Class 4 Hemorrhage / Neonate resuscitation Flashcards
3 antepartum hemorrhages?
- Placenta previa
- Abruptio placentae
- Uterine rupture
What is the most common presentation for placenta previa?
-Painless vaginal bleeding
What is a complete previa?
-When cervical os is entirely covered by placenta
All patients with vaginal bleeding are considered to have a________ until proven negative by ultrasound
Placenta previa
Patients w/ previous C/S and current placenta previa are at high risk for what?
-Placenta accreta
When is a regional epidural appropriate for a placenta previa?
- Bleeding is not severe
- Stable patient
- Euvolemic
What induction agents should be considered if patient is hemodynamically unstable?
-Ketamine or Etomidate
What is placenta accreta?
Abnormally deep attachment of theplacenta, through theendometriumand into the myometrium
Name the 3 levels of placenta accreta?
- Accreta = does not penetrate entire myometrium
- Increta = deeper into myometrium
- Percreta = Completely through myometrium
Placenta acretta is ______ diagnosed before birth.
Rarely
Acretta increased risk factors.
- Placenta previa
- Uterine scars
- Thin placenta decidua
- Female fetus
How to treat accreta?
-C-Section w/ hysterectomy
What is abruptio placentae (placenta abruption)? And what is a common sign?
- Premature separation of placenta from uterine wall
- Painful vag bleed
What is the most common cause of intrapartum fetal death?
-abruptio placentae (placenta abruption
Risk factors of abruptio placentae (placenta abruption)?
- HTN
- Trauma
- Cocaine
- ETOH
- Uterine abnormality
- Multiparity
Bleeding concealed in the uterus may lead to what?
-Underestimation of blood loss
When is uterine rupture most commonly seen?
-Prior classical C/S
Risk factors for uterine rupture
- Myomectomy
- Prolonged labor w/ oxyctocin
- enlarge uterus
What is the common presentation of uterine rupture?
- Sudden fetal distress
- Severe abd pain
- Frank blood
What is considered postpartum hemorrhage?
> 500cc blood loss
What is commonly associated with postpartum hemorrhage?
- Prolonged labor
- Preeclampsia
- Multiple gestation
- Uterine Atony
Drugs used to treat uterine atony?
- Oxytocin
- Methylergonovine (IM only)
- Prostaglandin F2 (no asthma pt)
Causes of postpartum hemorrhage
- Perineal laceration
- Retained placenta (GETA)
- Uterine inversion (GETA)
When is a neuraxial block not a good idea?
-Hypovolemia
What is amniotic fluid embolism?
-entry of amniotic fluid into maternal circulation thru breaks in uteroplacental membrane
Typical presentation of amniotic fluid embolism?
- Tachypnea
- Cyanosis
- Shock
- Bleeding
Why is it imperative to delivery baby during amniotic fluid embolism?
-Chest compressions are worthless due to aortcaval compression
What is normal fetal HR in utero? What does decreased HR indicate?
- 120-160
- Asphyxia
What may indicate fetal distress?
-absence of HR variability
What happens with early deceleration patterns?
- Vagal response to head compression
- Not associated w/ distress
What causes late decelerations?
- Uteroplacental insufficiency
- Lack of O2
- Fetal distress
Normal PH for fetus? When is it too low?
- 25 - 7.35
- <7.1
Fetal PH less 7.20 may be _______, and require ______.
- Distressed
- O2
What is the APGAR score measure?
- Activity
- Pulse
- Grimace
- Apperance
- Respirations
4 keys to neonatal resusitation.
- Suction any meconium
- Resp rate should be 30-60
- HR should be >100
- Must keep infant warm
When to start chest compression on neonate?
-HR <60 or 60 - 80 and not rising
When to take APGAR scores
- 1 and 5 minutes
- If 5 min score is <7, repeat q5 until 20 mins or 2 score are greater than 7
What is to be done with neonate hypotension?
- Rule out Hypoglycemia, Hypomag, hypocalcemia
- 10ml/kg of LR or NS
Increased doses are typically recommended for ETT route in ________ resuscitation, but _________ for neonatal resuscitation
- Pediatric
- Not recommended
