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OBGYN & BURN Flashcards

1
Q

Identify A B C and D

A

A. Normal (Decidua)

B. Increta (17%)

C. Percreta (5%)

D. Accreta (75-78%)

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2
Q

Describe what the image shows

A

Placenta Increta

  • Placenta invasion to myometrium
  • Leads to massive bleeding after delivery
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3
Q

Describe what the image shows

A

Placenta Accreta

  • Placenta adhesion to uterine myometrium without invasion
  • Leads to massive bleeding after delivery
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4
Q

Identify A B and C

A

A: Marginal placenta previa.

B: Partial placenta previa.

C: Complete placenta previa.

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5
Q

Identify A and B

A

A. Apparent bleeding from premature separation

B. Concealed bleeding from premature separation

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6
Q

Placenta adhesion to uterine myometrium without invasion leading to massive bleeding after delivery

A

Placenta Accreta

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7
Q

Placenta acreta is likely to occur in patients with a history of?

A
  1. previous C/S
  2. placenta previa,
  3. uterine trauma
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8
Q

Placenta invasion to myometrium that leads to massive bleeding after delivery

A

Placenta Increta

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9
Q

placenta invasion to myometrium, serosa and adjacent pelvic structures

A

Placenta Percreta

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10
Q

There are 3 types of placental abnormal implantations, placenta acreta, increta and percreta. How are they diagnosed and managed

A

Dx: U/S. MRI

Management: C/S or postpartum hysterectomy

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11
Q

The two MCC of 3rd trimester bleeding are?

A

Placenta previa and placental abruption

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12
Q

Placenta previa is?

A

abnormally implanted placenta on the lower uterine segment and covers or borders on the cervical os.

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13
Q

Identify 3 types of placenta previa

A
  1. Marginal – within 2 cm of os
  2. Total – completely covers os ( C section)
  3. Partial – partially covers os ( C section)
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14
Q

The Overall incidence and mortality of Placenta previa is?

A

1%

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15
Q

What are the risk factors of placenta previa

A
  1. Large placenta
  2. Accreta
  3. Previous C/S
  4. Multipara
  5. Malpresentation
  6. Advance maternal age
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16
Q

Do NOT do a vaginal exam for this patient

A

Patient with placenta previa

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17
Q

What are the signs and symptoms of a patient with placenta previa and how is it diagnosed?

A
  1. Painless vaginal bleeding which stops automatically
  2. Preterm labor
  3. Maternal hemorrhage with hypotension
  4. Diagnosed with U/S, MRI
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18
Q

This patient should always have a C-section delivery

A

Patient with placenta previa

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19
Q

What is the most common cause of neonatal motality and mobidity?

A

Placenta Previa

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20
Q

Describe the management of a patient with placenta previa

A

1.Expectant (wait till delivery)

–Hospitalization; bed rest and observation if < 37 weeks with mild to moderate bleeding

–I/V fluids , typing & cross matching

–Maintain crit > 30

–Await lung maturity ( steroid shots)

  1. Coagulopathy is common; may need replacement
  2. Delivery

–Do L/S ratio, if immature give steroid to mom

  • Always C/S
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21
Q

Patient with placenta previa has an abnormal L/S ratio. What would you do?

A

Give steroids to the mother

The lecithin–sphingomyelin ratio is a test of fetal amniotic fluid to assess for fetal lung immaturity

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22
Q

What are the complications of Placenta previa

A
  1. Premature delivery – most common cause of neonatal M&M
  2. Placenta accreta – do Hystrectomy
  3. PPH
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23
Q

This occurs when the normally implanted placenta separates from decidua basalis prior to delivery, bleeding may be overt or concealed.

A

Abruptio Placenta

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24
Q

What are the risk factors of placenta abraptio

A
  1. Maternal hypertension
  2. Cocaine , smoking M
  3. Trauma
  4. Preterm premature rupture of membranes
  5. Hypertonic uterus
  6. Previous history
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25
Q

Abruptio Placenta is diagnosed by?

A
  1. Clinical suspicion
  2. U/S
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26
Q

What is the incidence of abruptio placenta

A

1/100

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27
Q

What are the signs and symptoms of Abruptio placenta?

A
  1. Painful vaginal bleeding; high volume. Concealed vs. revealed
  2. Uterine tenderness
  3. Hypovolemia
  4. Retroplacental hematoma ( 2500 ml !)
  5. Contractions- low amplitude , high frequency
  6. Abdominal/back pain
  7. Fetal bradycardia(fetal distress) −Due loss of maternal gas exchange area
  8. Fetal demise- most common cause
  9. Maternal coagulopathy- most common cause of DIC −Replacement of clotting factors and platelets
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28
Q

The most common cause of fetal demise is?

A

Abruptio placenta

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29
Q

Fetal bradycardia in Abruptio placenta is due to?

A

loss of maternal gas exchange area

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30
Q

What arr the complications of placenta abruptio?

A
  1. DIC ( low platelets, factor V, VIII; high fibrin split products)
  2. Shock
  3. ARF
  4. Loss of fertility- uterine atony secondary to “Couvelaire uterus”
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31
Q

Describe the management of a patient with Abruptio Placenta

A
  1. Expectant- preterm fetus without signs of distress; follow coagulation profile
  2. C-section- if fetal distress ( fix mother’s coagulopathy first)
  3. Massive blood transfusion
  4. No delay
  5. Replacement of clotting factors, platelets
  6. NO EPIDURAL if concerns over volume and coag
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32
Q

Compare the incidence of placenta abruption vs placenta Previa

A

AP: 1/100

PP: 1/200

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33
Q

Compare the pathophysiology of placenta abruptio vs placenta Previa

A

AP: Premature separation of normally implanted placenta

PP: Abnormal implantation near or at os

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34
Q

Compare the risk factors of placenta abruptio vs placenta Previa

A

AP: HTN, abd trauma, tobacco or cocaine use

PP: Prior C/S, grand multiparous

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35
Q

Compare the signs and symptoms of placenta abruptio vs placenta Previa

A

AP: Painful vaginal bleeding , uterine hyperactivity, fetal distress

PP: Painless vaginal bleeding

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36
Q

Compare the diagnosis of placenta abruptio vs placenta Previa

A

Transabdominal/transvaginal U/S for both

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37
Q

Compare the management of placenta abruptio vs placenta Previa

A

Abruptio Placenta

  1. Stabilize the pt with premature fetus; expectant management with frequent monitoring
  2. Moderate to severe: immediate delivery

Placenta Previa

  1. NO vaginal exam!
  2. Stabilize
  3. Mag sulf
  4. Fetal lung maturity
  5. Delivery if unstable Bleeding
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38
Q

Compare the complications between placenta previa vs abruptio placenta

A

Abruptio Placenta

  1. DIC
  2. Shock
  3. Ischemic necrosis of distal organs
  4. Fetal anemia

Placenta Previa

  1. Placenta accreta.
  2. Fetal anemia
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39
Q

Prematurity is Birth before?

A

37 weeks of gestation

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40
Q

Complications of prematumrity are due to immature organs. These include?

A
  1. Respiratory distress syndrome −Give surfactant inhalation
  2. PDA
  3. Hypoxia or shock −Can cause gut ischemia
  4. Infections (CMV following blood transfusion)
  5. High bilirubin , hypocalcemia
  6. Intracranial hemorrhages
  7. Hypothermia
  8. Congenital anomalies
  9. Retinopathy resulting in visual loss
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41
Q

__________ is given to stop premature contraction

A

B2 agonist e.g. ritodrine

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42
Q

Avoid atropine with ritodrine because?

A

It can cause tachycardia that leads to pulmonary edema

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43
Q

What are the side effects of Ritodrine to the mom

A
  1. hypokalemia
  2. hyperglycemia
  3. tachycardia
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44
Q

What are the side effects of ritodrine on the fetus

A

Same as the mother though tachycardia may be more pronounced or less

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45
Q

These drugs are given in prematurity to prevent postanesthetic apnea

A

Aminophyllin or caffeine

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46
Q

This drug may prevent retinopathy of prematurity

A

Vitamin E

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47
Q

Anesthetic considerations in prematurity

A
  1. Airway , fluid and temperature control
  2. High risk of postanesthetic apnea

−Give aminophyllin or caffeine

3.Avoid fluctuation in PaO2 level [Normal =60-80 mmHg]

−Monitor pulse ox constantly

−Avoid excessive oxygenation

  1. Vit. E may prevent retinopathy
  2. Fentanyl with decreased requirement is favored
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48
Q

This drug may cause VIII nerve damage

A

Aminoglycosides

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49
Q

This drug may cause Clear cell adenocarcinoma of vagina/Cx, genital abnormalites

A

Diethylstilbestrol

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50
Q

This drug may cause Limb abnormalities (phocomelia) “seal limbs”

A

Thalidomide

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51
Q

This drug may cause Transposition of great vessels, cleft palate

A

Amphetamine

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52
Q

This drug may lead to microcephaly, mental retardation, abnormal face , limb dislocation, heart /lung fistulas

A

Ethanol

These symptoms describe Fetal alcohol syndrome

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53
Q

This drug may cause Congenital goiter, hypothyroidism, mental retardation

A

Iodide

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54
Q

This drug may cause decreased bone growth, small limbs , discoloration of teeth

A

Tetracycline

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55
Q

This drug may lead to Cartilage damage

A

Fluoroquinolones

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56
Q

this teratogen may cause Kernicterus

A

Sulfonamides

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57
Q

This teratogen is used in the treatment of acne and may result in multiple anomalies

A

Isoretinoin*

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58
Q

Griseofulvin can cause which teratogenic effects

A

multiple anomalies

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59
Q

This teratogen can cause Skeletal and facial abnormalities, mental retardation, stillbirth, IUGR

A

Warfarin

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60
Q

These drugs can cause cleft lip/ palate

A

Phenytoin, Carbamazapine

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61
Q

This teratogen can cause Fetal anticonvulsive syndrome, neural tube defect

A

Valproic acid

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62
Q
A

Fetal alcohol syndrome

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63
Q

What is the most serious risk factor associated with surgery during pregnancy

A

Uterine asphyxia

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64
Q

to avoid supine hypotension in obstetric anesthesia

A

Uterine displacement

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65
Q

Pregant women are more prone to hypoxia due to?

A

Low FRC

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66
Q

_______ substances diffuses rapidly through the placenta

A

lipid soluble substances

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67
Q

Pregnant women are at a high risk of thromboembolism. What is used to prevent DVT

A

prevent DVT with pneumatic compression stockings during C/S

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68
Q

_______ is the most frequent complication of spinal and epidural

A

Hypotension

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69
Q

Hypotension is a complication of spinal and epidural treated by?

A

Left uterine displacement

IV hydration

ephedrine

70
Q

Decrease the dose muscle relaxants in pregnant women treated with Mag sulfate because?

A

It increases sensitivity to both depolarizing and non-depolarizing muscle relaxant

71
Q

In prenant women, Lidocaine (in high dose) causes?

A

uterine vasoconstriction and increased tone

72
Q

Fetal acidosis facilitate ______ while maternal alkalosis favors ________

A

ion trapping

diffusion across placenta

73
Q

Most common cause of polyhydramnios is?

A

esophageal atresia

74
Q

Most commonly injured verve during abdominal hysterectomy is?

A

Femoral nerve

75
Q

Foot drop during vaginal hysterectomy

A

Common peroneal nerve injury

76
Q

The most commonly injured nerve during vaginal delivery is?

A

Lumbosacral nerve resulting in low back pain

77
Q

___________ are the most common cause of anesthesia-related maternal mortality

A

Airways complications

78
Q

Most common mobidities in pregnant women is?

A

−Hemorrhage

−Preeclampsia

79
Q

Regionals are preffered to opioids in OB because?

A

Opioids cross the placental barrier. Regionals are preferred

80
Q

Pregnant women are at high risk for aspiration, apprpriate anesthetic interventions woud be?

A
  1. Always consider full stomatch
  2. Give H2 blockers and metroclopramide
81
Q

1.Level of block for C/S is?

82
Q

Common problems with GA in OB are ?

A

Rapid desaturation

laryngeal spasm/edema

aspiration

83
Q

__________ are most common cause of anesthesia-related maternal mortality

A

Airways complications

84
Q

Epidemiology of burns

A
  1. 2.5 millions burn injuries per year
  2. 100,000 hospitalization per year
  3. 10,000 deaths per year
85
Q

Types of burns

A
  1. Thermal
  2. Electrical
  3. Chemical
  4. Radiational
86
Q

Deferentiate between first degree, second degree and third degree burn

A
  1. First degree; superficial, limited to epidermis
  2. Second degree; partial thickness, extends to dermis
  3. Third degree; full thickness-no pain?
87
Q

Inhalation burn injury

A

−Direct thermal insult => pulmonary edema and ARDS

−Smoke

−Deactivation of surfactant =>atelectasis

−CO poisoning

88
Q

The primary cause of death in burn patients is?

A

Infections

  • Loss of skin barrier
  • Inhalation injury and pulmonary infection
89
Q

Pathophysiology of burns

A

1.Inhalation injury

−Direct thermal insult => pulmonary edema and ARDS

−Smoke

−Deactivation of surfactant => atelectasis

−CO poisoning

2.Hypovolumia / Shock

−Total body edema due to increased permeability

−Pulmonary loss

  1. Hyperkalemia due to tissue destruction
  2. Infections—primary cause of death

−Loss of skin barrier

Inhalation injury and pulmonary infection

90
Q

Hypovolemia in burns is due to?

A

−Total body edema due to increased permeability

−Pulmonary loss

91
Q

Hyperkalemia in burns is due to?

A

tissue destruction

92
Q

Resuscitation of burn patients

A

−Treat the shock first. If no shock fluid administration aims to replace the deficit and suppy the maintenance fluid.

−Evaluate Total Body Surface (TBSA) Area burned by “rule of nines”.

−3 ml/kg/% BSA burned of crystalloid /24 hrs

  • First ½ over 8 hrs
  • Second ½ over next 16 hrs
93
Q

Wound care in burns

A

−Gentle debridment

−Partial thickness

  • cover with topical antibiotics

−Complete thickness

  • Topical antibiotics
  • Excise burn wound to remove necrotic tissues
  • Cover with skin graft
  • Keep extremities elevated
94
Q

Treatment of infections in burns

A

−Sputum C/S

−Wound infection

  • Resect to viable tissue
  • Antibiotics ( tissue injection and IV)
95
Q

Metabolic changes in burns

A

−Requirement increases – catabolic state

−(25 kcal/kg/day) + (40 kcal /% TBSA burned/day)

−Higher protein : calorie ratio

96
Q

Long term care treatment in burns

A

−Splints – opposes contractures

−Pressure garments – prevent scar and edema

−Range of motion – prevents contractures

97
Q

Anesthesia Consideration for burn patients

A
  1. Intubate before edema develops
  2. Sux is contraindicated due to hyperkalemia => cardiac arrest
  3. Higher doses of non-depolarizing muscle relaxant
  4. Halothane is best avoided if epinephrine is being used to stop bleeding
98
Q

Rule of nine in burns

A

Head and neck = 9% =(4.5 front + 4.5 back)

Upper extrimities= 18% =2(4.5% front +4.5% back)

Trunk= 36% = 2(18% back + 18% front)

Lower Extrimities= 36% = 2(9% front +9% back)

Perenial = 1%

99
Q

Early deceleration

A
  1. Decelerations ( low FHR) begin and end at approximately the same time as the uterine contraction [normal FHR = 120-160 bpm]
  2. Head compression
  3. NO fetal distress
100
Q

Late deceleration

A
  1. Persist after contraction is over
  2. Associated with fetal hypoxia - decrease uteroplacental perfusion
  3. Possibly due maternal hypotension or abruption
  4. Assess fetal pH
  5. Deliver the baby ASAP when
  • Persistent
  • Fetal bradycardia
101
Q

Variable deceleration

A
  1. Variable in shape, severity and timing
  2. Occur at any time during contraction
  3. Umbilical cord compression and low blood flow
  4. Associated with fetal hypoxia
  5. Respiratory acidosis- with good fetal reserve metabolic acidosis does not occur
  6. Occurs in oligohydramnions
  7. Change mother position (back to side)
102
Q

VEAL CHOP

103
Q

Incidence of gestational diabetes

104
Q

What are the risk factors of gestational diabetes

A
  1. Past history
  2. Prior abortions
  3. Still births
  4. Obesity
  5. Maternal age >30
  6. Large fetus
105
Q

History and physical in a patient with gestational diabetes

A

Asymptomatic

Fetus larger for gestational age

106
Q

Labs for patient with gestational diabetes

A
  1. Glycosuria, fastening hyperglycemia
  2. Abnormal GTT (glucose tolerance test)
107
Q

Treatment of gestational diabetes

A
  1. Diet control
  2. Insulin
  3. Avoid oral hypoglycemic agent (can cause fetal hypoglycemia)
108
Q

Compare maternal vs fetal complications of gestational diabetes

A

Maternal Complications

  1. Preterm labor
  2. Polyhydramnion
  3. C/S for macrosomia
  4. Preeclampsia/eclampsia
  5. DM type II

Fetal Complications

  1. Macrosomia
  2. Shoulder dystocia
  3. Perinatal mortility 2-5%
  4. Congenital defects
  5. Hypoglycemia
109
Q

Any pregnancy outside the uterine cavity

A

Ectopic Pregnancy

110
Q

Ectopic Pregnancy Risk factors

A
  1. PID
  2. Pelvic surgery
  3. IUD
111
Q

Ectopic Pregnancy H&P

A
  1. Abdominal/pelvic pain “knife-like”
  2. Abnormal vaginal bleeding
  3. Pelvic mass
  4. Shock if ruptures
112
Q

Diagnosis of ectopic pregnancy

A

Elevated HCG w/o an intrauterine pregnancy on U/S

113
Q

Treatment of ectopic pregnancy

A

Surgery vs. medical (Methotrexate)

114
Q

What are the Complications of ectopic pregnancy?

A

Shock

Infertility

Maternal death

115
Q

The most common site of ectopic pregnancy is?

116
Q

Hydatidiform Mole

A
  1. Gestational trophoblastic disease (GTD)
  2. Growth of an abnormal fertilized egg or an overgrowth of tissue from the placenta
  3. Cystic swelling of chorionic villi and proliferation of chorionic epithelium (trophoplast)
  4. Abnormal vaginal bleeding
  5. Benign GTD (molar pregnancy) 80%
117
Q

Complete molar pregnancy

A

Result from sperm fertilization of an empty ovum, most commonly have a chromosomal pattern of 46,XX and are completely derived from father

118
Q

Incomplete molar pregnancy

A

Result when a normal ovum is fertilized by two sperms, have a chromosomal pattern of 69 XXY

119
Q

Malignant GTD consist of?

A

invasive mole and choriocarcinoma

120
Q

Risk factors of hydatidiform

A
  • Extreme of age
  • Folate deficiency
121
Q

History/PE in hyadatidiform mole

A
  1. First trimester painless uterine bleeding
  2. passage of molar vesicles
  3. uterine size increase and date discrepancy
  4. very high BP
  5. preeclampsia*
  6. intractable N/V
122
Q

Evaluation of Hydatidiform Mole

A

Very high b-HCG and “snow storm” appearance on pelvic U/S with no fetus present

123
Q

Treatment of Hyadatidiform Mole

A

−D&C reveals “cluster-of-grapes” tissue

−Methotrexate with HCG monitoring

−Hystrectomy for invasive disease

124
Q

Complications of Hydatidiform Mole

A
  • Pulmonary mets
  • trophoblastic emboli
  • ARD
125
Q

Compare and contrast specifics of Complete mole vs Incomplete mole

126
Q

Nonselective termination of pregnancy at <20 weeks

A

Spontaneous Abortion

127
Q

Common cause of 1st trimester bleeding

A

Spontaneous Abortion

128
Q

History /PE of spontaneous abortion

A
  1. Vaginal bleeding and tissue passage
  2. Closed vs. open os
129
Q

Evaluation of spontaneous abortion

A
  1. B HCG
  2. U/S
  3. Culdocentesis
130
Q

Treatment of spontaneous abortion

A
  1. Stabalize
  2. D&C =>Complications e.g. perforation and hemorrhage
  3. Antibiotics
  4. RhoGAM if appropriate
131
Q

Compare and contrast different types of spontaneous abortion

A

Complete abortion

<20 weeks’. All products of conception (POC) expelled, Os closed, uterine bleeding

Incomplete abortion

< 20 weeks’ gestation. Some POC expelled

Open os, bleeding

  • D&C

Threatened abortion

< 20 weeks. No POC expelled. Intact membrane, os closed, bleeding , viable fetus

Complete REST

Inevitable abortion

<20 weeks’ gestation. No POC expelled, rupture membrane, os open, bleeding with cramps

  • Emergent D&C

Missed abortion

No fetal heart tone. No POC expelled. Retain fetal tissue. Os closed. No bleeding

Nonviable tissue not expelled in 4 weeks

  • Evacuate uterus
  • D&C

Septic abortion

Infection associated with abortion; endometritis

  • D&C, antibiotics

Intrauterine fetal death

No fetal heart tone

  • D&C
132
Q

Pathological consequences of abnormal entry of fluids, particulate matter or secretions into lower airways

A

Aspiration Pneumonia

133
Q

S/S of aspiration pna

A
  1. SOB
  2. Bronchospasm
  3. Fever
  4. Pink and frothy sputum
  5. Cx: infiltration in lower segments
  6. ABG: hypoxia
  7. Bacterial infection of lower airways

−Pyopneumothorax, pulmonary necrosis & abscess

134
Q

Treatment of aspitation pna

A
  1. Tracheal suction and lavage
  2. Antibiotics
  3. Mechanical ventilation
135
Q

Loss of >500 ml of blood within first 24 hrs of delivery

A

Postpartum Hemorrhage

136
Q

Complications of postpartum hemorrhage are?

A
  1. Hemorrhagic shock
  2. Transfusion related risks
137
Q

Causes of PPH

A

Uterine Atony is the most common cause

Genital Tract Trauma

Retained Placental Tissue

138
Q

The most common cause of postpartum hemmorhage is?

A

Uterine atony

139
Q

Comapare and contrast risk factors asscociated with different causes of postpartum haemmorhage

A

Uterine Atony

  1. Over-distension of uterus ( multiple gestation, macrosomia)
  2. Prolong labor
  3. Uterine myomas
  4. Mag sulf
  5. GA
  6. Uterine infection

Genital Tract Trauma

  1. Precipitous labor
  2. Forceps , vacuum extraction
  3. Large infant
  4. Inadequate episiotomy repair

Retained Placental Tissue

  1. Placenta accreta/increta/percreta
  2. Preterm delivery
  3. P. Previa
  4. Previous C/S or D&C
  5. Uterine leiomyomas
140
Q

Compare and contrast the diagnosis of different causes of PPH

A

Uterin Atony: Palpation of a softer, flaccid “boggy” uterus w/o firm fundus

Genital Tract Trauma: Careful examination, look for laceration

Retained Placental Tissue: Careful inspection for missing part of placenta. U/S

141
Q

Compare and contrast treatment of different causes of PPH

A

Uterine Atony

  1. Bimanual uterine message
  2. MCC of PPH (90%)
  3. Oxytocin infusion
  4. Methylergonovine
  5. PGF2a if not hypertensive

Genital Tract Trauma

  1. Surgical repair of physical defect

Retained Placental Tissue

  1. Manual removal of remaining placenta. D&C.
  2. Placenta accreta/increta/percreta require hystrectomy
142
Q

In OB venous air embolism occurs when?

A

Occur at the time of placental separation

Lodge in pulmonary arteries

143
Q

What are the signs and symptoms of VAE

A
  1. Mill-wheel murmur
  2. Chest pain
  3. SOB
  4. Decreased end-tidal CO2
  5. Elevated CVP
144
Q

Put the patient anti-Trendelenburg position with left lateral tilt of 15° in case of VAE. This is to?

A

Increases chances of trapping air in right atrium from where air can be sucked out via CV cath

145
Q

Steep Trendelenburg position increases chance of VAE during CS because?

A

It increases the gradient between heart and surgical field during Cesarean.

146
Q

3rd leading cause of maternal death

A

Amniotic Fluid Embolism

147
Q

Amniotic Fluid Embolism

A
  • Rare but deadly; 3rd leading cause of maternal death
  • Amniotic fluid gets into maternal circulation due to break in the uteroplacental membrane
148
Q

S/S of amniotic fluid emboli

A
  1. Chills
  2. sudden onset of dyspnea(PE)
  3. hypotension
  4. hypoxia
  5. coma
  6. DIC
  7. uterine atony
  8. cardiopulmonary arrest
149
Q

Treatment of Amniotic fluid embolism

A
  1. Stabilization
  2. Resuscitation
  3. NaHCO3
  4. Deliver ASAP
  5. Dobutamine if LVH
  6. Digitalis or frusemide if á CVP
  7. Hydrocortisone
  8. Check for DIC
150
Q

BP >140/90 mmHg after 20th week and resolve within 48 hrs after delivery

A

Pregnancy Induced Hypertension

151
Q

Preeclampsia

A
  • Hypertension (160/110), proteinuria (> 5 g/day) and edema hand, face, lung
  • Oliguria (< 500 ml /day), headache, visual disturbance , hepatic tenderness, hyperreflexia
152
Q

Eclampsia

A

(+)Seizures in preeclampsia

153
Q

HELLP syndrome

A

high maternal and fetal mortality= Call for immediate delivery

Hemolysis, _E_levated _L_iver enzymes, _L_ow _P_latelet count

154
Q

Risk factors for PIH

A
  1. Nulliparity
  2. Extereme of age (<15 or >35)
  3. Multiple gestation
  4. Vascular disease due to SLE and DM
    • family history
  6. Chronic HTN
  7. HELLP syndrome
155
Q

Pathophysiology of PIH

A
  1. Elevated thromboxane A2
  2. Decreased PGI2
  3. Elevated endothelin-1
  4. Decreased NO
  5. Elevatd renin
156
Q

This condition mimics PIH

A

Cocaine abuse

157
Q

What are the signs and symptoms of PIH

A
  • Uterine vasospasm => uteroplacental insufficiency , low I/V volume, low GFR, edema , CNS dysfunctions
  • Decreased uterine BF
158
Q

The only cure for PIH is?

A

Delivery of baby

159
Q

The first drug of choice in PIH is?

160
Q

This antihypertensive should be avoided in managent of PIH due to adverse fetal effects

161
Q

High dose of nitropruside will cause cyanide toxicity because?

A

Nitroprusside metabolism (hydrolysis) results in cyanide ion production. To treat cyanide toxicity give sodium thiosulfate to produce thiocyanate which is less toxic and is eliminated by the kidneys

162
Q

Mag sulfate is used in PIH to?

A

prevent convulsions (Mag sulf antagonizes calcium)

163
Q

Required level of magnesium in PIH =

164
Q

Treatment of PIH

A
  1. Only cure is delivery of baby
  2. Monitor PT, PTT, platelet, FSP
  3. Hydralazine and methyldopa to control HTN. Labetalol is drug of first choice
  4. Esmolol should be avoided due to adverse fetal effects. M
  5. High dose of nitroprusside => (S/E cyanide toxicity) WHY ??
  6. Seizures require mag sulf and benzo
  7. Mag Sulf to prevent convulsion (Mag sulf antagonizes calcium)
  8. Magnesium depresses CNS by decreasing Acetylcholine release
  9. Mechanism of action of magnesium
    - Prevents Ca++ entry into cell=> smooth muscle relaxation

Required level of magnesium = 4-6 mEq/L

165
Q

Magnesium toxicity

A

−Absent deep tendon reflexes

−Ventilatory failure ( requires prompt intubation and ventilation)

−Heart block (Prolong PQ, wide QRS), cardiac arrest

−Hypotension

−Drowsiness and hypoventilation in fetus

−Atonic uterus

166
Q

Treatment of magnesium toxicity

A

−D/C magnesium

−Intubation and ventilation

−IV calcium gluconate ( calcium antagonizes effects of magnesium)

167
Q

Complications of PIH

A
  1. Pulmonary edema/ cerebral hemorrhages (leading causes of maternal death)
  2. DIC
  3. Prematurity
  4. Prematurity/fetal distress
  5. Intrauterine growth retardation
  6. Placental abruption
  7. ARF, cerebral edema
  8. Fetal/maternal death ; leading cause
168
Q

Anesthesia complications of PIH

A

Avoid katamine as it causes HTN

169
Q

Compare and contrast features of Mild preeclampsia, severe preeclampsia and Eclampsia

170
Q

Compare and contrast management of preclampsis and Eclampsia

A

Management of Preeclampsia

  1. If term or fetal lung mature; deliver
  2. If severe; expedite delivery by induction or C/S
  3. Bed rest, monitor BP, reflexes, weight and proteinuria
  4. Control BP ; diastolic < 90-100
  5. Seizure prophylaxis by mag sulf

Management of Eclampsia

  1. Supplemental O2
  2. Mag sulf + benzo
  3. Monitor fetal status
  4. Initiate steps to delivery
171
Q

The image below shows?

A

Retinal hemorrhage in HELLP

A&P III (6 decks)

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