Dunn OB/GYN IV Flashcards
38yo F G3P2002
- labor and delivery 31 weeks
- significant vaginal bleeding
- abdomen - mobile mass
- no pain
- US - placental over cervical os
placenta previa
placenta tissue over cervical os
placenta previa
painless antepartum bleeding after 20 weeks
US before digital exam - don’t want hemorrhage
severity of placenta previa
total - os totally covered
partial
marginal - edge of placenta at margin of os
low-lying - implanted lower uterus close to os
fetal vessels at cervical os
vasa previa
risk fx placenta previa
previous PP previous C section multi gestation multiparity advanced age infertility tx previous abortion smoking cocaine** male fetus non white
tx of placenta previa
asymptomatic - plan C section
bleeding - emergeny C section possible
vaginal delivery
attempted if placental edge >10mm from internal os
four Ts of post partum hemorrhage
tone - no contraction - bleeding
trauma
tissue
thrombus
tx of uterine atony bleeding
massage
pitocin/cytotec
methergine - no with HTN
hemabate - no with asthma
halogenated anesthetics
cause of uterine atony
second most common cause of PPH
trauma
most common cause of PPH
PPH = post partum hemorrhage
atony
ITP
idiopathic thrombocytopenic purpura
abnormal platelet function
cause of thrombus PPH
also amniotic fluid embolus and vWD
17yo G1P0 at 38 weeks
- feeling dizzy
- edema
- HTN
- HA
- obese
- elevated uric acid
tx - induce labor
preeclampsia
leading cause of maternal and prenatal morbidity and mortality worldwide
preeclampsia
risk fx for preeclampsia
HTN renal disease age >40 or <18 fam hx antiphospholipid antibody syndrome DM multifetal gestation high BMI AA
diagnosis of preeclampsia
systolic >140
diastolic >90
-two occasions at least 4 hours apart after 20 weeks of gestation
proteinuria >0.3g in 24 hr urine
protein/Cr ratio >0.3
dipstick +1
pt with new onset HTN w/out proteinuria
diagnosis of preeclampsia -platelet 1.1 liver transaminases 2x normal pulmonary edema cerebral or visual sx
severe preeclampsia
CNS dysfunction
hepatic abnormality
severe BP elevation >160/110
mild preeclampsia
no end organ damage
BP >140/90
early onset preeclampsia
<34 weeks
high risk of fetal death
late onset preeclampsia
> 34 weeks
preeclampsia indications for delivery
nonreassuring fetal heart sounds rupture membrane uncontrollable BP oliguria Cr >1.5 pulmonary edema SOB or chest pain and pulse ox <94% HA RUQ pain HELLP syndrome
severe HA, visual abnormality, RUQ tenderness, epigastric pain
severe preeclampsia
need urgent delivery
HELLP
hemolysis
elevated liver enzymes
low platelets
with preeclampsia
pathology - aberrant placentation
diagnosis of HELLP
RUQ tender, edema, HTN
platelet <100,000
abnormal liver function
periphera smear w/ schistocytes/bilirubin
tx of preeclampsia
delivery
preeclampsia antepartum management
antiHTN
-labetalol, hydralazine, nifedipine
mag sulfate
bed rest
corticosteroids
delivery at 37 weeks
postpartum preeclampsia management
no NSAIDs
antiHTN
monitor BP 72 hours after delivery
prevention of preeclampsia
low dose ASA starting late 1st trimester
weight loss
exercise
prognosis of preeclampsia
early detection - decreased risk serious complications
fetal complications of preeclampsia
complications related to prematurity
uteroplacental insufficiency
oligohydramnios
eclampsia
preeclampsia - leads to coma
if gets severe
tx of eclampsia
ABCs
seizure tx - IV MgSO4**
stabilize mother
control BP
deliver fetus
postpartum HTN and seizure control
PRES
posteror reversible encephalopathy syndrome
cerebral edema, ischemia, hemorrhage to posterior hemispheres
MRI/CT changes
due to HTN
HA, AMS, visual disturbances, seizures
tx - control HTN, seizures
prognosis - most recover 2 weeks
can cause death
