Antepartum and Postpartum hemorrhage and complication in OB ppt

Question 1

what is the leading cause of maternal and fetal mobidity and mortality

Answer 1

peripartum hemorrhage

Question 2

what is the primary mechanism for controlling blood loss at parturition

Answer 2

uterine contraction

Question 3

3 main causes of antepartum hemorrhage

Answer 3

placentia previa
placental abruption
uterine rupture

Question 4

should u do vag exams with placentia previa?

Answer 4

no way,

or performed under a double set up

Question 5

what shoiuld anesthesia do to ALL women with placenta previa?

Answer 5

evaluate them early
2 large PIV
labs
volume resusitation

Question 6

what is the most common cause of DIC

Answer 6

placenta abruption

Question 7

management for abruption

Answer 7

FHR monitoring
2 large bore IVs
labs
O2
LUD
delivery
c-section??

Question 8

what are better choices for induction in hypovolemia?

Answer 8

ketamine and etomidate

Question 9

causes of postpartum hemorrhage

Answer 9

labor < 3 hr
intrument delivery
GA
prolonged labor
Macrosomia
Twins
choriamnionitis
Prior c-section
stimulated labor
Hx of postpartum hemorrhage
fetal demise
amniotic fluid embolus
tocolytic therapy
multiparity

Question 10

most common cause of postpartum hemorrhage?

Answer 10

uterine atony

Question 11

1st line drug for uterine atony?

Answer 11

oxytocin

20 units to 1000ml LR (may double to 40 units)

Question 12

what must be avoided with use of methergine and why. (when used to contract uterus)

Answer 12

vasopressors

b/c it causes aplha-adrenergic stimulation

Question 13

Post dural puncture h/a s/s

Answer 13

postural
photophobia
frontal-occipital in nature (dull throbbing)
diplopia
may not have immediate onset(12-48 hrs post)

Question 14

total CSF fluid

Answer 14

150 ml

Question 15

treatment for PDPH

Answer 15

caffine
IV hydration
epidural blood patch

Question 16

blood patch how is it done?

Answer 16

same level or one beneath
15-20 mL of pt's blood
lie for one hour post supine
may repeat one
strict aseptic tech

Question 17

complications of LA injection into intravascular space

Answer 17

mubness tingling mouth
metallic taste
ringing in ears
seizure
CV collapse
(give test dose watch for HR to increase 30 beats in 30 sec)

Question 18

s/s of accidential subarachnoid injection

Answer 18

usually discovered with test dose (3-5 min)
total spinal signs
hypotension