Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

OB (Wolfe Summer 24") > Complications in OB > Flashcards

Complications in OB Flashcards

1
Q

“Term for singleton pregnancy is ____ completed weeks to ____ weeks.

A

37-42

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

pre-term labor: regular uterine contractions occurring at least q___ min resulting in cervical change prior to ___ weeks.

A

q10
37 weeks

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Very low birth weight (VLBW)

A

any infant < 1500g.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Low birth weight (LBW)

A

any infant < 2500g at birth.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Respiratory Distress Syndrome: Exacerbated by…..

A

intrapartum hypoxia, maternal stress

Almost all infants <27 wks GA, almost 0% by 36 wks GA.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Cause of Intracranial Hemorrhage

A

Uncontrolled delivery/trauma, neonatal HTN.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Association of PTL with genital tract colonization with :

A

Group B Strep, Neisseria gonorrhoeae, and bacterial vaginosis organisms.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

C-section or vaginal delivery?
Concern regarding intracranial hemorrhage:

A

No difference

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

C-section or vaginal delivery?
Obstetrician use of outlet forceps to assist delivery :

A

no difference

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

C-section or vaginal delivery?
Breech:

A

C-section is proven safer in PTL with breech presentation
Will do scheduled c section with breech

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What is Tocolylitic therapy?

A

Attempt to stop or slow contractions to avoid PTL.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Reasons for tocolytic therapy:

A

Gestational age 20-34 wks, EFW < 2500 g, absence of fetal distress.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

How long can Tocolytic therapy be used?

A

Used for short-term (<48 hrs),

to permit corticosteroid treatment to aid fetal lung maturation, or allow transfer to a facility with appropriate NICU facilities.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Methylxanthines: how does Phosphodiesterase work?

A

increase intracellular cAMP —> uterine muscle relaxation.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Tocolytic Therapy: Calcium Channel Blockers (Nifedipine) MOA…

A

Myometrium contractility related to free calcium concentration: decrease in Ca2+ —->decrease contractility.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Maternal side effects of CCBs

A

-Hypotension, tachycardia, dizziness, palpitations
-Facial flushing
-Vasodilation, peripheral edema
-Myocardial depression, conduction defects
-Hepatic dysfunction
-Postpartum hemorrhage
-Fetal side effects
-Decreased UBF –>fetal hypoxemia and fetal acidosis

LOTS!

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Calcium Channel Blockers may increase risk of_______ _________ due to uterine atony refractory to ________ and _________ F-α2

A

postpartum hemorrhage
oxytocin and prostaglandin F-α2

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Tocolytics: Prostaglandin Synthetase Inhibitors MOA

A

Mechanism of action: decrease cyclooxygenase ———> decrease prostaglandin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

TOCOLYTIC THERAPY: Magnesium MOA

A

-May compete with calcium for uterine smooth muscle surface binding —–> decrease contractility.

-Prevents increase in intracellular calcium.

-Activates adenylcyclase —–> increase cAMP.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Magnesium: Patient is more sensitive to both _________ and _________

A

depolarizing and nondepolarizing muscle relaxants.

21
Q

1 treatment in tocyltic therapy

A

Magnesium

22
Q

Magnesium and MAC:

A

MAC is decreased for inhalational anesthetics

23
Q

Normal treatment range of Magnesium for tocolytic therapy:

A

4-7 mg/100 mL

24
Q

Magnesium toxicity dose: = loss of deep tendon reflexes

A

8-10 mg/100 mL

25
Q

Magnesium toxicity dose: respiratory depression, cardiac conduction defects (wide QRS, inc. P-R interval)

A

10-15 mg/100 mL

26
Q

Magnesium toxicity dose: cardiac arrest

A

20+ mg/100 mL

27
Q

Magnesium toxicity treatment

A

calcium gluconate or CaCl

28
Q

Tocolytic: Beta adrenergic agonists (terbutaline, ritodrine) MOA

A

Direct stimulation of β-adrenergic receptors in uterine smooth muscle —–> increase cAMP ——> uterine relaxation.

29
Q

Side effects of Beta adrenergic agonists (terbutaline, ritodrine)

A

-Nausea, vomiting
-Anxiety, restlessness
-Hyperglycemia, hyperinsulinemia, hypokalemia, acidosis
-Tachycardia, arrhythmias, dec. peripheral vascular resistance, dilutional anemia, dec. colloid oncotic pressure, pulmonary edema

30
Q

Frequency of Beta agonist pulmonary edema

A

Incidence 1-5% of parturients receiving beta adrenergic tocolytic therapy

31
Q

Risk factors for Beta agonist pulmonary edema

A

-Increased IVF administration
-Multiple gestation
-Tocolysis greater than 24 hrs
-Concomitant magnesium therapy
-Infection
-Hypokalemia
-Undiagnosed heart disease

Infection – increased pulmonary capillary permeability
Echocardiogram – no evidence of LV dysfunction
Decreased colloidal oncotic pressure – further dec. due to sodium and water retention with beta adrenergics

32
Q

Fetal mortality risk is increased ___-___x in twins vs. singleton pregnancy

A

5-6 times

33
Q

Mortality of second twin is greater than first twin because…

A

-Placental abruption
-cord prolapse
-malpresentation

34
Q

Triplet or higher pregnancy – almost always delivery by ________.

A

c-section

35
Q

Local anesthetic considerations for Multiple gestation pregnancy.

A

-May require rapid increase in density of block if internal manipulation of twin B or conversion to C-section.

-2-chloroprocaine 3% is preferred for rapid onset

36
Q

MULTIPLE GESTATION ANESTHESIA CONSIDERATIONS :

A

-Early epidural placement and time to assess functionality.
-Inc. risk of hemorrhage – large bore IV, blood T&C.
-Inc. risk of aortocaval compression due to inc. uterus size.
-Delivery in OR, treat as C-section with regards to precautions (i.e. aspiration prophylaxis), O2, monitors.

37
Q

What to give for internal manipulation and uterine relaxation (multiple gestation)

A

Nitroglycerin 100 mcg initially, repeated to max of 500 mcg.

38
Q

Signs and Symptoms of Uterine Rupture

A

-Sudden abdominal pain despite functioning epidural
-Vaginal bleeding
-Hypotension
-Cessation of labor
-Fetal distress – most reliable sign

39
Q

Diagnosis of Uterine Rupture

A

manual exploration, laparotomy

40
Q

Risk factors for Uterine Rupture

A

-Previous uterine surgery
-Trauma
-Multiparity
-Uterine anomaly
-Oxytocin
-Placenta percreta
-Tumors
-Macrosomia
-Malposition

41
Q

Most common abnormal presentation

A

longitudinal – vertex or breech

42
Q

Risks of abnormal presentation

A

Inc. risk of fetal death, asphyxia, birth trauma, cord prolapse, maternal infection (d/t internal manipulation)

43
Q

_______ ______is an absolute indication for c-section

A

Transverse lie

44
Q

% success of manipulation of fetus for Breech

A

50-80%

Regional anesthesia – inc. maternal comfort, inc. success rate.

45
Q

Post Maturity- definition and risks

A

Gestation beyond 42 wks, risks often evident at 40-41 wks
Dec. uteroplacental blood flow –> fetal distress
Umbilical cord compression due to oligohydramnios
Meconium staining of amniotic fluid
Inc. incidence of macrosomia, shoulder dystocia

46
Q

IUFD Causes

A

CORD ACCIDENTS!

-Chromosomal abnormalities
-Congenital malformations
-Multiple gestation
-Infection
-Placental factors
-Maternal immunological or thyroid disease
-Isoimmunization
-Maternal trauma

47
Q

Cord prolapsed through cervix, compressed, approx. __ minutes window before fetal compromise.

A

10

48
Q

Umbilical cord length

A

<30 cm risks compression, constriction, rupture.
>72 cm risks cord entanglement

49
Q

Most reliable sign of Uterine Rupture

A

-Fetal distress – most reliable sign

OB (Wolfe Summer 24") (3 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions