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Personal OB > Class 4 Hemorrhage / Neonate resuscitation > Flashcards

Class 4 Hemorrhage / Neonate resuscitation Flashcards

1
Q

3 antepartum hemorrhages?

A
  • Placenta previa
  • Abruptio placentae
  • Uterine rupture
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2
Q

What is the most common presentation for placenta previa?

A

-Painless vaginal bleeding

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3
Q

What is a complete previa?

A

-When cervical os is entirely covered by placenta

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4
Q

All patients with vaginal bleeding are considered to have a________ until proven negative by ultrasound

A

Placenta previa

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5
Q

Patients w/ previous C/S and current placenta previa are at high risk for what?

A

-Placenta accreta

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6
Q

When is a regional epidural appropriate for a placenta previa?

A
  • Bleeding is not severe
  • Stable patient
  • Euvolemic
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7
Q

What induction agents should be considered if patient is hemodynamically unstable?

A

-Ketamine or Etomidate

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8
Q

What is placenta accreta?

A

Abnormally deep attachment of theplacenta, through theendometriumand into the myometrium

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9
Q

Name the 3 levels of placenta accreta?

A
  • Accreta = does not penetrate entire myometrium
  • Increta = deeper into myometrium
  • Percreta = Completely through myometrium
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10
Q

Placenta acretta is ______ diagnosed before birth.

A

Rarely

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11
Q

Acretta increased risk factors.

A
  • Placenta previa
  • Uterine scars
  • Thin placenta decidua
  • Female fetus
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12
Q

How to treat accreta?

A

-C-Section w/ hysterectomy

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13
Q

What is abruptio placentae (placenta abruption)? And what is a common sign?

A
  • Premature separation of placenta from uterine wall

- Painful vag bleed

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14
Q

What is the most common cause of intrapartum fetal death?

A

-abruptio placentae (placenta abruption

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15
Q

Risk factors of abruptio placentae (placenta abruption)?

A
  • HTN
  • Trauma
  • Cocaine
  • ETOH
  • Uterine abnormality
  • Multiparity
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16
Q

Bleeding concealed in the uterus may lead to what?

A

-Underestimation of blood loss

17
Q

When is uterine rupture most commonly seen?

A

-Prior classical C/S

18
Q

Risk factors for uterine rupture

A
  • Myomectomy
  • Prolonged labor w/ oxyctocin
  • enlarge uterus
19
Q

What is the common presentation of uterine rupture?

A
  • Sudden fetal distress
  • Severe abd pain
  • Frank blood
20
Q

What is considered postpartum hemorrhage?

A

> 500cc blood loss

21
Q

What is commonly associated with postpartum hemorrhage?

A
  • Prolonged labor
  • Preeclampsia
  • Multiple gestation
  • Uterine Atony
22
Q

Drugs used to treat uterine atony?

A
  • Oxytocin
  • Methylergonovine (IM only)
  • Prostaglandin F2 (no asthma pt)
23
Q

Causes of postpartum hemorrhage

A
  • Perineal laceration
  • Retained placenta (GETA)
  • Uterine inversion (GETA)
24
Q

When is a neuraxial block not a good idea?

A

-Hypovolemia

25
Q

What is amniotic fluid embolism?

A

-entry of amniotic fluid into maternal circulation thru breaks in uteroplacental membrane

26
Q

Typical presentation of amniotic fluid embolism?

A
  • Tachypnea
  • Cyanosis
  • Shock
  • Bleeding
27
Q

Why is it imperative to delivery baby during amniotic fluid embolism?

A

-Chest compressions are worthless due to aortcaval compression

28
Q

What is normal fetal HR in utero? What does decreased HR indicate?

A
  • 120-160

- Asphyxia

29
Q

What may indicate fetal distress?

A

-absence of HR variability

30
Q

What happens with early deceleration patterns?

A
  • Vagal response to head compression

- Not associated w/ distress

31
Q

What causes late decelerations?

A
  • Uteroplacental insufficiency
  • Lack of O2
  • Fetal distress
32
Q

Normal PH for fetus? When is it too low?

A
  1. 25 - 7.35

- <7.1

33
Q

Fetal PH less 7.20 may be _______, and require ______.

A
  • Distressed

- O2

34
Q

What is the APGAR score measure?

A
  • Activity
  • Pulse
  • Grimace
  • Apperance
  • Respirations
35
Q

4 keys to neonatal resusitation.

A
  • Suction any meconium
  • Resp rate should be 30-60
  • HR should be >100
  • Must keep infant warm
36
Q

When to start chest compression on neonate?

A

-HR <60 or 60 - 80 and not rising

37
Q

When to take APGAR scores

A
  • 1 and 5 minutes

- If 5 min score is <7, repeat q5 until 20 mins or 2 score are greater than 7

38
Q

What is to be done with neonate hypotension?

A
  • Rule out Hypoglycemia, Hypomag, hypocalcemia

- 10ml/kg of LR or NS

39
Q

Increased doses are typically recommended for ETT route in ________ resuscitation, but _________ for neonatal resuscitation

A
  • Pediatric

- Not recommended

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