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OB - Spring 2016 > Labor & Delivery - Hemorrhagic Conditions/Complications - Unit 2 (Class) > Flashcards

Labor & Delivery - Hemorrhagic Conditions/Complications - Unit 2 (Class) Flashcards

1
Q

What is placenta previa?

A

When the placenta isn’t in the right spot.

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2
Q

What are the three types of placenta previa?

A

Marginal, partial, total.

Marginal = low lieing, but still greater than 3cm away from the opening of the cervix (oz).

partial = closer than 3cm/might somewhat cover oz.

Total = completely covers oz.

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3
Q

Placenta previa - happens _ in ___ cases.

A

1 in 300

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4
Q

What are the clinical manifestations of placenta previa?

A

Painless bleeding (painless because they are bleeding into an open cavity.

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5
Q

How do we manage placenta previa?

A

stable and baby is stable = we want to wait.

If patient is sent home, we need to educate - when do come back, NOTHING IN VAGINA, etc.

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6
Q

PP - blood that is bright red = active, pink = start, dark/red= old. T/F?

A

True

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7
Q

What is abruptio placentae?

A

late pregnancy - separation of a normally implanated placenta before the fetus is born. Can be partial or complete (complete is a huge problem).

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8
Q

What can cause an abruptio placentae?

A

cocaine, maternal HTN, cigarette smoking, multigravida, short umbilical cord, abdominal trauma, PROM, history of abruption.

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9
Q

What are some clinical manifestations?

A

Concealed - bleeding on inside.

Apparent - outside bleeding!

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10
Q

Dysfunctional labor: power - what does this mean?

A

Ineffective maternal pushing. Help her with positioning (gravity) and teach how to push.

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11
Q

Dysfunctional labor - passenger - what does this mean?

A

Fetal size, fetal presentation/position, multifetal pregnancy/fetal anomalies, etc.

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12
Q

Dysfunctional labor - passage & psyche - what do these mean?

A

Passage - pelvis and maternal soft tissue obstructions (a full bladder will impede contraction pattern and also hold the baby up there!)

Psyche - pain, fear, nonsupport, or personal situation - perception is important!

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13
Q

For a primigravida, they should dilate ___ cm ever hour (average).

___ CM for multiple children.

A
  1. 2

1. 5

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14
Q

What is precipitous labor?

A

3 hours from start to finish. Very intense contractions, baby might poop (meconium) because it’s under so much stress, facial bruising, low apgars, etc.

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15
Q

What is a precipitous delivery?

A

One before physician gets there.

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16
Q

What is premature rupture of membranes? Cause? PPROM?

A

ROM before onset of labor (pPROM = preterm premature rupture of membranes

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17
Q

What are some complications of premature rupture of membranes?

A

Infection, oliohydraminios, preterm birth infant respiratory distress syndrome.

18
Q

How do we manage premature rupture of membranes?

A

First determine if actually ruptured, induction if contractions do not start on own (term), consider baby state/safety/lung maturity if not term, antibiotics given

19
Q

PROM - orgasm is good?

A

NOT AT ALL. Could start contractions if you’re preterm. Avoid breast stimulation as well.

20
Q

PROM - antibiotics given, but if there’s a foul smell..

A

it might be time for delivery!

21
Q

What are dates for “preterm” ?

A

20-37 weeks

22
Q

Tocolytics - What does magnesium sulfate do?

A

Decreases contractions - it stops labor AND can treat preeclampsia - Loading dose = 4-6 grams over 30 minutes and then maintenance 1-4 grams/hour.

23
Q

What are the criteria for mag sulfate?

A

Urine output at least 30 ml/hr, presence of DTR, respirations at least 12 a minute, etc.

24
Q

What is the antidote for magnesium sulfate? Give when?

A

Calcium Gluconate (10%) One reason to give is if RR is not above 12.

25
Q

Mag sulfate - can it decrease variability of fetus?

A

yup

26
Q

Calcium antagonist (tocolytic) - what does it do?

A

Nifedipine, CCB - reduces smooth muscle contractions. 10-20 mg every 3-6 hours (same as loading dose).

27
Q

Terbutaline (Tocolytic) - what does it do?

A

Terbutaline is the drug of choice.

28
Q

What is the antidote for terbutaline?

A

Propanolol

29
Q

Tocolytics - what is the prostaglandin syntehsis inhibitor?

A

Indomethacin - only given before 32 weeks gestation and for 48-72 hours.

30
Q

Corticosteroids - what are they used for?

A

NOT A TOCOLYTIC. Used to mature fetal lungs at 24-34 weeks. Delay birth 24 hours after giving if at all possible.

31
Q

Prolonged pregnancy - longer than….

A

42 weeks.

32
Q

What are some complications of prolonged pregnancy?

A

Insufficiency of the placenta, less reserves to tolerate labor, reduced amniotic fluid —> cord compression, meconium, large infant, etc.

33
Q

What are some placental emergencies?

A

Placenta previa, placenta accrete (increta, perceta), prolapsed cord

34
Q

what is placenta accrete?

A

When the placenta attaches too deep into the uterine wall, but not yet in the muscle.

35
Q

What is placenta increta?

A

penetrates deep into the wall and into the muscle.

36
Q

What is placenta percereta?

A

Attaches deep into the wall - so deep it goes through the muscle onto another organ even!

37
Q

Prolapsed cord - if you feel it, YOU KEEP YOUR HAND THERE! T/F?

A

True

38
Q

Prolapsed cord - #1 priority =….

A

getting pressure off the cord.

39
Q

What is a partial rupture of the uterus? Complete?

A

contained (won’t go into perineal cavity). Complete = filling up the abdominal cavity.

40
Q

Inversion of uterus - what is it?

A

uterus will turn itself inside out after baby is born.

41
Q

What is anaphylactoid syndrome (amniotic emboli) ?

A

Fluid gets into blood stream of the mom and acts like an emboli and usually travels to lungs…very rare and fatal. :(

OB - Spring 2016 (18 decks)

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