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Questions and Answers
What is the first step in the resuscitation management for vaginal bleeding in the third trimester?
What is the first step in the resuscitation management for vaginal bleeding in the third trimester?
An immediate C-section is required if any one parameter is abnormal during assessment.
An immediate C-section is required if any one parameter is abnormal during assessment.
True
What does 'LUS' stand for in the context of placenta previa?
What does 'LUS' stand for in the context of placenta previa?
Lower uterine segment
In cases of vaginal bleeding during the third trimester, the administration of __________ and crystalloids is essential for resuscitation.
In cases of vaginal bleeding during the third trimester, the administration of __________ and crystalloids is essential for resuscitation.
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Match the assessment parameters with their corresponding actions:
Match the assessment parameters with their corresponding actions:
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What is the preferred mode of delivery for a placenta that is low lying (within 1 cm of internal os)?
What is the preferred mode of delivery for a placenta that is low lying (within 1 cm of internal os)?
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Active management for placenta previa involves continuing the pregnancy to attain fetal lung maturity.
Active management for placenta previa involves continuing the pregnancy to attain fetal lung maturity.
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What action should be taken if the placenta is in the lower uterine segment at 36 weeks?
What action should be taken if the placenta is in the lower uterine segment at 36 weeks?
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In the case of placenta previa with active bleeding, the mode of delivery is a _____ section.
In the case of placenta previa with active bleeding, the mode of delivery is a _____ section.
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Match the ultrasound terms with their definitions:
Match the ultrasound terms with their definitions:
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Which of the following is a cause of antepartum hemorrhage (APH)?
Which of the following is a cause of antepartum hemorrhage (APH)?
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Abruptio placenta involves the premature separation of a normally located placenta.
Abruptio placenta involves the premature separation of a normally located placenta.
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What is the primary mechanism that leads to bleeding in placenta previa?
What is the primary mechanism that leads to bleeding in placenta previa?
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In cases of APH in the third trimester, P/V is contraindicated until __________ is ruled out.
In cases of APH in the third trimester, P/V is contraindicated until __________ is ruled out.
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Match the following causes of APH with their definitions:
Match the following causes of APH with their definitions:
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What is the drug of choice for single drug therapy for obstetric complications?
What is the drug of choice for single drug therapy for obstetric complications?
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Multidrug therapy for obstetric complications includes Etoposide, Methotrexate, Actinomycin D, Cyclophosphamide, and Oncovin.
Multidrug therapy for obstetric complications includes Etoposide, Methotrexate, Actinomycin D, Cyclophosphamide, and Oncovin.
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What tumor marker is associated with monitoring in cases of invasive mole or choriocarcinoma?
What tumor marker is associated with monitoring in cases of invasive mole or choriocarcinoma?
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In cases of molar pregnancy, a hysterectomy may be indicated if the patient is aged ≥ ______ and has a complete family.
In cases of molar pregnancy, a hysterectomy may be indicated if the patient is aged ≥ ______ and has a complete family.
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Match the following conditions with their corresponding descriptions:
Match the following conditions with their corresponding descriptions:
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What stage of FIGO is characterized by involvement of the pelvis and its organs?
What stage of FIGO is characterized by involvement of the pelvis and its organs?
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Stage 3 FIGO includes metastasis to the brain and liver.
Stage 3 FIGO includes metastasis to the brain and liver.
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In the WHO risk scoring system, what age category is typically considered high risk?
In the WHO risk scoring system, what age category is typically considered high risk?
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FIGO Stage 1 implies that the disease is limited to the __________.
FIGO Stage 1 implies that the disease is limited to the __________.
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Match the following FIGO stages with their characteristics:
Match the following FIGO stages with their characteristics:
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What grading is associated with a concealed placental abruption?
What grading is associated with a concealed placental abruption?
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A low lying placenta is classified as Type 2.
A low lying placenta is classified as Type 2.
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What is the most common type of abruption placenta?
What is the most common type of abruption placenta?
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A characteristic of Grade 3 features in the mother includes bleeding, pain in abdomen, and __________.
A characteristic of Grade 3 features in the mother includes bleeding, pain in abdomen, and __________.
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Match the type of placental abruption with its characteristics:
Match the type of placental abruption with its characteristics:
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What is the primary criteria for expectant management in cases where the period of gestation is less than 37 weeks?
What is the primary criteria for expectant management in cases where the period of gestation is less than 37 weeks?
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Active management is appropriate when all criteria indicate an unstable condition.
Active management is appropriate when all criteria indicate an unstable condition.
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What medication is given if the period of gestation is less than 34 weeks and there is a risk of lung immaturity?
What medication is given if the period of gestation is less than 34 weeks and there is a risk of lung immaturity?
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In cases of placenta previa, if active bleeding is present, the preferred mode of delivery is a __________.
In cases of placenta previa, if active bleeding is present, the preferred mode of delivery is a __________.
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Match the following procedures with their corresponding conditions:
Match the following procedures with their corresponding conditions:
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At what gestational weeks is the best time to perform an ultrasound for placenta previa?
At what gestational weeks is the best time to perform an ultrasound for placenta previa?
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Placenta previa is classified when the distance between the placenta and internal os is greater than 2cm.
Placenta previa is classified when the distance between the placenta and internal os is greater than 2cm.
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What is the term for the premature separation of a normally located placenta?
What is the term for the premature separation of a normally located placenta?
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Type 3 placenta previa involves the placenta covering the internal os _____.
Type 3 placenta previa involves the placenta covering the internal os _____.
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Match the types of placenta previa with their characteristics:
Match the types of placenta previa with their characteristics:
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Which of the following is a primary symptom of placenta previa?
Which of the following is a primary symptom of placenta previa?
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Abdominal pain is a common symptom of placenta previa.
Abdominal pain is a common symptom of placenta previa.
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What is the investigation of choice for diagnosing placenta previa?
What is the investigation of choice for diagnosing placenta previa?
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In cases of abruptio placenta, the bleeding is often __________ and accompanied by abdominal pain.
In cases of abruptio placenta, the bleeding is often __________ and accompanied by abdominal pain.
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Match the symptoms with their corresponding conditions:
Match the symptoms with their corresponding conditions:
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Which of the following is the most common risk factor for placenta previa?
Which of the following is the most common risk factor for placenta previa?
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Abruption of the placenta can be associated with a couvelaire uterus.
Abruption of the placenta can be associated with a couvelaire uterus.
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What condition is characterized by a high chance of recurrence of 15%?
What condition is characterized by a high chance of recurrence of 15%?
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The risk factor associated with abruptio placenta includes __________ deficiency.
The risk factor associated with abruptio placenta includes __________ deficiency.
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Match the condition with its associated risk factor:
Match the condition with its associated risk factor:
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What is the most common cause of transverse lie at term?
What is the most common cause of transverse lie at term?
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Retroplacental bleeding always indicates the need for hysterectomy.
Retroplacental bleeding always indicates the need for hysterectomy.
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List one risk factor for placenta previa.
List one risk factor for placenta previa.
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Study Notes
Antepartum Hemorrhage
- Any bleeding from the genital tract beyond 28 weeks of pregnancy.
- Causes include placenta previa, abruptio placenta, vasa previa, preterm labor, and uterine rupture.
Placenta Previa
- Occurs when the placenta is located in the lower uterine segment, covering the cervix.
- Symptoms include painless vaginal bleeding in the third trimester.
- Diagnosis is made by ultrasound.
Abruptio Placenta
- Premature separation of a normally located placenta from the uterine wall.
- Symptoms include painful vaginal bleeding, abdominal pain, and uterine tenderness.
- Diagnosis is made by clinical examination and ultrasound.
Placenta Previa Types
- Type 1: Placental edge lies within 2cm of the internal os.
- Type 2: Placental edge reaches the margin of the internal os.
- Type 3: Placenta partially covers the internal os.
Abruptio Placenta Types
- Revealed: Visible bleeding with no retroplacental clot.
- Concealed: Retroplacental clot present, no visible bleeding.
- Mixed: Both bleeding and retroplacental clot present.
Placenta Previa Risk Factors
- Previous history of placenta previa
- Large placental size
- Diabetes
- Rh-negative pregnancy
- Twin pregnancy
- Succenturiate lobe
- Placenta bilobata
- Adhesion formation
- History of C-section/uterine surgery/uterine curettage
- Smoking
- Endometritis
- Increased maternal age
- Increased maternal parity
Abruptio Placenta Risk Factors
- Previous history of abruptio placenta
- Folic acid deficiency
- Cigarette smoking and cocaine abuse
- External trauma
- Increased maternal age and parity
- Thrombophilia
- Preeclampsia/chronic hypertension
- Fibroid uterus
- Twin pregnancy
- Polyhydramnios
- Single umbilical artery
- Preterm rupture of membrane
Couvelaire Uterus
- Blood clots in the myometrium, making the uterus appear bruised.
- Associated with increased risk of postpartum hemorrhage.
Management of Placenta Previa
- Expectant: Bed rest, monitoring maternal vitals and fetal heart rate.
- Active: Immediate cesarean section.
Management of Abruptio Placenta
- Depends on severity: Expectant management or immediate cesarean section.
Gestational Trophoblastic Disease (GTD)
- A group of rare tumors that develop in the uterus after pregnancy.
- Can be invasive or metastatic.
- Treatment includes chemotherapy and hysterectomy.
Single Drug Therapy for GTD
- Methotrexate is the drug of choice.
- Multidose therapy, given on days 1, 3, 5, and 7.
- Beta-hCG levels are monitored.
Multidrug Therapy for GTD
- EMACO/Bagshaw regimen: Etoposide, Methotrexate, Actinomycin D, Cyclophosphamide, Oncovin.
- Cisplatin may be added if resistant.
Radiotherapy for GTD
- Indicated for brain metastasis.
- Follow-up for 12 months.
Hysterectomy for GTD
- Indicated in cases of intractable hemorrhage, persistent trophoblastic disease, and advanced age.
FIGO Staging System for GTD
- Stage 1: Limited to the uterus.
- Stage 2: Involvement of the pelvis and its organs.
- Stage 3: Involvement of the lungs.
- Stage 4: Metastasis to the brain or liver.
WHO Risk Scoring System for GTD
- Low risk: Age < 40, no prior GTD, no risk factors.
- High risk: Age > 40, prior GTD, or risk factors present.
Histopathological Examination of GTD
- Invasive mole: Edematous chorionic villi.
- Choriocarcinoma: No villi-like structure, presence of syncytiotrophoblast and cytotrophoblast.
- PSTT: No villi-like structure, intermediate trophoblast.
Important Features
-
Placenta previa: Placenta is located within 2 cm of the internal os.
- Diagnosis should be made in the third trimester.
- Abruptio placenta: Thromboplastin release leads to DIC.
- Couvelaire uterus: Bruised uterus due to blood clots in the myometrium.
- Stallworthy sign: Fetal distress due to the fetal head being pushed into the pelvis.
- Chronic abruption oligohydramnios sequence (CAOS): Rare association with abruptio placenta.
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Description
Explore the critical conditions associated with antepartum hemorrhage, including placenta previa and abruptio placenta. This quiz covers the symptoms, diagnosis, and classifications of these conditions, vital for understanding maternal-fetal health. Perfect for medical students and healthcare professionals.
