Obstetric Complications

Question 1

Side effects tocolysis

Answer 1

CCB-dizziness, flushing, hypotension, suppressed heart rate function when used with mag. Contraire: hypotension, preload dependent lesions

NSAIDS - nausea, gastritis, platelet dysfunction. Contraindications: Platelet bleeding disorder, liver or kidney dysfunction, GI ulcer, asthma

Beta agonist-tacycardia, hypotension, tremor, palpitations, pulm edema, hypokalemia. Contraindications: tachycardia sensitive heart condition and poorly controlled diabetes.

Mag- flushing, diaphoresis, loss of DTR, resp depression, cardiac arrest. Contraindication myasthenia gravis

Question 2

PPH

Answer 2

Tone, trauma, tissue, thrombin

Only.move to IR if stable
Don’t delay moving to hyst

Steps: maintain BP and O2, correct coagulopathy, stop bleeding,

Surgery: D&C, artery ligation, compression sutures, hyst

Question 3

Accreta risk factors

Answer 3

Previa
CS
AMA
Multiparity
Prior uterine surgery, ablation, embolization

Question 4

Volume of resuscitation

Answer 4

pRBCs- 300 mL, inc hg 1
Plts- 50 ml up 7500
FFP-250 ml inc fibrinogen 10-15 (includes all clotting factors)
Cryo - 40ml inc fibrinogen 10-15 ml (fibrinogen, factor 8, 13, vWF)

Question 5

Goals massive transfusion

Answer 5

Prevent hypothermia, correct hypocalcemia, hyperkalemia, acidosishg>7, plts->50, fibrinogen>100, PT/PTT <1.5 times normal, hemodynamically.stable

Coagulopathy+hypothermia+acidosis=>65% mortality

Question 6

Acute hemolytic rxn

Answer 6

Fever and chills
Flank and back pain
Chest pain
Vasoconstriction and ischemia
Circulatory collapse
Shock
Microangiopathic thrombosis

Question 7

Post dural headache

Answer 7

Symmetric frontal/occipital starting 24 hrs post spinal

Due to translocation CSF to lumbar area when upright, causes h/a and vasodilation.

Diff: lactation h/a, subdural hematoma, brain tumor, AVM, cortical vein or dural sinus thrombosis

Tx: caffeine, fluids, analgesics, blood patch

Question 8

Anesthesia levels

Answer 8

Perineum S2-S4
Labor T10-12
CS T4

Question 9

Betamethasone

Answer 9

Lowers RDS, IVH, NEC and mortality

Question 10

Prior PTD with twins

Answer 10

If <30 wks then risk up to 40%

If >30 wks then much lower risk of recurrence

Question 11

Effects of PPROM on neonate

Answer 11

RDS
NEC
IVH
Sepsis