OB complications Flashcards
What 3 races are more likely to die from pregnancy-related causes
- African American
- American Indian
- Alaska Native
Most common causes GLOBALLY of maternal death (3)
- hemorrhage
- HTN disorders
- sepsis
Most common causes of maternal death in the developed world (3)
- HTN disorders
- embolic disorders
- Hemorrhage
More things that lead to maternal death globally(7)
- Anemia
- Obstructed labor
- HIV/AIDS
- unsafe abortion
- early marriage??? hahahha what does this mean - prob that they make 12 yr olds have babies :( ok now i feel bad for laughing :(.. this class depresses me on so many levels ~this class makes me want to die~ i have to add to this card everytime i come across it :) i feel like i am dying a slow, painful death. i feel that.
- high parity birth
- advanced maternal age
Preterm delivery (weeks?)
prior to 37 weeks
What % of deliveries in the U.S are preterm?
Other countries?
12-13%
5-9% in other developed countries
Demographic characteristics that increase the risk for preterm labor (9)
*trigger warning* long-ass list on the other side
- non-caucasian
- extremes of age<17 or >35
- low socioeconomic status
- low pre-pregnancy BMI
- history of preterm delivery
- inter-pregnancy interval <6mon
- abnormal uterine atony
- trauma
- abdominal surgery during pregnancy
Obstetric Factors that increase risk of preterm delivery (7)
*trigger warning
- vaginal bleeding
- infection
- short cervical length
- multiple gestation
- assisted reproductive technologies
- preterm premature rupture of membranes
- polyhydraminos
What procedure is performed to help prevent preterm labor
cervical cerclage
BIG ouch, no thx
What 3 drugs are discussed for the potential prevention of preterm labor
- prophylactic antibiotics
- prophylactic beta-agonists
- progesterone
What is used for pain management for cervical cerclage
neuraxial andddd maybe a smidge of versed if you ask v nicely
What is given to the mother to help babies lung maturation in the event of preterm delivery
corticosteroids: betamethasone or dexamethasone
What 2 drugs are given to reduce contractions
- mag sulfate
- terbutaline
What kind of muscle is the myometrium
smooth
What is the incidence of pregnancy-related thromboembolic events
1-1.7 per 1000 pregnancies
At what stage/period in the pregnancy are moms at highest risk for embolus
postpartum (specifically, highest risk in 1st week postpartum)
two most important modifiable risk factors for thromboembolism
- obesity
- immobility
What complication mimics normal pregnancy symptoms
DVT
Symptoms of DVT
lower leg edema and pain
What is used to diagnose PE
U/S
Are D-dimers elevated in normal pregnancies
yup
If you suspect PE and the patient does NOT have DVT symptoms what is the next step
CXR
If you suspect PE, No DVT symptoms, CXR normal then what
V/Q scan
If you suspect PE, No DVT symptoms, CXR abnormal then what test do you order
CTA
When suspecting PE what 2 tests prompt treatment if positive
- CTA
- V/Q scan
also CUS ( i think this is just for DVT not PE)
If you suspect PE and DVT symptoms are present what test should be performed
Compressional U/S (CUS)
If CUS is negative what should be performed next in the presence of suspected PE
CXR
What 2 drugs are used to anticoagulate when thromboembolism is diagnosed
- LMWH
- unfractionated heparin
At what volumes can venous air embolism become lethal
200-300mL
What symptoms intraoperatively could indicate a venous air embolism (5)
- chest pain
- SOB
- sudden hypoxemia
- hypotension
- arrhythmia
What actions help prevent further air entrainment
- flood field with saline
- lower surgical field relative to the heart
For Airway management during VAE what actions should be taken (4)
- Administer 100% oxygen
- d/c nitrous
- intubate
- support ventilation
CV interventions for VAE
- chest compressions
- IV volume expansion
- vasopressors
In a VAE situation should delivery be expedited
yup
What should be considered after VAE event
- evaluate for intracerebral air
- consider hyperbaric oxygen therapy
Confirmatory test for AFE
there isn’t one
AFE airway management
100% FiO2
intubate
CV support for AFE management
- LUD
- fluids & vasopressors
- large bore IV
- consider A-line
- chest compressions
Should you monitor the fetus and expedite delivery during AFE event
obviously
heme management during AFE event
- MTP
- send coags electrolytes
- normothermia
What unit do moms go to after AFE
ICU
The umbilical cord protrudes ahead of the fetus
prolapsed cord
What are we concerned about with prolapsed umbilical cord
cord compression
Most common cause of maternal mortality worldwide
hemorrhage (25%)
What accounts for 12.5% of pregnancy-related deaths in the US
hemorrhage
Are most adverse outcomes related to hemorrhage considered preventable
yup
Failure to do what 3 things has contributed to hemorrhage-related adverse outcomes
- recognize risk factors
- accurately estimate blood loss
- initiate treatment in a timely fashion
What is the primary mechanism for controlling blood loss during delivery
uterine contraction (due to oxytocin)
Uterine contractions constrict which vessels
spiral arteries and placental veins
coagulation mechanisms after disruption of vascular integrity
- platelet aggregation and plug formation
- local vasoconstriction
- clot polymerization
- fibrous tissue fortification of the clot
What 2 things are considered LATE signs of hemorrhage especially in young healthy patients
- tachycardia
- hypotension
As blood loss increases does the reliability of EBL increase or decrease
decrease
When the placenta implants near/on the cervix
Placenta Previa
Incidence of placenta previa
4:1000
Complication associated with placenta previa
antepartum hemorrhage
If a patient is known placenta previa and is having elective/non-urgent CD, is there still a significant risk for hemorrhage
yup
With placenta previa is there an increased or decreased risk for placenta accrete
increased
Which form of anesthesia for placenta previa cases is associated with more stable hemodynamics and lower transfusion rates
epidural anesthesia
Is it okay to use 50% nitrous to limit volatile agents in a active bleeding Previa patient
yup
When the placenta separates from the uterus prior to delivery
placental abruption
What populations have been found to have an increased risk for placental abruption
- African American women
- patients hospitalized for acute and chronic respiratory disease
Obstetric Conditions associated with placental abruption (5)
- advanced maternal age
- multiparity
- preeclampsia
- premature rupture of membranes
- chorioamnionitis
maternal comorbidities associated with placental abruption (5)
- HTN
- resp illness (acute or chronic)
- substance abuse
- cocaine use
- tobacco use
Which type of trauma direct or indirect is associated with placental abruption
both do :(
Anesthesia management considerations for placental abruption vaginal delivery
- neuraxial
- treat hypovolemia
- sympathectomy can increase risk to extend abruption
- consider PCA
Placental abruption anesthesia management for CD
- General preferred
- aggressive volume resuscitation
- uterine atony requires uterotonic drugs
Risk factors for Uterine rupture (7)
- prior uterine surgery
- induction of labor
- high dose oxytocin
- connective tissue disorder
- forceps
- internal podalic version
- excessive fundal pressure
what volume is considered Postpartum hemorrhage for vaginal delivery
>500ml
What volume is considered postpartum hemorrhage for CD
>1000 mL
Common causes of postpartum hemorrhage
- uterine atony
- retained placenta
- genital trauma
- uterine inversion
- placenta accreta
Most common cause of severe postpartum hemorrhage (80%)
uterine atony
First-line drug for prophylaxis and treatment of uterine atony
oxytocin
side effects of oxytocin
- tachycardia
- hypotension
- myocardial ischemia
What other intervention is recommended besides uterotonic agents to help prevent uterine atony
uterine massage
2 treatments for uterine atony besides oxytocin
- Ergot alkaloids-fungus-methergine (wut)
- prostaglandins-hemobate
Least common hematoma seen with genital trauma
retroperitoneal
retained placenta
failure to completely deliver placenta
What can be given to help relax the uterus in the presence of retained placenta
- high-dose volatile
- nitroglycerin
What serious OB condition is associated with concurrent vagal reflex mediated bradycardia
Uterine Inversion
What dose of Nitroglycerin may be needed to relax the uterus for uterine inversion
200-250mcg (larger dose)
Placenta accreta
placenta that invades the uterine wall and is inseparable from it
accreta vera
adherence of the basal plate of the placenta to the myometrium
chorionic villi invade the myometrium
Increta
invasion through the myometrium, into serosa and maybe other organs
percreta
with what OB complication may an Internal iliac artery balloon catheter be necessary
placenta accreta
in 2/3 of cases of placenta accreta blood loss exceeds
2000cc
in 15% of placenta accreta blood loss exceeds
5000cc
in 6.5% of placenta accreta cases, blood loss exceeds
10,000cc (holy shit)
is there even that much blood in there rip
What 3 OB complications trigger DIC
- retention of dead fetus
- placental abruption
- AFE
What often accompanies DIC
- circulatory shock
- renal failure
Label the degree of Previa: Marginal, Total, or Partial
A. Total
B. Partial
C. Marginal
