Maternal HMG Wolfe Flashcards
What is placenta previa?
When the placenta is malpositioned, can be partially or totally covering the cervical os
How does placenta previa present?
Painless vaginal bleedng
How can you prove against a placenta previa in a mother with vaginal bleeding?
U/s
What patients are high risk for placenta accreta?
Previous C/s
Current previa
Thinplacenta decidua
Uterine scare (Ashermans syndrome): D&C, myomectomy, c/s
Anesthetic consideration of previa
If bleeding isn’t ongoing/ severe, RA is appropriate
Ensure 2 large bore IVs
Fluid warmers
Blood available
Emergency C/s under GA, consider Ketamine or Etom if patient is hemodynamically unstable
What are different types of abnormal placental implantations?
AIP
Accreta- Attached to myometrium
Increta- Invades the myometrium
Percerta- Penetrates the uterus
Whats the most common cause of intrapartum fetal death?
Abruptio Placentae
Risk factors for abruptio placenta
Cocaine
ETOH
Trauma
HTN
Multi gestation
Structural abnormality
Uterine rupture is mostly seen ____
Prior c/s with vertical incision
Hx: myomectomy, prolonged labor with oxytocin infusion, enlarged uterus
Signs of uterine rupture, treatment
Severe abdominal pain unrelieved by an epidural
Frank or occult bleeding
Profound fetal distress
Tx: volume, emergency laparotomy under GA
Consider PPH when blood loss exceeds ___
500ml
But 1000ml is more definitive
Causes and common associations of PPH
Cause: uterine atony, perianal laceration, retained placenta, uterine inversion
Associations:
Prolonged labor
Preeclampsia
Multiple gestation
Treatment of PPH
Oxytocin
Fluid
Methylergonovine 0.2 IM (If iv, will cause htn)
PGF2 but not to asthmatics bc bronchospasm
Mortality of Amniotic fluid embolism (anaphylactoid syndrome of pregnancy) is ____
85%
Presentation of AFE
Sudden tachypnea
Cyanosis
Shock
Generalized bleeding/ DIC
