OB Emergencies Flashcards
Anatomical and physiologic changes
Joints relax: progesterone
Heart is displaced to the left
-Left axis deviation on EKG
Diaphragm moved up 4cm
-Chest tubes should be inserted one ICS higher
Respirations
Minute ventilation increases
Respiratory alkalosis
Cardiac
Increases 20-30% by 10 weeks, up to 43% by term
Baseline HR increase by 10 BPM
Approx. 10mmHg decrease in blood pressure
Blood volume
-Circulatory volume increases 40-45%
-Pregnant won’t exhibit clinical sings of hypovolemia till late and severe blood loss
-Risk for DVT and PE
Effacement
Cervical thinning, measured from 0-100%
Dilation
Cervical opening, measured in centimeters 0-10cm
HELLP
Hemolytic anemia
Elevated
Liver enzymes
Low
Platelet count
HELLP treatment
Blood product administration
Magnesium and antihypertensives
Delivery of fetus and placenta
Preeclampsia
Presentation:
Hypertension
Proteinuria
Hyperreflexia
Edema
Abdominal pain
Preeclampsia treatment
IV mag bolus 4-6 grams over 20 minutes
IV mag drip 2-4 grams per hour
IV labetalol, hydralazine, or nifedipine
Delivery of fetus and placenta
Magnesium Toxicity
Symptoms: loss of DTR, resp depression, AMS
Treatment: calcium gluconate or calcium chloride
Mag exposed baby:
Lethargic
Higher likelihood of need of resuscitation
Placenta previa
Presents as painless bright red vaginal bleeding
Treatment:
Vaginal exam is contraindicated
Maintain maternal hemodynamic stability
Transport for C-section
Placental abruption
Separation of a normally positioned placenta from uterine wall
Painful bleeding with radiation to the back
Sinusoidal pattern
Indicates impending fetal demise
High rate of fetal morbidity/mortality
Early deceleration
Mirror contraction, normal during active labor, indicates head compression
Variable decelerations
Abrupt decrease in fetal HR, characterized by v/w- shapes
-Indicates cord compression
Treatment: change maternal position, fluid administration, 100% oxygen, tocolysis
Late decelerations
Nearly symmetrical with contraction, but begins and returns to baseline after the contraction ends
-Indicates placental insufficiency
-Requires immediate intervention
VEAL CHOP
Variable Decel = Cord compression
Early decel = Head compression
Acceleration = okay
Late Decel = Placental Insufficiency
APGAR
Appearance
Pulse
Grimace
Activity
Respirations
Suction
Mouth, then nose
First stage of labor
Begins at onset of labor and ends when cervix is 100% effaced and dilated
Second stage of labor
Begins when cervix is completely effaced/dilated and ends with birth of baby
Third stage of labor
Begins with birth of baby and ends with delivery of placenta
Normal serum magnesium level
1.5-2.5
Premature rupture of membranes
(PROM)
Spontaneous rupture of amniotic sac before 37 weeks
Treatment:
-Delivery within 24 hours
Or
- Hospitalization with IV antibiotics until delivery
Turtle Sign
Shoulder dystocia applied traction to pull head back towards uterus
Treatment:
Mcroberts maneuver
Flex mother’s knees against her chest during next contraction
Apply “suprapubic” pressure
Amniotic fluid embolism
Small amount of amniotic fluid enters maternal circulation and induces anaphylactoid reaction
Treatment: “A-OK”
Atropine
Ondansetron
Ketorolac
Normal fetal heart rate
110-169 bpm
Fetal tachycardia
Compensates for transient hypoxia
Maternal fever
Fetal bradycardia
Cord compression
Placental insufficiency
Maternal hypotension
Uterine rupture
Absent variability
Associated with fetal distress
Minimal variability
0-5 bpm
Moderate variability
6-25 bpm
Marked variability
> 25 bpm
Acceleration heart rate
Increase > 15 bpm lasting > 15 seconds
