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OB Final Exam > Crash Course Module 7 > Flashcards

Crash Course Module 7 Flashcards

1
Q

the initial response of hemostasis is facilitated by

A

von Willebrand factor = primary hemostasis

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2
Q

secondary hemostasis

A

Unstable platelet plug, initiation of coagulation cascade with deposits and stabilization of fibrin

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3
Q

which factor decreases in pregnancy

A

Protein S

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4
Q

which factors have no change in pregnancy

A

Protein C, Antithrombin III

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5
Q

EBL for vaginal and cesarean delivery

A

EBL ≥ 500 ml for vaginal delivery and ≥ 1000 ml for cesarean delivery

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6
Q

what is commonly associated with placenta previa

A

prior uterine scar (trauma)

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7
Q

conditions associated with placenta previa

A

Multiparity
Advanced maternal age
Smoking history
Male fetus
Previous cesarean delivery or other uterine surgery
Previous placenta previa

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8
Q

gold standard for diagnosis of placenta previa

A

transvaginal US

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9
Q

classic sign of placenta previa

A

painless vaginal bleeding during the second or third trimester

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10
Q

steroids given for anyone ____________ weeks if bleeding

A

24-34 weeks

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11
Q

Lower uterine segment is ____________ vascular than normal sites of implantation

A

less

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12
Q

define placental abruption

A

Complete or partial separation of the placenta from the decidua basalis before delivery of the fetus

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13
Q

classic presentation of abruption

A

Vaginal bleeding
Uterine tenderness and tense to palpation
Increased uterine activity (hypertonus)

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14
Q

____________ is 96% specific in identifying placental abruption

A

ultrasound

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15
Q

couvelaire uterus

A

It occurs when vascular damage within the placenta causes hemorrhaging that progresses to and infiltrates the wall of the uterus into the peritoneum

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16
Q

uterine scar dehiscence

A

most common! does not result in massive hemorrhage, FHT abnormalities, does not require emergent cesarean or postpartum laparotomy

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17
Q

uterine rupture

A

a uterine wall defect with hemorrhage and/or fetal compromise with emergent cesarean or postpartum laparotomy

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18
Q

The most common and most reliable clinical sign of uterine rupture in labor is

A

fetal bradycardia

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19
Q

other s/s of uterine rupture

A

vaginal bleeding, hypotension, hematuria, and absence of uterine contractions, change in fetal positioning, FHR abnormality, severe abdominal pain, shoulder pain

BREAKTHROUGH BLEEDING WITH NEURAXIAL

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20
Q

vasa previa

A

Velamentous insertion of the fetal vessels over the cervical os (i.e. the fetal vessels transverse the fetal membranes ahead of fetal presenting part)

Fetal vessels are not protected by the placenta or the umbilical cord.

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21
Q

postpartum hemorrhage vaginal vs cesarean

A

More than 500 mL blood loss after vaginal delivery and more than 1000 mL after cesarean delivery

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22
Q

Most common cause of maternal mortality worldwide

A

postpartum hemorrhage

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23
Q

factors a/w postpartum hemorrhage

A

Increases in augmented labor, obesity, multiple gestation, hypertensive disorders of pregnancy and advanced maternal age

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24
Q

4 Ts of PPH

A

tone, trauma, tissue, thrombin

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25
Q

most common cause of PPH (80%)

A

uterine atony

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26
Q

risk factors of uterine atony

A
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27
Q

side effects of pitocin

A

can cause vasodilation, tachycardia, hypotension, myocardial ischemia, coronary vasoconstriction

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28
Q

retained placenta definition

A

as failure to deliver the placenta completely within 30 minutes after delivery of the infant

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29
Q

med given for manual removal of retained placenta

A

Nitroglycerin IV 50 to 100 mcg or sublingually via spray (manual removal)

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30
Q

anesthetic management for uterine inversion

A

Nitroglycerin IV (50-250 mcg) or Spray

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31
Q

placenta acreta

A

defines a placenta that in whole or in part invades the uterine wall and is inseparable from it

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32
Q

placenta accreta vera

A

is adherence of the basal plate of the placenta directly to uterine myometrium without an intervening decidual layer

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33
Q

placenta increta

A

occurs when the chorionic villi invades the myometrium.

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34
Q

placenta percreta

A

represents invasion through the myometrium into serosa and sometimes into adjacent organs, most often the bladder

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35
Q

what factors ↑ in pregnancy

A

Factors VII, VIII, X, & fibrinogen

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36
Q

who needs an RhoGAM shot?

A

an Rh negative mom on her SECOND pregnancy

If a Rh negative mom receives Rh positive blood, nothing will happen on the first exposure but then the immune system will respond to the foreign Rh antigen by producing anti-Rh antibodies

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37
Q

when is RhoGAM given

A

IM at 28 weeks and within 72 hrs after birth

38
Q

TRALI

A

New acute lung injury/acute respiratory distress syndrome that occurs within 6 hours of transfusion

39
Q

TRALI patho

A

host neutrophil activation in the recipient’s lung from factors in the donor blood including anti-human leukocyte antigen (HLA) antibodies

40
Q

TRALI manifests as

A

respiratory distress/hypoxemia, bilateral pulmonary infiltrates/edema, fever (1-2º C), hypotension and cyanosis

41
Q

TACO patho

A

circulatory system overwhelmed by high volume transfusion

42
Q

s/s taco

A

sudden dyspnea, orthopnea, tachycardia, wide pulse pressure, hypoxemia, htn

43
Q

TRALI vs TACO

A
44
Q

what is TXA used for

A

antifibrinolytic

45
Q

gestational HTN definition

A

Elevated BP after 20 weeks of gestation without proteinuria (in the absence of chronic HTN or systemic manifestations of preeclampsia)

46
Q

when does GHTN usually resolve

A

by 12 weeks postpartum

47
Q

preeclampsia definition

A

a multi-organ disease characterized by new onset of hypertension and proteinuria after the 20th week of gestation.

48
Q

preeclampsia w/o severe features

A

BP >/= 140/90 after 20 weeks gestation

Proteinuria

49
Q

preeclampsia WITH severe features

A
50
Q

eclampsia

A

Central nervous system involvement

New onset of seizures or unexpected coma during pregnancy or the postpartum period in preeclamptics without a preexisting neurologic disorder

51
Q

when do most eclamptic seizures occur

A

Most occur intrapartum or within the first 48 hours after delivery

52
Q

how do most moms with eclampsia present

A

80% have headache and visual disturbances

53
Q

other s/s eclampsia

A

photophobia, epigastric or RUQ pain, hyperreflexia, altered mental status either before or after seizures

54
Q

HELLP syndrome

A

Hemolysis, Elevated Liver enzymes, Low Platelet in women with preeclampsia

55
Q

HELLP lab findings

A

AST >/= 70 IU/L and ALT elevated

Platelet count usually < 100,000 per mm3

56
Q

HELLP is associated with

A

DIC, placental abruption, pulmonary edema, acute renal failure, liver hemorrhage or failure, ARDS, sepsis, stroke and death

57
Q
A
58
Q

pre-E is primarily a disorder of…

A

older, nulliparous women

59
Q

what is a protective factor against pre-E

A

smoker (nicotine inhibition of thromboxane A-2 synthesis and/or stimulation of nitric oxide release)

60
Q

preeclampsia patho diagram

A
60
Q

Defective trophoblastic invasion causes…

A

reduced uteroplacental blood flow, stressed placenta and possibly preeclampsia

61
Q

most common hematologic disorder in women with preeclampsia

A

thrombocytopenia

62
Q

the most common cause of severe thrombocytopenia in the second half of pregnancy

A

preeclampsia

63
Q

s/s of DIC

A

low fibrinogen, prolonged PT and PTT, drop in platelets and probably signs of bleeding

64
Q

DIC usually occurs in

A

severe liver involvement

65
Q

normal pregnancy GFR

A

↑ 40-60 %

66
Q

in pre-E what happens to GFR

A

GFR decreases, and renal function worsens

67
Q

____________ parallels severity of pre-E

A

oliguria (late sign)

68
Q

cure for pre-E

A

delivery

69
Q

pre-E have ____________ depletion

A

intravascular volume

70
Q

most common calcium channel blocker for treating hypertension of pregnancy

A

nifedipine

71
Q

nifedipine mechanism of action

A

Inhibits the influx of extracellular calcium into smooth muscle

Relaxes arteriolar and arterial smooth muscle beds

72
Q

labetalol mechanism of action

A

alpha- and beta-adrenergic (1:7 alpha to beta Ratio)

73
Q

neonates may have increased rates of ____________ with labetalol

A

hypoglycemia and bradycardia

74
Q

hydralazine mechanism of action

A

Direct acting arteriolar vasodilator to reduce afterload (fluid expansion with use)

Selectively vasodilates the uterine and renal vasculature

75
Q

nipride mechanism of action

A

Arteriolar dilator, potential for tachyphylaxis and metabolic acidosis with prolonged use

76
Q

cyanide toxicity may occur with

A

nipride (maternal and fetal –limited ability of fetal liver to metabolize cyanide)

77
Q

nitro mechanism of action

A

venodilator

78
Q

anticonvulsant of choice in pre-e with severe features

A

10% MgSO4

79
Q

Mg mechanism of action

A

Acts centrally at NMDA receptors to raise the seizure threshold

Stabilizes neurons in the cerebral cortex

Inhibits the release of acetylcholine and decreases excitability of muscle membranes

Mild vasodilator, especially the cerebral circulation

80
Q

MgSO4 dose

A

4-6 grams in 100 ml over 20 minutes followed by an infusion of 1-2 grams/hour for 24 hours after delivery or last seizure

81
Q

EKG changes with Mg level of…

A

6-12 mg/dL

82
Q

therapeutic Mg levels

A

4.8-9.6 mg/dL

83
Q

what EKG changes would u see with Mg elevation

A

prolonged PR
widened QRS

84
Q

loss of DTR Mg level

A

12 mg/dL

85
Q

SA/AV node block Mg level

A

18 mg/dL

86
Q

cardiac arrest Mg level

A

24 mg/dL

87
Q

treatment of Mg toxicity

A

IV Calcium gluconate 1 gram or Calcium chloride 300 mg

88
Q

Mg levels rise in fetal blood in ____________ hrs and amniotic fluid in ____________ hrs

A

Magnesium levels rise in fetal blood within 1 hour and amniotic fluid within 2-3 hours

89
Q

how long should Mg be continued post partum

A

12-24 hrs

OB Final Exam (15 decks)

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