Complications of the Obstetric Patient Flashcards
PPH definition
EBL >500 for vaginal delivery or >1000mL for c section
PPH is the result of (6)
uterine atony (80%) uterine abnormalities placental retention lacterations uterine inversion coagulation abnormalities
uterine atony is associated with (4)
multiparty
prolonged oxytocin infusion
polyhydraminos
multiple gestation
PPH treatment includes
uterotonics
surgical intervention
intrauterine balloon
PPH uterotonics used to stimulate uterine contractions include (4)
oxytocin
methylergonovine
prostaglandins (carboprost, hemabate)
misoprostal
MOA and dosage of methergine
ergot alkaloid with strong vascular effects, administered SQ (.2mg)
MOA and dosage of prostaglandins (carboprost, hemabate)
initiate strong intramuscular contractions
250mcg IM or directly into uterine muscle
route of admin and dosage of misoprostal
administered rectally, vaginally, orally
800-1000mcg
what other meds can be considered for PPH especially during surgical intervention
can give antifibrinolytics, transfuse, can give nitroglycerin during surgical intervention to relax muscles and get retained placenta out if thats the problem. hysterectomy may happen
preeclampsia is characterized by 4 things you usually always see and 4 more things in worst case scenarios
SBP >140mmHg after 20w gestation DBP >90mmHg after 20w gestation proteinuria plt count <100,000 impaired liver fx and/or RUQ pain renal insufficiency pedema cerebral or visual disturbances
preeclampsia results in/can result in (4)
increased vascular tone and sensitivity to catecholamines
pronounces upper aw edema during labor
thrombocytopenia
hepatocellular necrosis
preeclampsia CNS effects
HA, hyperexcitability, hyperreflexia
management of preeclampsia: pharmacological
magnesium sulfate
management of preeclampsia directed at
avoiding ureteroplacental hypo perfusion
HTN managment, delivery is only way to end disease process
what kind of anesthetic is preferred for the pre eclamptic patient
regional preferred over GA
HELLP is a complication of preeclampsia that results in (3)
hemolysis
elevated liver enxymes
low platelet count
signs of HELLP include
HTN, proteinuria, n/v
obese parturients are at increased risk for
HTN, DM, complicated labor
placenta previa
placenta implants on lower uterine segment and covers opening to cervix
sx of placenta previa
painless vaginal bleeding. hemodynamically significant blood loss, increases risk in postpartum bleeding
placenta previa: vaginal delivery or c section?
c section indicated
placenta accreta
placenta normally implants into endometrium. this describes implantation into myometrium and growth through myometrium into surrounding organs
placenta accreta is associated with
massive hemorrhage, uterine artery embolization
placenta accreta: vaginal delivery or c section
cesarean hysterectomy
placenta abruption and at risk patients
separation of placenta from uterus during delivery. higher in women with HTN and preeclampsia
placenta abruption signs include
hemorrhage
uterine irritability
abdominal pain** aka painful bleeding
fetal hypoperfusion and distress
placenta abruption: open venous sinuses allows
amniotic fluid to enter circulation. increased incidence of DIC
AFE is a rare event that can occur during
labor, vaginal delivery, or c section. occasionally associated with placental abruption
signs of AFE include
anxiety, dyspnea, hypoxia, HoTN, CV collapse, coagulopathy
tx of AFE
supportive
how many weeks gestation accounts for 70% of all premature births
34-36w
birth weight below _____ is associated with these long term complications
1500g
resp distress syndrome, intracranial hemorrhage, hyperbilirubinemia
delaying preterm labor with these drugs allows lungs time to develop
mag sulfate
CCB
beta sympathomimetics
what usually results in spontaneous respiration for neonatal resuscitation
tactile stimulation
