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OB > Obstetric Emergencies > Flashcards

Obstetric Emergencies Flashcards

1
Q

Categories of C section

A

Grade I: Emergency - Immediate threat to woman or fetus
Grade II: Urgent - maternal fetal compromise which is not immediately life threatening
Grade III: Scheduled - needing early delivery but no maternal or fetal compromise
Grave IV: Elective - time to suit woman and maternity team

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2
Q

What constitutes Class I Emergency or Class II Urgent C sections?

A

NRFHR class III FHR tracings umbilical cord prolapse
Hemorrhage antepartum - placenta previa, abruptio placenta, uterine rupture, abnormal placentation, vasa previa
Hemorrhage postpartum - uterine atony, medical treatment first
Abnormal presentation
Dystocia

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3
Q

presentation for cord prolapse

A

during or after rupture of membranes
mean dilation 5cm
prompt vaginal examination when FHR changes with ROM

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4
Q

labor related risk factors for obstetric hemorrhage

A 
induction of labor >24 hours
prolonged 2nd stage of labor
mag sulfate
laceration/hematoma
uterine inversion
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5
Q

placental and uterine risk factors for obstetric hemorrhage

A 
placenta previa/low lying, accrete, increta, percreta
placental abruption
retained placenta
chorioamniotis
larger uterine myoma
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6
Q

four T’s for obstetric hemorrhage

A

tone
trauma (inversion)
tissue (retained tissue, invasive placenta)
thrombin

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7
Q

class I hemorrhage blood loss volume and maternal response

A

900cc asymptomatic

15% blood loss

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8
Q

class II hemorrhage blood loss and maternal response

A

1200-1500cc
20-25%
mild tachy, mild tachypnea, orthostatic hypotension, narrowing pulse pressure, decreased capillary refill

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9
Q

class III hemorrhage blood loss volume and maternal response

A

1800-2100 cc
30-35%
severe tachy, tachypnea, cool extremities, severe hypotension, confusion

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10
Q

class IV hemorrhage, blood loss volume and maternal response

A

> 2400cc 40%

oliguria, decreased LOC shock, aggressive resuscitation

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11
Q

risk factors for placental abruption

A

cocaine, smoking, HTN
premature ROM, abdominal trauma, previous abruption
advanced maternal age, advanced parity

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12
Q

anesthesia for abruptio placenta

A

2 large bore IVs, IVF non dextrose, blood products available
FHR monitoring
vaginal bleeding: airway exam, co morbidities, massive blood loss

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13
Q

induction meds perferred for GA for abruptio placenta

A

etomidate 0.3mg/kg
ketamine 0.5-1mg/kg

but avoid ketamine with uterine hypertonus

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14
Q

risk factors for placenta previa

A

previous placenta pervia, uterine surgeries including abortions, previous cs delivery

advanced maternal age, smoking hx, multiparity

male fetus

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15
Q

difference between placenta previa and abruptio placenta

A

placenta previa is painless vaginal bleeding, no uterine tenderness, mild early contractions, normal uterine resting tone

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16
Q

fetal M&M from placenta previa

A

increased incidence of prematurity

increased incidence of IUGR, fetal anemia, and congenital anomalies

17
Q

what to know before implementing anesthesia for placenta previa patient

A

gestational age
maternal fetal condition
amount of bleeding
type of previa

18
Q

placenta accreta, increta, percreta

A
  • basal plate placenta adheres to uterine myometrium without intervening decidual layer
  • placenta chorionic villi invade the myometrium
  • invades through the myometrium into serosa and surrounding organs
19
Q

anesthesia for acreta/increta/percreta

A

massive hemorrhage
large bore IVs, a-line, CVP, blood products available, cell saver

GA
Sympathectomy of regional avoided
increases risk of failed airway, aspiration, etc. must be considered
advantage of intubation in face of massive hemorrhage

regional 
intubation can be avoided
awake for birth
sympathectomy disadvantage
epidural vs spinal depends on length of sx
20
Q

surgical considerations for acretra, increta, placenta

A

possible peripaprtum hysterectomy
IR consult for embolization
intrauterine balloon tamponade
consider OB suite vs main OR

21
Q

main risk factor for uterine rupture

A

uterine scars (increases with C/S or myomectomies)

others: oxytocin, prostaglandin, abdominal trauma, grand multiparity, fetopelvic disproportion, fetal malpresentation, macrosomia, instrument assisted vaginal delivery

22
Q

s/s and treatment for uterine rupture

A

s/s: nonspecific, fetal bradycardia, maternal hypotension, abdominal pain, change in uterine tone and contractions

23
Q

risk is to fetus, not mother

A

vasa previa

24
Q

neonatal volume replacement in vasa previa

A

colloid, salt and blood balanced solution

25
Q

tx for vasa previa

A

30 weeks - at hospital
36 elective C/S

rupture stat delivery or CS, GA if no epidural

26
Q

causes of post partum hemorrhage

A
  1. uterine atony
  2. retained placental products
  3. genital tract trauma
  4. coagulation abnormalities
  5. placenta acreta
27
Q

first ,second, and third line treatments for uterine atony

A

first line - fluids, pressors, bladder emptying, 10-20u of oxytocin IV, uterine massage

second line- transfusion, removal of retained placenta, ergot alkyloids (methergine 0.2mg iM), uterine tamponade, prostaglandins, IV PGE2 or 15 methyl plostaglandin F2 alpha (IM carboprost, hemabate)

third - invasive measures, embolization, surgical ligation, hysterectomy possible

28
Q

tx for uterine inversion

A

relaxation for replacement of uterus
NTG 50-100 mcg or GA RSI ETT
oxytocin 20u/L after replacement

29
Q

meds for hemorrhage

A

oxytocin 20-80 U/L iv - dilute!, causes hypotension
methergine 0.2mg IV q2-4h- AVOID in HTN or raynaud’s
hemabate, carboprost - 250mg IM avoid with asthma, renal, hepatic, CV disease, risk of diarrhea ,fever and tachy
cytotec- 800-1000mcg

30
Q

Iatrogenic risk factors for cord prolapse

A

Obstetric manipulation, amniotomy, artificial ROM, placement of internal monitors

31
Q

Maternal and fetal risk factors for cord prolapse

A

Maternal is multiparity
Fetal - small size/weight, abnormal presentation, abnormally long umbilical cord, multiple gestation, prematurity, abnormal placental insertion, male gender, polyhydramnios, decreased FHR

32
Q

Patient history risk factors for obstetric hemorrhage

A 
Obesity >40 BMI
Multiparity, multiple gestation
Fetal wt > 4000g
Coagulopathy/ bleeding d/o
Prior c/s uterine sx or laparaotomies
Hx of OB hemorrhage
33
Q

S/s of abruptio placenta

A

Vaginal bleeding
Abdominal pain
Uterine tenderness & hypertonus
Fetal distress/demise

34
Q

Fetal effects of abruptio placenta

A

Less surface area available for O2 delivery

Fetal distress demise worse than previa

35
Q

T or F If mild abruption of abruptio placenta, no evidence of NRFHR, vaginal delivery may be attempted

A

T

36
Q

Goal of placenta previa

A

Monitor and maintain pregnancy until 37 weeks

Increased bleeding calls for CS

37
Q

Treatment for uterine rupture

A

Laparotomy / CS under GA

Hysterectomy

OB (10 decks)

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