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Co-Exisiting Disease 2 > OB > Flashcards

OB Flashcards

1
Q

4 OB emergencies

A

Non reassuring fetal status
OB hemorrhage
Intrapoartum problems
AFE/material cardiac arrest

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2
Q

Fetal tachycardia?

A

> 160 bpm for >10min

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3
Q

6 causes for fetal tachycardia

A

Maternal fever, infection, fetal anemia, drugs, maternal anxiety; maternal hemorrhage

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4
Q

5 steps to help fetal tachycardia?

A

L lateral position; increase IV hydration; O2 face mask; notify MD; may need to decrease uterine activity

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5
Q

What is fetal bradycardia?

A

<110 bpm for >10min

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6
Q

6 causes of fetal bradycardia

A

Profound fetal hypoxia, epidural drugs, maternal hypotension, maternal substance abuse, cord compression, uterine tachysystole

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7
Q

4 responses to fetal bradycardia

A

L lateral position; increase IV hydration; O2 via face mask; notify MD

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8
Q

Decel at onset of beginning of contraction, recovery at the end of contraction, head compression (vagal response)

A

Early deceleration (type 1)

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9
Q

6 OB treatment for non reassuring fetal status

A 
Maternal position
O2
Stop pitocin 
Fetal scalp stimulation 
Maternal hydration 
Correction of hypotension
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10
Q

Fetal bradycardia occurs when with CSE and epidural?

A

30 min of CSE and 1 hr after epidural

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11
Q

7 key factors to maternal hemorrhaging:

A 
Advanced maternal age 
Multiple gestation pregnancies 
Increased C-section rate (placenta previa/accrete)
HCT <30 
Fetal demise 
Infection 
Prolonged labor
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12
Q

Causes of PPH (5 T’s)

A 
Tone (uterine tone)
Tissue (retained placenta)
Tissue (placenta accreta)
Turned inside out (uterine inversion)
Trauma (genital trauma)
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13
Q

High concentrations of TXA have been found to inhibit what allowing neural excitation and possibly reducing the seizure threshold?

A

NMDA receptors

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14
Q

Fibrinogen concentration from non pregnancy levels to pregnancy levels?

A

250-400 to 600

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15
Q

Fibrinogen level <200 with severe PPH can be corrected with what?

A

FFP, cryoprecipitate or fibrinogen

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16
Q

What are the most common coagulopathy?

A

Dilutional thrombocytopenia or DIC

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17
Q

Does salvaged red cells have high HCT than banked blood?

A

YES 40-60%

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18
Q

Blood flow to uterus?

A

600ml/min

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19
Q

If blood loss exceeds what then the decrease in CO and BP will result in rapid deterioration?

A

25%

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20
Q

What 3 things occur during pregnancy but can cause issues during delivery (antepartum)

A

Placenta previa, placental abruption, uterine rupture

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21
Q

Total placenta previa completely covers the what?

A

Cervical os

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22
Q

What is the classic sing of placenta previa?

A

Painless vaginal bleeding during the 2nd or 3rd trimester

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23
Q

Type of deli ever for placenta previa?

A

Generally c-section

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24
Q

Placental abruption has premature separation of normally implanted placenta after how long?

A

20 wks gestation

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25
Q

2 presentations of placental abruption?

A

Painful vaginal bleeding

Change in uterine activity

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26
Q

9 key contributing factors for placental abruption?

A 
Maternal age older than 40 
Premature rupture of membranes 
Smoking/cocaine
Previous abruption
HTN/preeclampsia
African American 
Trauma
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27
Q

Uterine rupture occurs due to?

A

Separation at uterine scar

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28
Q

Failure of the uterus to contract at parturition?

A

Uterine Atony

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29
Q

3 most common uterine atony?

A

Cause of postpartum hemorrhage
Reason to perform c-section hysterectomy
Indication for blood transfusion

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30
Q

Diagnosis of uterine atony

A

Soft postpartum uterus and vag bleeding

Engorged uterus can hold 1000ml of blood

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31
Q

High risk factor of uterine atony

A

High concentration of volatile agents

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32
Q

Medical therapy for uterine atony?

A

Pitocin, methergine (ergot alkaloids), hemabate, cytotec

33
Q

Adherence to myometrium, no invasion through uterine muscle

A

Placenta accreta vera

34
Q

Invasion of myometrium

A

Placenta increta

35
Q

Invasion of uterine serosa or other pelvic structures

A

Placenta precreta

36
Q

What accounts for 50% of unplanned hysterectomies during c-section

A

Placenta accreta

37
Q

Abnormally adherent placenta

A

Placenta accreta

38
Q

Placenta accreta pts with 1 previous c-section increase risk by how much?

A

10%

39
Q

Placenta accreta pts with 2 or more previous c-section increase risk by how much?

A

50%

40
Q

What is placenta accreta diagnosed?

A

Postpartum when the placenta fails to separate from uterine wall

41
Q

Entrapment of the anterior should beneath the pubic symphysis, long duration may cause compromise fetal blood

A

Shoulder dystocia

42
Q

Compression may be indicated on FHR monitor with either variable or prolonged decelerations

A

Umbilical cord

43
Q

Lasts <30min SOB and low CO state from the severe pulmonary HTN and R heart dysfunction causes HTN

A

Phase 1 of amniotic fluid embolism

44
Q

LV failure, pulmonary edema and coagulopathy, and dont make it through first insult

A

Phase 2 of amniotic fluid embolism

45
Q

Neurological dysfunction (seizures and coma)

A

Phase 3 of amniotic fluid embolism

46
Q

What is diagnosis after 20 wks gestation?

A

Preeclampsia

47
Q

Preeclampsia BP?

A

> 140/90

48
Q

What is diagnosed before 20 wks gestation and/or not resolved after 12 wks postpartum?

A

Chronic HTN

49
Q

Is that diagnosed for the first time after 20 wks, after mid-pregnancy and usually resolves after 12 wks postpartum

A

Gestational HTN

50
Q

Severe preeclampsia BP

A

> 160/110

51
Q

4 risk factors of preeclampsia

A

Limited maternal exposure to paternal sperm antigens
Preeclampsia In previous pregnancy
Pre existing maternal disease (HTN, DM, obesity, CKD)
Multi gestations

52
Q

What is the one thing that decreases preeclampsia?

A

Cigarette smoking

53
Q

When does preeclampsia clinical manifestations generally developed?

A

> 34 wks

54
Q

What cures preeclampsia?

A

Delivery of placenta

55
Q

Hepatic necrosis: AST/ALT, albumin, bilirubin

A

Increase, decrease, increase

56
Q

3 reasons to upper walkway edema?

A

Reduced colloid osmotic pressure
Increased vascular permeability
Excessive elevation in vascular hydrostatic pressure

57
Q

Impaired flow due to increased arterial resistance

A

Decrease uteroplacnetal perfusion

58
Q

Uteroplacental has uterine sensitivity to what?

A

Oxytocin

59
Q

OB management steps (3)

A

Delivery of placenta
Management of HTN
Seizure prophylaxis

60
Q

Goal if you have HTN (>160/110)

A

Decrease MAP by 20%

61
Q

Standard care for eclampsia seizure prophylaxis

A

Magnesium sulfate

62
Q

What is used to treat magnesium toxicity

A

Calcium chloride

63
Q

Loading dose of magnesium sulfate

A

4-6g over 20 min

64
Q

Infusion dose for magnesium sulfate

A

1-2g/hr

65
Q

Normal serum mg level

A

1.7-2.4

66
Q

Eclampsia prophylaxis serum mg level

A

5-9

67
Q

Effects of hypermagnesemia (2)

A

Prolongation of NDMR

Uterine atony

68
Q

HELLP syndrome

A

Hemolysis, elevated liver enzymes 2x higher, low platelets <100,000

69
Q

Treatment and recovery of HELLP syndrome

A

Delivery, corticosteriods for lung development in baby

Within 6 days of delivery

70
Q

6 drugs that can precipitate bronchospasm

A 
Opioids 
BB
Histamine releasing NMD
Reversal agents 
Ergot alkaloids (hemabate)
Prostaglandin F
71
Q

Physiological changes in an obese parturient (4)

A

Decreased chest wall compliance
Increased O2 consumption and CO2 production
Decreased lung volumes
Increased risk of HTN secondary to increased CO and BV

72
Q

Minimum local anesthetic concentration for obese women was what percent lower than non obese women

A

41%

73
Q

What is the leading cause of maternal mortality?

A

CV disease

74
Q

4 particular cardiac disease

A

Pulmonary HTN
Aortic aneurysm
LVOT obstruction
Severe cardiomyopathy

75
Q

2 R to L shunts

A 
TOF
Eisenmengers syndrome (avoid elevation in PVR)
76
Q

4 hypercoagulable states:

A

Protein C, S, or antithrombin III deficiency, or Leiden factor V

77
Q

Pts with hypercoagulable states may be receiving what?

A

Prophylactics heparin

78
Q

Is there a slight increased risk for relapse during pregnancy for MS pts?

A

Yes

79
Q

Does pregnancy have an overall negative effect on long term outcome of MS?

A

NO

Co-Exisiting Disease 2 (11 decks)

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