GYN&OB Flashcards
The clinical presentation of Amniotic Fetal Embolism AFE occurs in two distinct phases.
First phase occurs when the AFE in the maternal circulation triggers a release of inflammatory mediators. This results in pulmonary artery vasospasm and right ventricular dysfunction, causing hypoxemia and hypotension. There is systemic vasodilation from the inflammatory response. This phase can last up to 30 minutes.
The second phase occurs in those who survive the first phase. Here the left ventricle fails due to impaired filling from a dysfunctional right ventricle and a deviated intraventricular septum. The left ventricular failure results in hypotension and elevated pulmonary pressures. The biochemical mediators also trigger coagulopathy resulting in massive hemorrhage.
Amniotic Fetal Embolism resembles ….. and results in 3 features?
2 Presentation phases of AFE?
Treatment/Mgmt?
AFE closely resembles a systemic inflammatory response resulting in hypotension, noncardiogenic pulmonary edema, and coagulopathy. The clinical presentation is in two phases: 1) pulmonary hypertension with right ventricular dysfunction, 2) left ventricular failure and coagulopathy. Treatment of AFE is primarily resuscitative, and includes, endotracheal intubation, fluids, vasopressors/inotropes, and blood products.
The criteria for recognizing AFE are
1) Acute hypotension or cardiac arrest
2) Acute hypoxia (dyspnea, cyanosis, respiratory arrest)
3) Coagulopathy or severe hemorrhage
4) Occurs at the onset of labor, during a cesarean delivery, or within 30 minutes post-partum
Risk factors for gastroesophageal reflux in pregnancy are …
BMI and weight increased are a risk?
Gestational age, GERD prior to pregnancy, and multiparity.
BMI, weight gain during pregnancy, and rate of weight gain do not correlate with reflux symptoms.
pregnancy effect on gastric emptying?
Gastric emptying of both solids and liquids is not slowed during pregnancy, but is slowed during labor.
Esophageal peristalsis and intestinal transit are slowed during pregnancy due to increased progesterone and decreased motilin concentrations.
In order to assist with fetal manipulation, …. is recommended as a fast and efficient tocolytic that resolves quickly.
Nitroglycerin
There are only two factors in the coagulation cascade that are decreasedduring pregnancy and these are …
factor XI and factor XIII
Normal cardiovascular changes in pregnancy
BP decreases slightly
HR increases by 10-20 beat/min
SV increases
CO increases up to 50%
Normal changes of pulmonary in pregnancy
MV increases because of increased TV, but RR remains sane or increases slightly
RV + Carbon dioxide -> decreases
Theses changes will caused hyperventilation and respiratory alkalosis
Laboratory changes in pregnancy
T4 and TBG increases but Free T4 remains normal
Hg increases but plasma volume increases too, thus net result decrease in H/H
Decreases BUN:Cr ratio because of increased GFR
ESR and alkaline phosphatase increases.
Proteinuria and glucosuria are normal
LFT and electrolytes stays normal.
Average weight gain in pregnancy?
28 Ib (12.5 kg)
If increased more think of maternal diabetes
If smaller weight gain, think hyperemesis gravidarum, psych or systemic illness.
Early decelerations are
Head compression
Probably a Vagal response which is normal
Variable decelerations
Cord compression
Late decelerations
Uretroplacental insufficiency
Management of variable or late decelerations
Place mother in lateral decubitus and O2 mask.
Stop oxytocin gtt.
Give tocolytics (if not in active labor).
IVF if mother is hypotensive
If decelerations continues then check fetal O2 sat or scalp pH.
Prepare for delivery
