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Advanced Principles B (Summer '24) > Complicated OB Pt. 1 (Exam I) > Flashcards

Complicated OB Pt. 1 (Exam I) Flashcards

1
Q

When is optimal timing to attempt ECV (External Cephalic Version)?

A

36-37 weeks

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2
Q

A fetus is unlikely to revert back to breach presentation after ECV after ____ weeks.

A

37

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3
Q

What medication should be given prior to ECV?

A

Tocolytic agents:

Terbutaline
NTG

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4
Q

ECV is commonly unsuccessful if the mom is feeling ____.

A

pain

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5
Q

What is done to treat the pain of ECV?

A

Neuraxial analgesia/anesthesia

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6
Q

What dermatome level is attempted with ECV?

A

T6

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7
Q

What complications can occur with ECV?

A
  • Placental abruption
  • Preterm labor
  • Worsening FHT’s
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8
Q

_______ _____ is characterized by abnormal placenta implantation on the upper uterine segment.

A

Placenta Previa

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9
Q

What are the four subcategories of placenta previa?

A
  • Low Lying - doesn’t infringe on cervical os.
  • Marginal - touches but doesnt cover top of cervix.
  • Partial - partially covers cervix.
  • Complete - covers cervix completely.
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10
Q

what are risk factors for placenta previa?

A
  • Older maternal age
  • Multiparity
  • Hx of smoking
  • Previous c-section / uterine surgery
  • Hx of placenta previa
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11
Q

What is the classic sign of placenta previa?

A

Painless vaginal bleeding in 2ⁿᵈ or 3ʳᵈ trimester.

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12
Q

In abruptio placentae, bleeding occurs from exposure of ______ vessels at the _________ interface.

A

decidual : decidual-placental

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13
Q

How is abruptio placentae defined?

A

Premature separation of the placenta (can be complete or partial).

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14
Q

What are the consequences of placental abruption on the fetus?

A

Reduced gas-exchange due to loss of placental-uterine interface:

  • bradycardia
  • late or variable decels
  • decreased / absent variability
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15
Q

What are some of the risk factors for placental abruption?
Which of these are the greatest?

A
  • HTN
  • Cocaine
  • Advanced maternal age
  • Smoking
  • Trauma
  • Multiple gestation
  • Pre-eclampsia
  • Chorioamnionitis
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16
Q

The classic sign of placental abruption is characterized by ________ vaginal bleeding.

A

Painful

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17
Q

What is couvelaire uterus?
When does it occur?

A
  • Blood forced through uterine wall into gastric serosa.
  • occurs with serious placental abruption.
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18
Q

What is the primary risk associated with placental abruption?

A

Hypovolemic / hemorrhagic shock

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19
Q

What causes consumptive coagulopathy on placental abruption patients?

A
  • Activation & usage of circulating plasminogen
  • Placental thromboplastin
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20
Q

Uterine rupture is most commonly associated with ______.

A

TOLAC

Trial of Labor after Cesarean

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21
Q

What is the most consistent clinical feature of uterine rupture?

A

Fetal bradycardia

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22
Q

What clinical features are seen with uterine rupture?

A
  • Fetal bradycardia
  • Vaginal bleeding
  • Severe abdominal pain (breakthrough neuraxial analgesia)
  • Shoulder pain
  • Hypotension
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23
Q

What is uterine blood flow at term gestation?

A

700 - 900 mL/min

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24
Q

Primary postpartum hemorrhage occurs within _____ hours of delivery.

A

24

Has a higher maternal morbidity & mortality.

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25
Q

Secondary postpartum hemorrhage occurs from _____ to _____ weeks post partum.

A

1 day to 6 weeks

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26
Q

Postpartum hemorrhage is defined as blood loss ≥ _____ mls or blood loss with signs of symptoms of hypovolemia within ____ hours of delivery.

A

1000 mls : 24 hours

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27
Q

What are some common causes of postpartum hemorrhage?

A
  • Uterine atony (most common)
  • Retained placenta
  • Cervical/vaginal lacerations
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28
Q

Failed release of _____ and ______ is the typical cause of uterine atony.

A

oxytocin & prostaglandins (uterotonics)

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29
Q

What is the first line uterotonic?

A

Oxytocin

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30
Q

What is the half life of oxytocin?

A

3 - 5 minutes

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31
Q

How is pitocin typically diluted?

A

20 units in 1000mLs

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32
Q

What are possible side effects of oxytocin?

A

Dose-dependent:

  • Tachycardia
  • Hypotension
  • Coronary vasoconstriction
  • Hyponatremia
  • Seizures
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33
Q

Typically, oxytocin is given at a rate of ______ to prevent side effects.

A

< 1 unit/min

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34
Q

What is the 2ⁿᵈ line uterotonic agent?

A

Methylergonovine (Methergine)

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35
Q

What is the dose of methergine?

A

0.2mg IM

36
Q

Can methergine be given IV?

A

NO

37
Q

What is the duration of methergine?

A

2 - 4 hours

38
Q

Which uterotonic is unstable at room temperature?

A

Methergine

39
Q

What is the max dose of Methergine?

A

0.8mg

40
Q

What are contraindications to methergine administration?

A
  • Preeclampsia
  • HTN
  • Vascular disease
  • Coronary artery disease
41
Q

If hypertension results from methergine, what drugs should be used to treat the hypertension?

A
  • NTG
  • Nitroprusside
42
Q

What is the 3ʳᵈ line uterotonic agent?

A

Carboprost (Hemabate)

43
Q

What drug should be given in a preeclamptic patient that has already received oxytocin for refractory uterine atony?

A

Carboprost

44
Q

What is the dose of carboprost?

A

250 mcg IM
or
Intrauterine q15-90 min

45
Q

What is the max dose of carboprost?

A

2000 mcg

46
Q

What are the primary adverse effects seen from carboprost?

A

Pulmonary:

  • Bronchospasm
  • VQ mismatch
  • Shunt
  • Hypoxia
  • ↑ PVR
47
Q

Extra caution should be given to patients with what condition before adminstering carboprost?

A

Reactive Airway Disease
aka
Asthma

48
Q

What is the dose of Misoprostol (Cytotec)?

A

600 - 1000mcg

49
Q

Risk for postpartum hemorrhage will increase if the interval between fetal delivery and placental delivery is greater than _______.

A

30 minutes

50
Q

What is the anesthetic treatment for retained placenta?

A

Induced uterine relaxation for surgical removal.

51
Q

What drugs are typically used to relax the uterus for retained placenta removal?

A
  • Nitroglycerin 25 - 50mcg IV
  • VAA’s
52
Q

What is placenta accreta?

A

Placenta invasion of the uterine wall

53
Q

What is placenta increta?

A

Placenta invasion of the myometrium

54
Q

What is placenta percreta?

A

Placental intrusion through myometrium into serosa & abdominal cavity (and potentially other organs).

55
Q

What are risk factors for placenta accreta?

A
  • C-section history
  • Placenta previa w/ or w/o uterine sx
  • Myomectomy hx
  • Asherman syndrome
  • Advanced maternal age
56
Q

What are the degrees of uterine inversion?

A
57
Q

What are the risk factors for uterine inversion?

A
  • Overzealous fundal pressure
  • Umbilical cord traction
  • Uterine atony
  • Placenta accreta
  • Overall anatomical abnormalities
58
Q

What are two complications commonly associated with uterine inversion?

A
  • Hemorrhage
  • Vagal bradycardia
59
Q

What is the definitive surgical treatment for PPH?

A

Peripartum hysterectomy

60
Q

Possible risk for needing a hysterectomy will increase with the patient’s number of previous ________.

A

c-sections

61
Q

How much higher is mortality for a peripartum hysterectomy vs a non-pregnant hysterectomy?

A

25x higher!

62
Q

Why are peripartum hysterectomy’s more challenging?

A
  • Large uterus
  • ↑ blood flow (700 - 900 mL/min)
  • Engorged vasculature
63
Q

What sensory level for neuraxial anesthesia must be maintained for a peripartum hysterectomy?

A

T4

Often these patients get GETA

64
Q

Parturients can typically tolerate EBL of ___% total blood volume before symptoms or vital sign changes occur.

A

15%

65
Q

_______ is a late sign of hemorrhage in parturient patients.

A

hypotension

Parturients have a higher blood volume at baseline.

66
Q

Fibrinogen should be maintained at > ________.

A

150 - 200 mg/dL

67
Q

What blood product should be given for a low fibrinogen?

A

Cryoprecipitate

68
Q

If blood loss is greater than 5L then ______ transfusion is indicated.

A

platelet

69
Q

1 bag of platelets increases the total count by ______ to ______.

A

5000 to 10000 mm3

70
Q

What dosing of TXA is indicated for PPH?

A

1g IV within 3hours of recognition of hemorrhage

71
Q

Can one attempt TOLAC after their previous c-section had a classic incision?

A

No

Only low transverse or low vertical incisions may attempt TOLAC

72
Q

Elevated levels of Fetal fibronectin (fFN) is predictive for what?

A

Preterm labor

73
Q

What medication class is used to accelerate fetal lung development?

A

Corticosteroids

  • Betamethasone 12mg IM q24
  • Dexamethasone 6mg IM q12
74
Q

What drug is given for fetal neuroprotection in preterm labor?

A

Magnesium sulfate

75
Q

What is a tocolytic?

A

β-adrenergic agonist that relaxes uterine smooth muscle

76
Q

What is a common tocolytic given for preterm labor?

A

Terbutaline

77
Q

What are the side effects of terbutaline?

A
  • Dysrhythmias
  • Pulmonary edema
  • Hypotension
  • Tachycardia
78
Q

Caution should be used when giving terbutaline to a parturient that is fluid overloaded, why?

A

↑ risk of pulmonary edema

79
Q

What NSAID tocolytic can be given for preterm labor?

A

Indomethacin

  • Inhibits cyclooxygenase, thus prevening synthesis of prostaglandins from arachidonic acid
80
Q

What are the side effects of indomethacin?

A

Nausea & heartburn

81
Q

How does magnesium treat preterm labor?

A
  • Competitive agonism of Ca⁺⁺ → reduces Ca⁺⁺ influx into uterine myocytes.
  • Limits acetylcholine
82
Q

What s/s are associated with long-term magnesium administration?

A
  • Flushing
  • Sedation
  • Chest pain
  • Blurry vision
  • Hypotension
  • Pulmonary edema
  • Abnormal neuromuscular function
83
Q

What is the primary diagnostic sign of hypermagnesemia?

A

Decreased deep tendon reflexes

associated with ↓ compensatory responses to hemorrhage.

84
Q

How will magnesium effect neuromuscular blocking drugs?

A

Mg⁺⁺ potentiates depolarizing and non-depolarizing neuromuscular blockers.

give sugammadex

85
Q

How is Mg⁺⁺ dosed?

A
  • 2 - 4 g load
  • 1 - 2 g/hr
86
Q

What are normal serum Mg⁺⁺ levels?

A

1.7 - 2.4 mg/dL

87
Q

What are therapeutic Mg⁺⁺ levels?

A

5 - 9 mg/dL

Advanced Principles B (Summer '24) (4 decks)

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