15

US identifies the types:

1. complete: complete covering the internal cervix os
2. partial: partial covering
3. marginal: often touching the os
4. vasa previa: fetal vessel over the os
5. low lying: implanted in the lower segment of the uterus but NOT covering (more than o cm but less than 2 away

Question 16

low lying placenta?

Answer 16

placenta that is implanted in the lower segment of the uterus but NOT covering the internal cervical os (more than o cm but less than 2 away)

Question 17

placenta previa - treatment / magement

Answer 17

• treatment is done when there is large bleeding or drop of Hct. (consists of strict pelvic rest + nothing + intercourse).
• There are several indications for immediate cesarean delivering
• prepare for life threatening bleeding (type + screen blood, CBC, PT)
• if preterm –> prepared with betamethasone
• c- section at 36-37 wks

Question 18

indications for immediate cesarean delivering in placenta previa

Answer 18

1. Unstoppable labor (cervix dilated more than 4 cm)
2. severe hemorrhage
3. fetal distress

Question 19

Placenta abruption vs previa (according to diagnosis)

Answer 19

previa –> painless vaginal bleeding

abruption –> painful vaginal bleeding

Question 20

vasa previa - mechanism

Answer 20

fetal vessels transverse the internal cervical os and are vulnerable to injury during amniotomy

Question 21

vasa previa - presentation

Answer 21

painless vaginal bleeding and feta HR abnormalities AFTER amniotomy

Question 22

Vasa previa - management

Answer 22

emergency C-section

Question 23

Vasa previa is frequently associated with

Answer 23

velamentous umbilical insertion

Question 24

velamentous umbilical insertion?

Answer 24

cord inserts in chorioamniotic membrane rather than placenta –> fetal vessels travel to placenta unprotected by Wharton jelly

Question 25

placenta invasion - types

Answer 25

_abn adheres to the superficial uterine wallincreta_ attaches to myometriumpercreta_ invades into uterine serosa, bladder wall, or rectal wall

Question 26

placenta invasion - presentation / treatment

Answer 26

patients are usually asymptomatic, unless invasion into the bladder or rectum results in hematuria or rectal bleeding . Haemorrhage and shock if placenta cannot detach after delivery --> often hysterectomy