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Exam 2 OB complications Flashcards

1
Q

Low Birth wt is

A

<2500g

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2
Q

Very Low BW is

A

<1500g

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3
Q

Extremely low BW is

A

<1000g

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4
Q

Micropreemie is

A

<750g

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5
Q

OB factors associated with preterm labor

A 
Vaginal bleeding
Infection (systemic, genital tract, periodontal)
Short cervical length
Multiple gestation
Assisted reproductive techniques
Preterm premature rupture of membranes
Polyhydramnios
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6
Q

Preterm delivery due to (3 things)

A

Preterm Premature Rupture of Membranes
Spontaneous preterm labor
Maternal/Fetal indications for delivery

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7
Q

Discuss Terbutaline Tx for preterm labor

A

Terbutaline- B-adrenergic agonist
Tocolytic therapy
B1 AND B2 stimulation- smooth muscle relaxation (uterus)(B1) and increased HR (B2)
Side effects- Hypotension, tachycardia, pulmonary edema, hyperglycemia, hypokalemia
*avoid with agents that inc HR
*Will cause SUX to have decreased onset

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8
Q

Discuss Mag Sulfate Tx for preterm labor

A

Se- Hypotension, Potentiates all NMBs, decrease dose and don’t use defasciculating dose

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9
Q

What is the portion of the fetus over the pelvic inlet

A

presentation

Cephalic, Breech, and Shoulder

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10
Q

Vertex, brow or face is what presentation?

A

Cephalic

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11
Q

What is the alignment of fetal spine with maternal spine?

A

Lie

longitudinal or traverse

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12
Q

Breech or vertex have a ____ lie.

A

Longitudinal

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13
Q

The relationship of special fetal bony point to maternal pelvis is

A

Position

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14
Q

Sacrum is position

A

Breech

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15
Q

Occiput is position

A

Vertex

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16
Q

Mentum is position

A

Face

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17
Q

Acromion is position

A

Shoulder

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18
Q

Complete breech

A

Hips flexed at hip and knees

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19
Q

Incomplete breech

A

1 or both legs are extended at the hip

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20
Q

Frank breech

A

lower ext are flexed at the hip, extended at the knee

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21
Q

Anesthesia for Breech delivery- NA considerations

A

May need more dense anesthesia for vaginal or C-Sec- 3% 2-chloroprocain or 2% lidocaine with epi and bicarb

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22
Q

What is the worse fear with breech delivery

A

Fetal head entrapment

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23
Q

Monozygotic twins chorion and amnion
1-2days
3-8 days
8-13 days

A

1-2 DD
3-8 MD
8-13 MM

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24
Q

Multiple gestation will have _____% increase in CO (SV increases ____% and HR increases _____%

A

CO increases 20% (SV increases 15%, HR increases 3.5%) with multiple gestation

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25
Q

Hypoxemia occurs more rapidly with multiple gestation b/c

A

Decreased FRC and Increased Maternal Metabolic Rate

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26
Q

Plasma volume increases and additional _____ml with multiple gestation

A

750ml

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27
Q

Use full lateral position with multiple gestation d/t greater risk for

A

aortocaval compression and supine hypotensive syndrom

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28
Q

Gestational HTN is

A

Increased BP after 20 weeks gestation without proteinuria

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29
Q

Preeclampsia is

A

New onset HTN and proteinuria after 20 weeks gestation

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30
Q

If no proteinuria with HTN after 20 weeks gestation, which other Sx would make you consider preeclampsia?

A 
Persistent epigastric or RUQ pain
Persistent cerebral symptoms
Fetal Growth restriction
Thrombocytopenia
Elevated Liver Enzymes
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31
Q

Eclampsia is

A

Preeclampsia with onset of seizures

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32
Q

What is HELLP Syndrome

A

Hemolysis (abnormal peripheral blood smear, Increased bilirubin >1.2mg/dl, Increased lactic dehydrogenases (LDH >600)
Elevated Liver- (AST>70, LDH >600)
Thrombocytopenia (plts <100,000)

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33
Q

Chronic HTN is

A

prepregnancy systolic >140 and or dystolic >90 or elevated BP unresolved by delivery

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34
Q

Dx criteria for Preeclampsia w/o severe features

A

BP >140/90 after 20 weeks gestation with proteinuria (>300mg/24h, protein creatine ratio >0.3 or 1+ on urine dipstick)

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35
Q

Dx criteria for Severe preeclampsia

A

BP 160/110, thrombocytopenia <100,000 Serum creatine >1.1 or 2x baseline, pulmonary edema, new onset cerebral or visual disturbance, impaired liver function (HELLP Sx)

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36
Q

Tx for HTN disorders

A

Bedrest, sedation, antihypertensive Tx.

37
Q

Most definitive Tx for hypertensive disorders

A

delivery of the fetus

38
Q

Labetalol Onset and Dose for HTN disorders

A

Onset- 5-10 min

Dose- 20mg IV, then 40-80mg every 10 min to max of 220mg

39
Q

Hydralazine Onset and Dose for HTN disorders

A

Onset- 10-20min

5mg IV every 20 mins for max of 20mg

40
Q

Mag sulfate Dosing and therapeutic levels

A

4-6g over 20-30 mins followed by 1-3g/hr

Therapeutic range 5-9ml/dl or 4-6mEq/L

41
Q

Hypermagnesemia plasma levels with toxic effect

A

> 12- loss of patellar reflexes
15-20- respiratory distress
25 asystole

42
Q

Tx for hypermagnesemia

A

Stop gtt, give calcium gluconate IV

43
Q

Do you want to do GA with HTN disorders?

A

No- have greater risk for potential AW catastrophe. NA should be initiated early d/t declining platelets and to avoid GA with emergency

44
Q

4 considerations with NA and preeclampsia

A

Assess Coagulation Status
IV hydration prior to epidural dosing of LA- lower need for fluids- avoid pulm edema
Risk for HTN is increased
Avoid Epi to avoid HTN

45
Q

Fluid maintenance for Pts with HTN disorders

A

Keep low, 75-100ml/hr to prevent cerebral edema

46
Q

When the placenta covers the opening of the Cervix

A

Placenta Previa

47
Q

Placenta covers cervical ox

A

Total Previa

48
Q

Placenta covers part of cervical os

A

Partial Previa

49
Q

Placenta lies 2cm of cervical os

A

Marginal previa

50
Q

What is the classic sign of placenta previa

A

painless vaginal bleeding in 2nd-3rd trimester

51
Q

Total previa with require what?

52
Q

Placental edge to os distance >1cm and or significant bleeding.

A

Total previa, will required C-Sec

53
Q

What anesthetic technique is preferred for Previa with overt bleeding

54
Q

What is the best induction drugs for previa with overt bleeding?

A

Ketamine 0.5-1mg/kg or Etomidate 0.3mg/kg

55
Q

Maintenance with

A

N2O and Low dose halogenated agent

56
Q

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

A

Placental Abruption

57
Q

Complications for Placental Abruption

A

Hemorrhagic shock, coagulopathy, fetal compromise or demise

58
Q

Maternal Comorbidities for Placental abruption

A

HTN, Acute or chronic respiratory illness, Substance abuse, maternal or paternal tobacco use, maternal cocaine use.

59
Q

Conditions associated with uterine rupture

A 
Prior uterine surgery
induction of labor
high dose oxytocin
prostaglandin induction
grand multiparity >5
morbidly adherent placenta
congenital uterine anomaly
connective tissue disorder
forceps application/rotation
internal podalic version
excessive fundal pressue
blunt or penetrating trauma
60
Q

Nonsurgical disruption of all uterine layers

A

Uterine rupture

61
Q

Incomplete disruption of uterine layers

A

Uterine dehiscence

62
Q

Presenting signs of Uterine rupture

A

Abd pain and abnormal FHR pattern

63
Q

What anesthetic technique for uterine rupture

A

GA- unless epidural already in place

64
Q

Fetal vessels cross fetal membranes before presenting part

A

Vasa Previa

65
Q

Loss of uterine tone and accounts for 80% of hemorrhage

A

Uterine Atony

66
Q

Oxytocin dose, contraindication and side effects

A 
Oxytocin
Dose- 0.3-0.6 IU/min IV
Contraindications: none
S/E: tachycardia, hypotension, myocardial ischemia, free water retention
Also: Has SHORT duration of action
67
Q

Ergonovine or methylergonovine: Dose, C/I and S/E

A

Dose:0.2mg IM
C/I: preeclampsia, HTN, CAD
S/E: N/V, arteriolar constriction, HTN
Also:: Has LONG duration of action and may be repeated once after 1 hr

68
Q

Methlyprostaglandin “Hemabate” Dose/CI/SE

A

Dose- 0.25mg IM
C/I Reactive AW disease, pulm HTN, Hypoxia
SE- Fever,chills,NV,D,BRONCHOCONSTRICTION
Also- may be repeated every 15 min up to 2 mg

69
Q

Adherence of basal plate of placenta to uterine myometrium without decidual layer

A

Placenta accreta vera

70
Q

Invasion through myometrium into sersoa and adjacent organs

A

Placenta percreta

71
Q

Chorionic villi invade the myometrium

A

Placenta increta

72
Q

How to manage Placenta Accreta

A

Same as other severe postpartum hemorrhage

73
Q

Technique of choice for Peripartum Hysterectomy?

74
Q

Features of Amniotic Fluid Embolism

A 
Maternal Hemorrhage
Hypotension
SOB
Coagulopathy
Restlessness / Agitation
Fetal Compromise
Cardiac Arrest
Seizures
75
Q

Clinical presentation of amniotic fluid embolism

A

Acute respiratory distress
Cardiovascular collapse
Coagulopathy near delivery

76
Q

Management of Amniotic Fluid Embolism

A 
Admin 100% O2
Intubate and support ventilation
Start CPR if needed
Ensure LUD
Admin fluids and pressors
Est large bore IV
Consider A line
Monitor fetal well being
Expedite delivery
Activate OB massive blood loss protocol
Check electrolytes
Give blood products as needed
Ensure normothermia
Ready the ICU for admission
77
Q

3 factors that contribute to increased risk for DVT and PTE

A

Hyper-Coagulopathy
Venous Stasis
Endothelial injury (Vascular damage)

78
Q

S/Sx of DVT

A

Nonspecific leg pain and edema

79
Q

S/Sx of PTE (pulm. thrombotic event)

A

Palpitations, anxiety, CP, cyanosis, diaphoresis, cough with or without hemoptysis, SOB
Signs of RV failure- split S2, JVD, parasternal heave, hepatic enlargement
ECG-RV strain(RAD, P pulmonale, ST changes, T-Wave inversion, SVT

80
Q

LMWH, prophylactic (NA wait time)

A

10-12 hours

81
Q

LMWH therapeutic (NA wait time)

82
Q

Sub Q- UFH prophylactic or therapeutic (NA wait time)

A

no wait to recommendation

83
Q

Warfarin (NA wait time)

A

4-5 days for INR to normalize

84
Q

When is Venous Air Embolism most likely to occur during pregnancy?

A

After placental separation, there is the potential for air trapping. Common during C-Sec- immediately after placenta separates from the endometrial surface and is exposed, air can enter the bloodstream.

85
Q

What is the clinical presentation for Venous Air Embolism?

A

Small amount- usually no symptoms
Massive amount- Hypotension, Hypoxemia, Potential Cardiac Arrest.
>200-300 ml or 3-5ml/kg is deadly

86
Q

Describe the pathophysiology of VAE.

A

Small amount of air in bloodstream—> Pulmonary vasospasm–>V/Q mismatch, hypoxemia, R sided HF, arrhythmias, and hypotension.
Air Volume >3ml/kg can cause RV outflow tract obstruction–> CV collapse.
Air into arterial circulation—>CV and neurological events.

87
Q

Worry about VAE if Pt complains of:

A

Chest pain
Dyspnea
Sudden Hypotension
Arrhythmias

88
Q

Resuscitation protocol of OB Pt with massive VAE

A

Prevent further air entrainment- flood surgical field with saline, lower the surgical field relative to the heart.

Administer 100% O2, d/c N2O, intubate and ventilate

Support circulation with chest compressions, IV volume expansion, and vasopressors

Expedite delivery

Evaluate for intracerebral air and consider hyperbaric O2 therapy

OB- Overview (3 decks)

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