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Block I: Reproduction & Sexuality > Clinical: Obstetric Complications > Flashcards

Clinical: Obstetric Complications Flashcards

1
Q

6 obstetric emergencies

A
  • Massive obstetric hemorrhage
  • Non-hemorrhagic shock
  • Shoulder dystocia
  • Eclampsia
  • Cord prolapse
  • Malpresentation
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2
Q

3 massive obstetric hemorrhages

A
  • Praevia
  • Abruption
  • PPH
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3
Q

2 non-hemorrhagic shocks

A
  • Amniotic fluid embolism
  • Acute uterine inversion
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4
Q

Define massive obstetric hemorrhage

A

Blood loss requiring replacement of patient’s total blood volume

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5
Q

3 potential locations of concealed bleeding

A
  • Uterus (couverlaire uterus of abruption)
  • Broad ligament hematoma
  • Peritoneal cavity
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6
Q

What is disseminated intravascular coagulation characterized by?

A

Activation of the coagulation sequence –> systemic micro-thrombi (sequelae of tissue hypoxia)

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7
Q

2 triggering pathways of disseminated intravascular coagulation

A
  • Release of tissue factor/thromboplastic factors into circulation
  • Widespread endothelial injury
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8
Q

2 mechanisms of disseminated intravascular coagulation

A
  • Activated monocytes –> release IL-1 and TNF alpha –> increase expression of tissue thromboplastic factor on endothelial cels + increase thrombomodulin
  • Consumption of coagulation factors, platelets, and activation of fibrinolytic pathways
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9
Q

4 sources of thromboplastic substances that may cause DIC

A
  • Leukemic cell granules
  • Placenta in obstetric complications
  • Carcinomas (Mucin-secreting adenocarcinomas)
  • Bacterial endo and exotoxins
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10
Q

3 organs damaged by micro-thrombi in DIC

A
  • Kidney
  • Adrenals
  • Brain
  • Heart and anterior pituitary
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11
Q

Kidney damage due to micro thrombi

A

Microinfarcts in the renal cortex (severe - bilateral renal cortical necrosis)

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12
Q

Adrenal damage due to micro thrombi

A

Bilateral adrenal hemorrhage (resembles Waterhouse-Friderichsen syndrome)

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13
Q

Brain damage due to microthrombi

A

Microinfarcts surrounded by foci of hemorrhage

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14
Q

DIC clinical manifestation (9)

A
  • Acute = bleeding tendency (i.e. obstetrical complications and trauma)
  • Chronic = thrombotic complications (i.e. cancer0
  • Minimal to profound shock
  • Renal failure
  • Dyspnea
  • Cyanosis
  • Convulsions
  • Coma
  • Hypotension
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15
Q

Lab findings of DIC (4)

A
  • PT and PTT typically prolonged
  • Thrombocytopenia
  • Low fibrinogen
  • Elevated plasma fibrin split products
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16
Q

Define placenta praevia

A

The placenta covers the internal cervical os completely or partially (0.5% to 1% of all births)

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17
Q

4 risk factors of placenta praevia

A
  • Previous cesarean sectrion (x6)
  • Mulitparity (x2.6)
  • Previous uterine surgery
  • IVF
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18
Q

4 different scenarios that predict placenta praevia management

A
  • Preterm fetus and no indication for delivery (observe)
  • Mature fetus and bleeding does not stop (C section)
  • Patient in labor (C section)
  • Severe bleeding and immature fetus (C section)
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19
Q

Management of placental abruption if no symptoms (no bleeding)

A

Observe mother and fetus

20
Q

Management of placental abruption if severe bleeding and fetus is alive

A

Cesarean section

21
Q

Management of placental abruption if bleeding and fetus is dead

A
  • Amniotomy + pakced red cells + coagulatoin factors + labor induction (vaginal birth)
  • If bleeding too severe –> C section
22
Q

When to consider vasa praevia

A

If bleeding occurs after amniotomy

23
Q

3 points of management of post-partum hemorrhage

A
  • Detect and treat antenatal anemia
  • Active management of third stage
  • IV access plus collect blood for group and cross match if assessed as at risk
24
Q

3 elements of active management of third stage for post-partum hemorrhage

A
  • Administration of a prophylactic oxytocic agent
  • Early cord clamping
  • Controlled cord traction of the umbilical cord
25
Q

2 prophlactic oxytocic agents

A

Ergometrine and Carboprost

26
Q

Define amniotic fluid embolism

A

Anaphylactic reaction to fetal antigens, mainly during delivery

27
Q

6 risk factors for amniotic fluid embolism

A
  • Multiparity
  • Abruption
  • Blunt abdominal trauma
  • External version
  • Fetal death
  • Amniocentesis
28
Q

13 clinical manifestations of amniotic fluid embolism

A
  • Rigors
  • Perspiration
  • Restlessness
  • Coughing
  • Cyanosis
  • Hypotension
  • Bronchospasm
  • Tachypnea
  • Tachycardia
  • Arrhythmia
  • Convulsions
  • MI
  • DIC
29
Q

Diagnosis of amniotic fluid embolism (4)

A
  • Clinical manifestations
  • Chest X ray
  • ECG
  • Blood gas analysis
30
Q

Usual presentation of amniotic fluid embolism

A

Sudden coughing attack after cesarean or vaginal birth

31
Q

When might uterus inversion occur?

A

If the fundal placenta is pulled out incautiously and forcefully

32
Q

Describe the events of shoulder dystocia (4)

A
  1. Fetal head is born
  2. Contraction ceases –> fetal head slips back into vagina (turtle phenomenon)
  3. Blue livid color of face caused by venous congestion (not hypoxia)
  4. Interruption of arterial perfusion –> fetal hypoxia and cerebral injury
33
Q

Shoulder dystocia management (4 maneuvers)

A
  • McRoberts maneuver
  • Woods maneuver
  • Jacqumiere maneuver
  • Rubin maneuver
34
Q

Describe the McRoberts maneuver

A
  1. Flex thighs sharply up onto the abdomen
  2. Suprapubic pressure
35
Q

Describe the Wood Maneuver

A

The posterior sohulder is rotated 180 degrees in a corkscrew manner so that the anterior shoulder is released

36
Q

Describe the Jacqumiere maneuver

A

Delivery of the posterior shoulder

37
Q

Describe the Rubin maneuver

A

The impacted anterior shoulder is rotated in abdomen direction

38
Q

3 methods of management for shoulder dystocia if all 4 maneuvers do not work

A
  1. Fracture of the clavicula (upward direction)
  2. Zavanelli maneuver
  3. Abdominal rescue after O,Leary & Cuva.
39
Q

Describe Zavanelli maneuver

A

Put the fetal head into the vagina and cesarean section

40
Q

Describe abdominal rescue

A

Lap + uterotomy: release the impacted anterior shoulder abdominally and the posterior sohulder vaginal and deliver the fetus vaginally

41
Q

7 risk factors for umbilical cord prolapse

A
  • Long umbilical cord
  • Breech
  • Transverse lie
  • Small fetus
  • Multiparity
  • Twins
  • Amniotomy
42
Q

8 clinical manifestations of eclampsia

A
  • Headaches
  • Blurred vision
  • Confusion
  • Severe HTN
  • Proteinuria
  • Edema
  • Hyper-reflexia
  • Eclamptic fit (seizure)
43
Q

6 points of management for eclampsia

A
  • Turn woman on side
  • Oxygen
  • Magnesion sulphate (IM or IV)
  • Anti-hypertensives (hydrallazine, labetolol)
  • Anti-seizure meds
  • DELIVER THE PLACENTA (and the baby!)
44
Q

6 potential consequences of eclampsia

A
  • Fetal death
  • Maternal asphyxia
  • Respiratory distress
  • Hemorrhage (thrombocytopenia/DIC)
  • Multi-organ failure
  • ICU
45
Q

2 malpresentations

A
  • Breech presentation
  • Transverse/oblique lie
46
Q

5 potential consequences of malpresentation

A
  • Prematurity
  • Multiple pregnancy
  • Obstruction (i.e. fibroids)
  • Fetal malformation (i.e. hydrocephaly)
  • Placenta praevia

Block I: Reproduction & Sexuality (23 decks)

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