OB Flashcards
MAC requirement decrease or increase with pregnancy?
Decrease 40%
Do MV and TV increase or decrease with pregnancy
Increase
Does CO increase with pregnancy
Yes
non-reassuring fetal status
Tachy >160 for >10min
Brady <110 for >10min
Early decels
associated with head compressions during contractions
resolves at end of contraction
benign
Variable decels
cord compression or in later stage of labor fetal hypoxia
decreased O2 available to fetus
Late decels
uteroplacental insufficiency
fetal hypoxia
Following CSE, uterine hypertonic is seen on tonometer with associated FHR changes. What is the cause of increased uterine activity following Neuraxial anesthesia?
Circulating epi levels decrease
Decreased B-adrenergic activity
increased uterine perfusion
increased uterine contractility
Treatment for uterine hypertonus
Terbutaline
Sublingual NTG
“70% effaced”
Effacement means that the cervix stretches and gets thinner
A cervix that’s 70 percent effaced is 70 percent of the way toward becoming short and thin enough to allow your baby to pass through the uterus
“-3 station”
During the last month, your doctor will estimate how far the baby’s head has moved down into (engaged) the pelvis. This is measured in “stations.” A baby is at –3 station when the head is above the pelvis and at 0 station when the head is at the bottom of the pelvis (fully engaged).
An imaginary line is drawn between the two bones in the pelvis (known as ischial spines). This is the “zero” line, and when the baby reaches this line it is considered to be in “zero station.” When the baby is above this imaginary line it is in a minus station. When the baby is below, it is in a “plus” station. Stations are measured from -5 at the pelvic inlet to +4 at the pelvic outlet.
PPH
Blood loss of more than 500mL SVD and 1000mL C-section
within 24h delivery = primary PPH (early)
after 24h = secondary PPH (late)
Contributing factors PPH
advanced maternal age multiple gestations increased C-section rate HCT <30 fetal demise infection prolonged labor <200mg/dL fibrinogen = hypofibrinogenemia
Gravida
Gravidity is defined as the number of times that a woman has been pregnant.
Parity
Parity is defined as the number of times that she has given birth to a fetus with a gestational age of 24 weeks or more, regardless of whether the child was born alive or was stillborn.
normal PLT count
A normal platelet count ranges from 150,000 to 450,000 platelets per microliter of blood
normal PLT count pregnancy
In the first trimester, the normal count is around 250,000 and decreases to about 225,000 at delivery.
Normal Hb
men, 13.5 to 17.5 grams per deciliter
women, 12.0 to 15.5 grams per deciliter.
Normal Hct
men = 41%-50% women = 36%-44%
Causes of PPH - 5 T’s
- TONE - uterine tone
- TISSUE - retained placenta
- TISSUE - placenta accreta
- TURNED INSIDE OUT - uterine inversion
- TRAUMA - placental abruption, genital trauma
uterine atony
failure of the uterus to contract after delivery of placenta and fetus. Maternal oxytocin and PGs cause contraction and primary mechanism for controlling BL after delivery
Uterine atony is the most common indication for blood transfusion and most common cause of intrapartum and postpartum hemorrhage
Methergine dose
Methylergovine
0.2mg IM
Contra HTN pre-e
Hemabate dose
Carboprost
PGF-2a
0.25mg IM
contra asthma
cytotec dose
Misoprostol
600-1000mcg rectal
