100 Maternal emergencies after 20 weeks of pregnancy Flashcards
Chronic hypertension in pregnancy is defined as a
Chronic hypertension in pregnancy is defined as a systolic blood
pressure of ≥140 mm Hg or a diastolic blood pressure of ≥90 mm Hg
that existed prior to pregnancy, is diagnosed before the 20th week of
gestation, or persists longer than 12 weeks after delivery.
Severe chronce hypertension in pregnancy defined as
Severe chronic
hypertension is systolic blood pressure >160 mm Hg or diastolic pressure
>110 mm Hg.
omen with chronic hypertension are at increased
risk for
placental abruption, preeclampsia, low birth weight, cesarean
delivery, premature birth, and fetal demise.2,3
Gestational hypertension
hypertension present only after the 20th week of pregnancy or in the immediate postpartum period but without proteinuria.
Safe treatment options for hypertensive women who are pregnant
labetalol, methyldopa, nifedipine, and hydralazine.4 All antihypertensive drugs cross the placenta
First line agents for chronic hypertension and Price pregnancy with those
Starting dose is 100 mg PO twice a day and the usual maintenance dose is 200 to 400 mg twice per day
What drug is usually added when labetalol and methyldopa are not adequately controlling on blood pressure?
Nifedipine.i
Medications and doses of acute management of hypertensive emergency and pregnancy
Hydralazine 5 mg IV or IM, labetalol 20 mg IV, or nifedipine 10 to 30 mg PO
What is the definition of pre-clamp Sia
Presence of de novo hypertension after 20 weeks of gestation combine with protein urea or other maternal organ dysfunction ( Reno liver neurologic).
Severe features of preeclampsia
Systolic blood pressure greater than 160 or diastolic blood pressure greater than 110 on two occasions at least four hours apart. Thrombocytopenia less than 100,000. Impaired liver function tests. Progressive renal insufficiency. Pulmonary Dema. Everybody’s visual disturbances.
Medications and doses of acute management of hypertensive emergency and pregnancy
Hydralazine 5 mg IV or IM, labetalol 20 mg IV, or nifedipine 10 to 30 mg PO
First line agents for chronic hypertension and Price pregnancy with those
Starting dose is 100 mg PO twice a day and the usual maintenance dose is 200 to 400 mg twice per day
What drug is usually added when labetalol and methyldopa are not adequately controlling on blood pressure?
Nifedipine.i
Severe features of preeclampsia
Systolic blood pressure greater than 160 or diastolic blood pressure greater than 110 on two occasions at least four hours apart. Thrombocytopenia less than 100,000. Impaired liver function tests. Progressive renal insufficiency. Pulmonary Dema. Everybody’s visual disturbances.
Laboratory evaluation for HELLP
CBC with differential, creatinine, LFTs, lactate dehydrogenase, urine protein, protein to creatinine ratio, Uric acid level.
Proposed causes of ecclampsia
At hero’s is and thrombosis lead to placental ischemia and infections. Poor placental perfusion is present to lead to the formation of free radicals, actually distress, and inflammatory responses that may influence the mechanistic development of preeclampsia
Only treatmeant to prevent preeclampsia and complications
Low-dose aspirin therapy
Laboratory abnormalities and help syndrome
Schistocytes on CBC and peripheral smear, platelets less than 100000, lfts mildly elevated, elevated bun and creatinine, elevated ldh and bilirubin
Thx for preeclampsia
Prolly outpatient mgmt. reassessments
Thx for severe preeclampsia, eclampsia, or Help
Iv mag and anti hypertensives. For eclampsia and help, deliver
How to administer iv magnesium
4 to 6 grams given over 20-30 minutes. Then, 2g per hour for at least 24 hours
First way to assess vaginal bleeding in the second have a pregnancy
Transvaginal ultrasound to determine the location of the placenta
How to diagnose Placental abruption
Diagnosis is mostly clinical. MRIs diagnostic required to transport a potentially unstable patient out of the ED or ICU for imaging
What’s worse Vasa previa or placenta previa
Vasa previa is worse because it is seldom recognized Prior to catastrophic vessel disruption during labor. Treatment as rapid operative delivery
What is premature rupture of membranes
Rupture of membranes prior to the onset of contractions
When is it considered preterm rupture of membranes
Before 37 weeks.
How do you manage premature rupture of membranes
Perform speculate emanation visually examine the service to identify dilation and test vaginal fluid. Do not perform digital cervical examination
How do you swab or vaginal fluid to determine membeane rupture
Suave the vaginal walls are posterior fornix. Do not swap cervical mucus because it can produce a frowning pattern. Then test with nitrazine paper or pH of 6.5 or blue color. Then look for for ferning under microscopy
I when you give steroids for preemies
Between 24 and 34 weeks of gestation.
Types of steroids and doses for inducing lung maturity
Betha Methasone 12 mg I am every 12 hours for two days or dexamethasone 6 mg I am every 12 hours for two days
Antibiotic regimen for premature preterm member and rupture
Ampicillin to grams IV every six hours and erythromycin 250 mg IV every six hours for 48 hours followed by amoxicillin 250 mg every eight hours and erythromycin base 333 mg every eight hours
What antibiotic do you not give for preterm premature rupture of membranes
Do not get Augmentin because it is associated with necrotizing enterocolitis
What is the presumed diagnosis in a postpartum woman with fever
Postpartum endometritis. Also considered pneumonia pyelonephritis mastitis from thrombophlebitis and appendicitis
Empiric combination for postpartum endometriosis
Clindamycin (900 mg every eight hours IV or 600 mg every six hours IV) and an aminoglycoside (most commonly gentamicin 5 mg per kilogram every 24 hours or 1.5 mg per kilogram every eight hours)
What specific lab maybe elevated in Group B streptococci Endometritis
Creatine phosphokinase
What is the most common time. For Peripartum cardio myopathy
In the last month of gestation or within the first five months after delivery
What is the only medicine in Perry part in cardiomyopathy that is not treated like normal congestive heart failure
Nitroprusside is relatively contraindicated because it can cause a thiocyabate or cyanide accumulation in the fetus
Can Warfare in be given in the postpartum period?
Yes it can they poses little rest of the breast-fed infants
What is the prognosis for Perry partum cardiomyopathy?
70% of women recover to normal ejection fraction within the first six months postpartum
How do you manage premature rupture of membranes
Perform speculate emanation visually examine the service to identify dilation and test vaginal fluid. Do not perform digital cervical examination
