Obstetric Complications + HTN Complications

Question 1

What is cervical insufficiency?

Answer 1

Inability of the uterine cervix to retain a pregnancy to viability in the absence of contractions or labor.

Question 2

When during the pregnancy do you evaluate the cervix for clerical insufficiency ? How do you tx?

Answer 2

16-20 wks; cerclage if cervix <25mm

McDonald= removable
Shirodkar = not removable need c section

Question 3

What is alloimmunization

Answer 3

Pregnant women has developed ab to foreign RBCs most commonly against those of her current or previous fetus but also caused by transfusion mismatch

Question 4

What is the antibody titer that shows no fetal risk (for alloimmunization)? What’s the best way to tell if baby is anemic?

Answer 4

less than 1:8 is okay! best way to assess anemia is with MCA doppler U/S = high systolic velocity = anemia

Question 5

Criteria for preterm labor

Answer 5

1. 20-37 week
2. 3 contractions in 30 min
3. Cervical dilation of at least 2 cm or effacement

Question 6

Matemal IV —

Answer 6

MgSO4

Question 7

Tocolgtic agents can be used to prolong pregnancy for no more than —

Answer 7

72 hrs ! Enough time to move mom to place with neonatal ICU and give IV bethamethasone

Question 8

4 tocolytic agents and their major C/I

Answer 8

1. MgSO4 IV - renal insufficiency and myasthenia gravies
2. Terbutaline - cardiac dz, DM, uncontrolled hyperthyroidism
3. CCB (nifedipine)- hypotension
4. Indomethacin(PG blocker) - >32 weeks = will close PDA :(

Question 9

Define Premature Rupture of Membranes

Answer 9

rupture of the fetal membranes before onset of labor

Question 10

What is the typical presentation of PROM? what is the MCC?

Answer 10

sudden gush of copeous vaginal fluid that is usually clear. U/S would show Oligohydramnios. MCC is infection(Chorioamnionitis) but can be non infectious

Question 11

How do you dx Chorioamnionitis? when do you commonly see this?

Answer 11

CLINICALLY DX! = maternal fever, uterine tenderness in the presence of confirmed PROM in absence of UTI or URI.

Question 12

Mother w/PROM that has uterine contractions present…how do you manage?

Answer 12

deliver baby + cervical culture to chck for chorioamnionitis = IV abx

Question 13

define Post Term Pregnancy. MCC?

Answer 13

pregnancy that is 40 weeks or over. MCC is idiopathic!

Question 14

How do you manage post term pregnancy?

Answer 14

1. check gestational age! make sure shes actually post term!
2. assess for likelihood of sucessful induction of labor by assessing cervix + bishop score. If bishop 8 or above = induce labor.

Question 15

define Gestational Hypertension. how do you tx?

Answer 15

sustained BP elevation of 140/90 or greater after 20 weeks WITHOUT PROTEINURIA. tx conservatively(rest, water, less salt) if really high can use labetalol or hydralazine

Question 16

What is the typical presentation of PROM? what is the MCC?

Answer 16

sudden gush of copeous vaginal fluid that is usually clear. U/S would show Oligohydramnios. MCC is infection(Chorioamnionitis) but can be non infectious

Question 17

How do you dx Chorioamnionitis? when do you commonly see this?

Answer 17

CLINICALLY DX! = maternal fever, uterine tenderness in the presence of confirmed PROM in absence of UTI or URI.

Question 18

Mother w/PROM that has uterine contractions present…how do you manage?

Answer 18

deliver baby + cervical culture to chck for chorioamnionitis = IV abx

Question 19

define Eclampsia. tx?

Answer 19

> 140/90, Proteinuria, SEIZURES.

tx: protect mothers airway and tongue, MgSO4 5g to stop seizures w/maintence 2g/h, IV oxy for deliver, diastolic BP goal 100-90 w/IV hydralazine and/or Labetalol

Question 20

How do you manage post term pregnancy?

Answer 20

1. check gestational age! make sure shes actually post term!
2. assess for likelihood of sucessful induction of labor by assessing cervix + bishop score. If bishop 8 or above = induce labor.

Question 21

define Gestational Hypertension

Answer 21

sustained BP elevation of 140/90 or greater after 20 weeks WITHOUT PROTEINURIA

Question 22

define Preeclampsia. tx?

Answer 22

Sustained bp of 140/90 or greater WITH Proteinuria(>300 mg or Pro/Cr >0.3) tx: <37 wks = rest, hydralazine, benzo in hospital. if >37 wks = IV oxytocin to induce labor, IV MgSO4 to prevent seizures

Question 23

pathophys of preeclampsia

Answer 23

diffuse vasospasm caused by loss of prego refractivness to vasoactive substances such as angiotension & changes decreases in prostacyclin(vasodil), increases in Thromboxane(vasoconstrictor)

Question 24

tx of preeclampsia w/severe features

Answer 24

=sustained BP >160/110, evidence of maternal jeopardy, edema

tx: DELIVER NOW! = IV oxytocin, IV MgSO4 to prevent seizures, IV Hydralazine and/or Labetalol

Question 25

define Eclampsia. tx?

Answer 25

> 140/90, Proteinuria, SEIZURES.

tx: protect mothers airway and tongue, MgSO4 5g to stop seizures w/maintence 2g/h, IV oxy for deliver, diastolic BP goal 100-90 w/IV hydralazine and/or Labetalol

Question 26

target diastolic bp in HTN mother

Answer 26

90-100

Question 27

define HELLP syndrome. tx?

Answer 27

Hemolysis(H)
Elevated Liver enzymes(EL)
Low Platelets(LP)

tx: prompt deliver w/corticosteroids to enhance post partium normalization of liver enzymes and platelet count.