15: Obsteric Complication Flashcards
Chadwick sign
Week 8-12
sign of pregnancy
Vaginal mucosa discolorationn- dark bluish or purplish red and congested
Perception of fetal movement
Btw 16-20 wks
Uterine changes- pregnancy
12 weeks: uterus palpable at symphysis pubis
20 weeks: uterus palpable at umbilicus
-After wk 20, the fungal height measured in cm from the pubis should approximate the gestational age in weeks
Hegar’s sign
6-8 weeks of pregnancy
-softening of the lower uterine segment at junction with Cervix (Goodell’s sign). On bimanual palpation cervix may seem to separate from fundus.
Braxton Hicks contractions
- begins at 12th week
- painless palpable uterine contractions at irregular intervals occurring throughout pregnancy
Ballottement
- Bimanual exam at 16-20th week
- tap on cervix with a finger-> cervix floats up and down to tap the finger back
Fetal heart sound
- Doppler: 6-10 weeks
- Fetoscope/ Stethoscope: 17-19 weeks
Bleeding in early pregnancy
- Abortion
- Ectopic pregnancy
- Normal implantation of ovum
Bleeding in late pregnancy
- Cervical: erosion, polyps, rarely carcinoma
- Vaginal: varicosities, lacerations
- Placental: abruptio placenta, placenta previa, vasa previa
- *Never perform a digital or speculum exam until US rules out placenta previa
Abruptio placentae
- Painful late-trimester vaginal bleeding with a normal placed placenta
- External bleeding (MC)
- Internal bleeding: increase in fundal height*
Classification of Abruptio placenta
0: asx
1: mild vaginal bleeding, slight tender uterus
2: moderate bleeding/ tenderness, maternal tachycardia with orthostatic HTN, fetal distress
3: Heavy bleeding, painful tetanic uterus, maternal shock, coagulopathy, fetal death
* *DIC is one of the most feared complication
Abruptio placenta- investigations
- Kleihauer-Betke test: determine the volume of fetal blood transfused into the maternal circulation
- Nonstress test & BPP (Biophysical profile)
Abruptio P- initial management
- External fetal monitoring
- Fluid resuscitation
- Blood transfusion
- Correct coagulopathy- fresh frozen plasma
Abruptio P- management
- 36wks with controlled bleeding: Vaginal delivery
- Maternal or fetal jeopardy: Emergency cesarean section
Placenta Previa
- Implantation of the placenta over or near the internal os of the cervix
- Painless vaginal bleeding 28-32wks
- DO NOT PERFORM vaginal and rectal exams-> might cause uncontrollable bleeding
P previa- types
- Total
- Partial
- Marginal
- Low-lying
P Previa- imaging
- Transabdominal ultrasonography
- Transperineal
- Transvaginal
- MRI
Vasa previa
-fetal vessels cross in close proximity of the inner cervical os
-Velamentous insertion
Triad
-Membrane rupture
-Painless vaginal bleeding
-Fetal bradycardia
Vasa previa- rx
-Cesarean delivery after confirming fetal lung maturity (Lecithin Sphingomyelin ratio of 2**)
HTN in pregnancy- categories
1: Chronic HTN
2: Preeclampsia-eclampsia
3: Preeclampsia superimposed on chronic HTN
4: Gestational HTN
Chronic HTN- info
BP over 140/90
1: before pregnancy or before 20wks gestation
2: after 20wks gestation and persists after 12wks post partum
Chronic HTN- rx
Rx started if SBP is greater than 160 or DBP is greater than 100
-Methyldopa
-Nifedipine
-Hydralazine
Sodium nitroprusside (only postpartum)
-Labetalol and Propranolol (NOT: atenolol, nadolol, metoprolol- accumulate in breast milk)
**Do NOT use ACE inhibitor and ARBs
Gestational HTN
- BP of 140/90 or greater than the first time during pregnancy
- No proteinuria
- BP returns tot normal less than 12wks postpartum
Preeclampsia/Eclampsia
- BP 140/90 or greater after 20wks gestation with proteinuria**
- Always ask about past hx of preeclampsia since it RECURS**
- Eclampsia: seizures that cannot be attributed to other causes
Preeclampsia superimposed on chronic HTN
1: New onset proteinuria
2: A sudden increase in proteinuria or BP, or a platelet count of less than 100,000, in a woman with HTN and proteinuria before 20wks gestation
Severe preeclampsia (1 of following)
1: 160/110 or higher on 2 occasions at least 6hrs apart
2: Proteinuria of >5g/24hr collection or >3+ on 2 random urine samples at least 4hrs apart
3: Pulmonary edema or cyanosis
4: Oliguria (<400mL in 24hr)
5: Persistent headaches
6: Epigastric pain or impaired liver fx
7: Thrombocytopenia
8: Oligohydramnios, decreased fetal growth, or placental abruption
HELLP syndrome
H: Hemolysis
EL: Elevated Liver enzymes
LP: Low Platelet count
Seizure- Rx, Px
- ABC: airway, breathing, circulation
- Magnesium sulfate (PreventionOC)** to all severe preeclampsia
Abnormal labor- cc
A: Mechanical dystocia
-narrow pelvis: android or platypelloid shape of pelvis
-abnormal fetal lie
-fetal macrosomia, hydrocephalus, encephalocele, cystic hygroma
B: Functional dystocia
-reduced frequency or intensity of uterine contractions
C: Iatrogenic
-oversedation
Abnormal labor- rx
- those who in passive phase: rest for several hrs
- High dose oxytocin (goal: 7 contraction per 15mins)
- Low dose oxytocin (goal: 3-5 contractions per 10mins)
- Dinoprostone & Misoprostol (**contraindicated for a scarred uterus for labor induction)
- Amniotomy (artificial rupture of membranes- ARM)
- Delivery (Cesarean section or Operative vaginal delivery)
