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MED: Women’s Health/Reproductive System > Ob/Gyn Emergencies > Flashcards

Ob/Gyn Emergencies Flashcards

1
Q

Describe first trimester bleeding:

A

Common – 30-40%

50% will miscarry

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2
Q

What are some of the causes of first trimester bleeding?

A 
Causes:
Spontaneous abortion
Incomplete abortion
Blighted ovum
Ectopic pregnancy
Molar pregnancy
Normal pregnancy
Cervical polyps
Infections
Cervical erosions
Cervical cancer
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3
Q

Most miscarriages are due to _____.

A

a genetic anomaly

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4
Q

What are the signs of a spontaneous abortion?

A
  1. intrauterine pregnancy at <20 weeks
  2. low or falling levels of hCG (hCG should normally double every 2-3 days in pregnancy)
  3. Bleeding, midline cramping pain
  4. open cervical os
  5. complete or partial expulsion of products of conception
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5
Q

If someone has had an abortion, then what do you need to check on in that states of the mother?

A

Rh status. If Rh neg, give Rho-gam

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6
Q

What are signs of ectopic pregnancy?

A
  1. amenorrhea or irregular bleeding and spotting
  2. pelvic pain, usually adnexal. SUDDEN ONSET, DOES NOT RADIATE.
  3. adnexal mass by clinical examination or U/S
  4. failure of serum level of beta-hCG to double EVERY 48 HOURS.
  5. no intrauterine pregnancy or transvaginal u/s with serum beta-hCG >2000 mu/mL
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7
Q

How do you treat ectopic pregnancy?

A

stable patient= watch and give methotrexate

unstable= hospitalize and surgery

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8
Q

What is placenta previa?

A

placenta grows into the opening of the mother’s cervix. PAINLESS vaginal bleeding in the 3rd trimester is placenta previa until proven otherwise. bleeding may stop on own, otherwise weigh considerations.

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9
Q

What is placenta abruption?

A

The placenta tear away from the lining of the uterus and can deprive the baby of oxygen. Vaginal bleeding in the presence of abdominal pain or back pain with a firm, tender uterus. Sometimes, hemorrhage is concealed. DIC can occur. If abruption is severe enough, then a c-section is indicated.

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10
Q

What is pre-eclampsia?

A

newly elevated blood pressure and proteinuria during pregnancy.

Blood pressure > 140/90 after 20 weeks
Proteinuria of >.3 gm in 24 hours.

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11
Q

Describe severe pre-clampsia?

A 
BP >160/110
protineuria >5g in 24 hours
thrombocytopenia
HELLP
pulmonary edema
IUGR
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12
Q

What is the cure for pre-eclampsia?

A

the only true cure is delivery of the fetus

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13
Q

what are the 6 areas of the body that pre-eclampsia effects?

A
  1. CNS
  2. kidney
  3. liver
  4. hematologic
  5. vascular
  6. fetal-placental unit
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14
Q

What is eclampsia?

A

the occurrence of seizures with the other features of pre-eclampsia.

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15
Q

What is HELLP syndrome?

A

hemoloysis
elevated liver enzymes
low platelets

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16
Q

How are you going to prevent seizures in the mom with eclampsia?

A

you must give MgSO4
If BP increases, give hydrazine or Nifedipine
give IV D5 1/2 NS TRA 100-250 cc/hr with accurate I’s and O’s

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17
Q

What is postpartum hemorrhage?

A

It is the most common maternal morbidity
Major cause of death worldwide
traditionally define as blood loss >500ml

18
Q

What are some risk factors for postpartum hemorrhage?

A

Antepartum: history of PPH, fetal macrosomia, multiple pregnancies

Intrapartum: prolonged third stage, episiotomy, c-section

19
Q

How should PPH be managed?

A
  1. await placental separation
  2. leave cord uncut until pulsation stops
  3. allow spontaneous placental delivery
  4. give oxytocin
20
Q

What are the 4 T’s of PPH?

A
  1. tone= soft, boggy uterus
  2. trauma= genital tract tear, inversion of uterus
  3. tissue= placenta retained
  4. thrombin= blood not clotting
21
Q

What is the most common cause of PPH?

A

loss of tone

22
Q

How do you manage loss of tone in regards to PPH?

A

bimanual uterine massage and compression
give oxytocic agents:
1. oxytocin
2. PG

23
Q

What are some of the causes of trauma that cause PPH?

A
  1. uterine inversion: suspect if shock is disproportionate to blood loss, replace uterus immediately
  2. uterine rupture: risk is prior uterine surgery/no vaginal delivery. fetal bradycardia is first sign.
  3. vaginal or cervical lacerations
  4. hematoma
24
Q

What are some of the reasons “tissue” can cause PPH?

A
  1. retained placenta that is not delivered within 30 minutes.
  2. invasive placenta (accreta)
25
Q

what is placenta accreta?

A

general term used to describe an abnormally adherent palcenta. It can invade into or beyond the myometrium ( increta) or into the serosa (percreta). After delivery of an infant, the placenta does not separate correctly. Hysterectomy can somtimes be required to stop the bleeding.

26
Q

How do you manage placental removal?

A
  1. STOP UTERINE MASSAGE! perhaps give anesthetic
  2. identify the “cleavage plane”
  3. cup edge in hand and remove
  4. explore uterine cavity to make sure it is all gone
  5. give oxytocin to stimulate contraction.
27
Q

What are the indicators of “thrombin” PPH?

A
  1. lack of response to usual PPH treatment
  2. no blood clot formation
  3. oozing from puncture sites
28
Q

What causes “thrombin” PPH?

A

ITP, TTP, von Willebrand’s, Hemophilia, HELLP, preclampsia, Disseminated intravascular coagulation

Order: CBC with PLT, INR, aPTT, fibrinogen level, d-dimer as a DIC screen

29
Q

What is active management of PPH?

A
  1. oxytocin with or soon after delivery
  2. clamp cord
  3. controlled cord traction
  4. uterine massage after placenta delivers
30
Q

What is shoulder dystocia?

A

impaction of the anterior shoulder against the symphysis after delivery of the fetal head. It varies by birth weight, usually increasing as weight increases.

31
Q

What are the risk factors for should dystocia?

A
  1. prior shoulder dystocia
  2. gestational diabetes
  3. postdates pregnancy
  4. macrosomia
  5. short stature
  6. high pregnancy weight and weight gain
  7. abnormal pelvic anatomy
  8. 1st stage arrest disorders
  9. prolonged 2nd stage
  10. turtling
32
Q

what are some of the complications of shoulder dystocia?

A

maternal:

  • soft tissue injuries
  • anal sphincter damage
  • PPH
  • uterine rupture
  • symphyseal seperation

neonatal:

  • brachial plexus palsy
  • clavicle fracture
  • humeral fracture
  • fetal acidosis
  • hypoxic brain injury
33
Q

How do we prevent shoulder dystocia?

A
  1. elective cesarean delivery is NOT indicated
  2. glycemic control
  3. weight control
  4. deliver in alternative positions or McRoberts
  5. Deliver anterior shoulder with momentum of head delivery
34
Q

what is a fetal sign that shoulder dystocia is taking place?

A

TURTLE SIGN –head bobs in and out

35
Q

What is the HELPERR mnemonic and when should it be used

A

After recognition of shoulder dystocia, use the HELPERR mnemonic

H= help (call for assistance)
E = eval for episiotomy
L = legs (McRoberts Maneuver)
P = Pressure (suprapubic pressure to dislodge)
E= enter the vagina
R- remove the posterior arm
R = roll the patient (to hands and knees…which will help dislodge)

36
Q

Is a shoulder dystocia a soft tissue injury?

A

NO

37
Q

What is the McRobert’s maneuver?

A

flex maternal hips so that thighs are on abdomen

  • straightens the lubsacral lordosis
  • increases AP diameter
  • flexes the fetal spine
38
Q

How long should you attempt suprapubic pressure for

A

30-60 seconds

39
Q

What do you attempt when you E (enter the vagina)

A

Rubin Manuever

  • approach ANTERIOR fetal shoulder from BEHIND
  • exert pressure on scapula to adduct most accessible shoulder and rotate to oblique position
  • do McRoberts Manuever

OR

Woods Screw Manuever

  • approach POSTERIOR fetal shoulder from the FRONT
  • gently rotate toward symphysis
  • combine with rubin maneuver

OR

Reverse Wood’s Manuever

  • approach POSTERIOR fetal shoulder from BEHIND
  • rotate fetus in opposite direction from Rubin or Woods screw
  • attempt if other maneuvers have failed
40
Q

How does rolling the patient onto all fours help?

A

increases pelvic diameter

41
Q

What is the Zavanelli Maneuver?

A

Zavanelli maneuver is an obstetric maneuver that involves pushing back the delivered fetal head into the birth canal in anticipation of performing a cesarean section in case of shoulder dystocia

42
Q

A symphsioomty is most often used where?

A

in 3rd world counties. break the pubic sympysis.

MED: Women’s Health/Reproductive System (14 decks)

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