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EMRG1305 > Complications of Pregnancy and Delivery > Flashcards

Complications of Pregnancy and Delivery Flashcards

1
Q

What are some maternal risk factors that affect pregnancy?

A
  • Age over 35, or younger than 20,
  • smoking/ consuming alcohol
  • Pregnancy with twins or more
  • miscarriage history
  • obesity/ anorexia
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2
Q

What are some health conditions that can complicate pregnancy?

A
  • Diabetes
  • Cancer
  • Hypertension
  • STI’s
  • Kidney problems
  • Epilepsy
  • Anemia
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3
Q

What is an ectopic Pregnancy?

A

Fertilized egg implants outside the uterus (90% fallopian tube; but also abdominal cavity low in cervix), Non viable, diagnosed before 12wks(6)

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4
Q

What are the symptoms of Ectopic Pregnancy

A

Pain, amenorrhea (missed periods), vaginal bleeding. Ruptured - hypotension and shock

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5
Q

How do you treat ectopic pregnancy pts?

A

Treat underlying presenting problem; abdo pain, sycope, hypotension, shock

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6
Q

What is a miscarriage?

A

Loss of pregnancy, naturally before 20wks

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7
Q

How do miscarriages present?

A

bleeding; with lots of clots and tissue, cramping.

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8
Q

What is hyperemesis Gravidarum?

A

Severe nausea/vomiting (3xday) during pregnancy, can lead to dehydration, vertigo, weight loss, preterm labour

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9
Q

What is Preeclampsia?

A

Hypertensive disorder that develops after 20wks, untreated may develop into eclampsia

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10
Q

What are signs and symptoms of Preeclampsia?

A

BP > 140/90
severe headache, blurred vision
upper abdo pain
N/V
Proteinuria
edema

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11
Q

What is eclampsia?

A

When a pre-eclamptic pt goes into seizure

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12
Q

How do you treat a pre-eclamptic pt?

A

Bring to hospital quick, don’t make them walk, they will develop plan and provide medications

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13
Q

How do you treat an eclamptic pt?

A

Treat them like a seizure pt

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14
Q

Why are babies of pts with untreated gestational diabetes large?

A

Excess glucose is transferred to the fetus and stored as fat

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15
Q

How is gestational diabetes different than other forms of diabetes?

A

It develops during pregnancy and usually resolves once baby is delivered

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16
Q

S/S of Gestational diabetes

A

Increased thirst, frequent urination, fatigue, nausea, frequent bladder and skin infections, blurred vision, dry mouth, yeast infections

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17
Q

What is placenta Previa?

A

When the placenta partially or fully covers the cervix.

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18
Q

What is prevented by placenta previa?

A

Vaginal delivery is not possible

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19
Q

What is a complication of placenta previa if delivery is attempted?

A

Can cause placenta to rupture, leading to massive blood loss

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20
Q

How frequent is Abruptio Placenta?

A

Occurs in 1% of all pregnancies

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21
Q

What is abruptio placenta?

A

The partial or full placental detachment at 20wks, when vascular structures are torn away from uterine lining.

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22
Q

A patient presents with severe abdominal pain described as tearing. She is currently 22wks pregnant with twins, what is likely diagnoses?

A

Abruptio Placenta

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23
Q

What are the risk factors of Abruptio Placenta?

A

Trauma, multiple fetus, short umbilical cord, previous c section, preeclampsia/eclampsia, age >35 years

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24
Q

What does AFE stand for

A

Amniotic Fluid embolism

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25
Q

What is an amniotic fluid embolism?

A

Amniotic fluid, fetal cells, hair or debris enters into maternal pulmonary circulation, causing cardiovascular collapse

26
Q

S/S of AFE

A

dyspnea, hypoxia, hypotension, possible cardiac arrest

27
Q

Why must all trauma pts be transported, even with only minor injuries presenting?

A

60-70% of fetal loss is reported from “minor injuries”

28
Q

Is violence a cause of trauma in pregnant pts?

A

yes, 20% women experience violence during pregnancy

29
Q

What modification must be done for CPR on pregnant (>20wks) pts?

A

Manually displace abdomen to the left to relieve pressure on the pts vena cava preventing full blood flow

30
Q

What is supine Hypotension Syndrome?

A

Compression of the vena cava by the uterus creates hypotension (some cases syncope) when the pregnant woman is supine

31
Q

Why should pts >20 weeks be laying left lateral whenever possible?

A

To minimize pressure on vena cava

32
Q

What are some common respiratory issues pregnant women have?

A

Stuffy, runny nose, epistaxis

33
Q

What is considered a pre-mature birth?

A

Delivery prior to 37 wks gestation

34
Q

What are some things to be aware about for pre-mature births?

A

hypothermia risk, usually require resus, poor lung compliance, underdeveloped alveoli(no surfactant prior to 28wks)

35
Q

What should you do if nuchal cord is wrapped around baby neck?

A

Document. If loose, slide over baby head, if it is tight, clamp and cut - deliver quickly

36
Q

What is a precipitous Labour? what complications may it cause?

A

Extremely rapid delivery, risk of tearing and postpartum hemorrhage

37
Q

What is a transverse lying position?

A

baby is positioned across the pelvis - can not be delivered in such position

38
Q

What are the different types of breech?

A

frank (bum), complete (feet/bum), and footling (feet first)

39
Q

What fetal positions will not deliver?

A

Transverse, oblique(diagonal),shoulder presentation(arm out)

40
Q

What is the approach to breech babies? Why?

A

Hands off use gravity to deliver, to avoid stimulation

41
Q

What is cord prolapse?

A

When umbilical cord presents prior to the neonate - problem as when baby tries to deliver it will cut off all circulation.

42
Q

What is the management procedure for prolapsed cord?

A

Knee to chest (attempt gravity to move back in), assess pulse, if has pulse - place back into vagina, if no pulse/weak - cradle gently, insert fingers to relieve pressure from presenting part. Once in position pulsations return, do not move.

43
Q

If delivery is imminent with prolapsed cord, what considerations should be made?

A

Try to deliver quickly(4mins) prepare to resuscitate

44
Q

What is shoulder dystocia?

A

Fetal shoulders, are stuck

45
Q

What are some risk factors for shoulder dystocia?

A

Previous shoulder dystocia, gestational diabetes, postdate deliveries, small mamas, high pregnancy weight(gain), abnormal pelvic anatomy

46
Q

What is turtling in shoulder dystocia?

A

During contraction, head is forced down, and out, when relaxation, head moves back

47
Q

How long do you have to deliver baby after head is delivered? What happens if not?

A

4 minutes, after that the baby is not getting adequate circulation, and may suffer hypoxic injury.

48
Q

What does ALARM stand for

A

Ask for help, Legs up (open pelvis), adduct shoulder(suprapubic pressure), roll over, Manually deliver arm if seen.

49
Q

How many times can ALARM be performed

A

Twice, one time by each partner.

50
Q

What are some maternal complications caused by Shoulder Dystocia?

A

Soft Tissue Injuries, Anal sphincter damage, cervical or vaginal tears, Uterine Rupture, Postpartum Hemorrhage

51
Q

What are some neonatal complications caused by Shoulder Dystocia?

A

Clavicle Fracture, Fetal Acidosis, Humeral Fracture, Brachial Plexus Palsy (transient/ permanent), Hypoxic Brain Injury, Death

52
Q

What is the McRoberts maneuver?

A

Hyperflex knees to chest, to open pelvis.

53
Q

What are the 4 T of postpartum hemorrhage?

A

Tone (exhausted uterus cannot contract), Tissue (parts of placenta retained), Trauma (uterine rupture/laceration), Thrombin (abnormal coagulation)

54
Q

Fundal massage can only be done after what?

A

placental delivery

55
Q

How is a fundal massage given?

A

One hand on lower abdomen, circular movement to massage uterus. Done for 10-15 minutes then reassessed

56
Q

If maternal bleeding occurs after fundal massage, what is the next step?

A

Bimanual compression

57
Q

How is bimanual compression given?

A

One hand above symphysis pubis & other on top of fundus. Squeeze together – for 5-10 minutes until bleeding stops. Apply same pressure as external wound

58
Q

How do you treat postpartum hemorrhage?

A

Assess, and treat for shock symptoms. Oxygen, fluids

59
Q

What circumstances allow for bimanual compression?

A

Pre-placental delivery hemorrhage, post placental delivery where fundal massage failed

60
Q

What is meconium

A

Baby’s first bowel movement - thick, sticky, dark green, consisting of cells, protein, fats and intestinal secretions

61
Q

What can cause meconium in utero

A

Fetal distress.

62
Q

Why is meconium pre-delivery a problem?

A

Baby can aspirate- infections, severe illness, potential death

EMRG1305 (2 decks)

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