OB Flashcards
4 OB emergencies
Non reassuring fetal status
OB hemorrhage
Intrapoartum problems
AFE/material cardiac arrest
Fetal tachycardia?
> 160 bpm for >10min
6 causes for fetal tachycardia
Maternal fever, infection, fetal anemia, drugs, maternal anxiety; maternal hemorrhage
5 steps to help fetal tachycardia?
L lateral position; increase IV hydration; O2 face mask; notify MD; may need to decrease uterine activity
What is fetal bradycardia?
<110 bpm for >10min
6 causes of fetal bradycardia
Profound fetal hypoxia, epidural drugs, maternal hypotension, maternal substance abuse, cord compression, uterine tachysystole
4 responses to fetal bradycardia
L lateral position; increase IV hydration; O2 via face mask; notify MD
Decel at onset of beginning of contraction, recovery at the end of contraction, head compression (vagal response)
Early deceleration (type 1)
6 OB treatment for non reassuring fetal status
Maternal position O2 Stop pitocin Fetal scalp stimulation Maternal hydration Correction of hypotension
Fetal bradycardia occurs when with CSE and epidural?
30 min of CSE and 1 hr after epidural
7 key factors to maternal hemorrhaging:
Advanced maternal age Multiple gestation pregnancies Increased C-section rate (placenta previa/accrete) HCT <30 Fetal demise Infection Prolonged labor
Causes of PPH (5 T’s)
Tone (uterine tone) Tissue (retained placenta) Tissue (placenta accreta) Turned inside out (uterine inversion) Trauma (genital trauma)
High concentrations of TXA have been found to inhibit what allowing neural excitation and possibly reducing the seizure threshold?
NMDA receptors
Fibrinogen concentration from non pregnancy levels to pregnancy levels?
250-400 to 600
Fibrinogen level <200 with severe PPH can be corrected with what?
FFP, cryoprecipitate or fibrinogen
What are the most common coagulopathy?
Dilutional thrombocytopenia or DIC
Does salvaged red cells have high HCT than banked blood?
YES 40-60%
Blood flow to uterus?
600ml/min
If blood loss exceeds what then the decrease in CO and BP will result in rapid deterioration?
25%
What 3 things occur during pregnancy but can cause issues during delivery (antepartum)
Placenta previa, placental abruption, uterine rupture
Total placenta previa completely covers the what?
Cervical os
What is the classic sing of placenta previa?
Painless vaginal bleeding during the 2nd or 3rd trimester
Type of deli ever for placenta previa?
Generally c-section
Placental abruption has premature separation of normally implanted placenta after how long?
20 wks gestation
2 presentations of placental abruption?
Painful vaginal bleeding
Change in uterine activity
9 key contributing factors for placental abruption?
Maternal age older than 40 Premature rupture of membranes Smoking/cocaine Previous abruption HTN/preeclampsia African American Trauma
Uterine rupture occurs due to?
Separation at uterine scar
Failure of the uterus to contract at parturition?
Uterine Atony
3 most common uterine atony?
Cause of postpartum hemorrhage
Reason to perform c-section hysterectomy
Indication for blood transfusion
Diagnosis of uterine atony
Soft postpartum uterus and vag bleeding
Engorged uterus can hold 1000ml of blood
High risk factor of uterine atony
High concentration of volatile agents
Medical therapy for uterine atony?
Pitocin, methergine (ergot alkaloids), hemabate, cytotec
Adherence to myometrium, no invasion through uterine muscle
Placenta accreta vera
Invasion of myometrium
Placenta increta
Invasion of uterine serosa or other pelvic structures
Placenta precreta
What accounts for 50% of unplanned hysterectomies during c-section
Placenta accreta
Abnormally adherent placenta
Placenta accreta
Placenta accreta pts with 1 previous c-section increase risk by how much?
10%
Placenta accreta pts with 2 or more previous c-section increase risk by how much?
50%
What is placenta accreta diagnosed?
Postpartum when the placenta fails to separate from uterine wall
Entrapment of the anterior should beneath the pubic symphysis, long duration may cause compromise fetal blood
Shoulder dystocia
Compression may be indicated on FHR monitor with either variable or prolonged decelerations
Umbilical cord
Lasts <30min SOB and low CO state from the severe pulmonary HTN and R heart dysfunction causes HTN
Phase 1 of amniotic fluid embolism
LV failure, pulmonary edema and coagulopathy, and dont make it through first insult
Phase 2 of amniotic fluid embolism
Neurological dysfunction (seizures and coma)
Phase 3 of amniotic fluid embolism
What is diagnosis after 20 wks gestation?
Preeclampsia
Preeclampsia BP?
> 140/90
What is diagnosed before 20 wks gestation and/or not resolved after 12 wks postpartum?
Chronic HTN
Is that diagnosed for the first time after 20 wks, after mid-pregnancy and usually resolves after 12 wks postpartum
Gestational HTN
Severe preeclampsia BP
> 160/110
4 risk factors of preeclampsia
Limited maternal exposure to paternal sperm antigens
Preeclampsia In previous pregnancy
Pre existing maternal disease (HTN, DM, obesity, CKD)
Multi gestations
What is the one thing that decreases preeclampsia?
Cigarette smoking
When does preeclampsia clinical manifestations generally developed?
> 34 wks
What cures preeclampsia?
Delivery of placenta
Hepatic necrosis: AST/ALT, albumin, bilirubin
Increase, decrease, increase
3 reasons to upper walkway edema?
Reduced colloid osmotic pressure
Increased vascular permeability
Excessive elevation in vascular hydrostatic pressure
Impaired flow due to increased arterial resistance
Decrease uteroplacnetal perfusion
Uteroplacental has uterine sensitivity to what?
Oxytocin
OB management steps (3)
Delivery of placenta
Management of HTN
Seizure prophylaxis
Goal if you have HTN (>160/110)
Decrease MAP by 20%
Standard care for eclampsia seizure prophylaxis
Magnesium sulfate
What is used to treat magnesium toxicity
Calcium chloride
Loading dose of magnesium sulfate
4-6g over 20 min
Infusion dose for magnesium sulfate
1-2g/hr
Normal serum mg level
1.7-2.4
Eclampsia prophylaxis serum mg level
5-9
Effects of hypermagnesemia (2)
Prolongation of NDMR
Uterine atony
HELLP syndrome
Hemolysis, elevated liver enzymes 2x higher, low platelets <100,000
Treatment and recovery of HELLP syndrome
Delivery, corticosteriods for lung development in baby
Within 6 days of delivery
6 drugs that can precipitate bronchospasm
Opioids BB Histamine releasing NMD Reversal agents Ergot alkaloids (hemabate) Prostaglandin F
Physiological changes in an obese parturient (4)
Decreased chest wall compliance
Increased O2 consumption and CO2 production
Decreased lung volumes
Increased risk of HTN secondary to increased CO and BV
Minimum local anesthetic concentration for obese women was what percent lower than non obese women
41%
What is the leading cause of maternal mortality?
CV disease
4 particular cardiac disease
Pulmonary HTN
Aortic aneurysm
LVOT obstruction
Severe cardiomyopathy
2 R to L shunts
TOF Eisenmengers syndrome (avoid elevation in PVR)
4 hypercoagulable states:
Protein C, S, or antithrombin III deficiency, or Leiden factor V
Pts with hypercoagulable states may be receiving what?
Prophylactics heparin
Is there a slight increased risk for relapse during pregnancy for MS pts?
Yes
Does pregnancy have an overall negative effect on long term outcome of MS?
NO
