Obstetric Emergencies Flashcards
What is the risk of uterine rupture with a previous LTCS?
0.5 - 0.9%
What is the risk of uterine rupture with a previous classical cesarean section?
4-9%
What is the risk of uterine rupture with a previous T shaped incision?
1 - 7%
In a shoulder dystocia what is the rate of pH decrease per minute?
0.04 unit/min
In a shoulder dystocia, how long does it take for the pH to go from 7.2 –> 7.0
5 minutes
What percent of shoulder dystocias are resolved with the McRoberts maneuver alone?
42%
What is the definition of the woodscrew maneuver?
anterior pressure applied to the posterior shoulder, abducts the shoulder
What is the definition of the Rubin maneuver?
posterior pressure applied to the anterior shoulder, adducts the shoulder
What is the Zavanelli maneuver?
replacement of the fetal head into the uterus, delivery by cesarean section
What maneuver has the highest rate of success compared to other maneuvers during shoulder dystocia?
Delivery of the posterior arm, 85% successful
What are the initial maneuvers that should be attempted during a shoulder dystocia?
McRoberts, Suprapubic pressure
What is the average blood loss at time of SVD?
500
What is the average blood loss at the time of CS delivery?
1000
What is the average blood loss at the time of planned cesarean hysterectomy (Accreta)?
1400
What is the average blood loss at the time of emergent cesarean hysterectomy?
3000 - 3500
What is the most common cause of PPH?
Uterine atony 70 - 80%
What is the dose and timing that you can give Methergine during a PPH?
0.2 mg IM q 2-4 hrs
What is the dose and timing that you can give hemabate during a PPH?
0.25mg IM q 15 minutes
What is the dose and timing that you can give Misoprostal during a PPH?
600 - 1000mcg PO, PR, SL
What is the incidence of Accreta with history of 0 prior CS delivery and known placenta previa?
3%
What is the incidence of Accreta with 1 prior CS delivery and known placenta previa?
11%
What is the incidence of Accreta with history of 2 prior CS delivery and known placenta previa?
40%
What is the incidence of Accreta with history of 3 prior CS delivery and known placenta previa?
61&
What is the incidence of Accreta with history of >4 prior CS delivery and known placenta previa?
67%
What is the incidence of Accreta with history of >5 prior CS delivery and no known placenta previa?
4.7%
TXA is what type of medicine?
Antofibrinolytic
How do you dose TXA?
1g IV infusion over 10 minutes
What risk does TXA reduce?
reduces PPH related death by 20 - 30% when given within 3 hrs of delivery
In setting of hemorrhage, in what ratio should you give crystalloid to blood loss?
3:1 ratio to EBL
What is the typical volume of 1 U PRBCs
300 cc
1 unit PRBC increases the hgb by ____ and the HCT by ____.
1, 3 %
What is the typical volume of 1 Unit of platelets
50 cc
What is the typical volume of a 6 pack of platelets
300 cc
1 unit increases the plt count by ____
75K
a 6 pack of plts increases the plt count by
45K
What are the indications to transfuse plts following vaginal delivery?
plts < 20 or DIC
What are the indications to transfuse plts following a CS?
plts < 50 or DIC
What is the typical volume of 1 U FFP?
250 cc
What are the components of FFP?
Fibrinogen, antithrombin, factors V, XI, XII
1 unit of FFP increases the fibroinogen level by _____
5-10mg/dL
What are the indications to give FFP?
DIC (Fibrinogen < 200), Coagulopathic liver disease, wafarin reversal
What is the typical volume of 1 unit of Cryoprecipitate?
40 cc
What are the components of cryoprecipitate?
Fibrinogen, vWF, factor VIII, XIII
What is the current recommended ratio of PRBC:plt: FFP during a massive transfusion?
1:1:1
What is the mortality rate associated with maternal amniotic fluid embolism?
80%
What is the pathophysiology of an amniotic fluid embolism?
Anaphylactic reaction to fetal cells/amniotic fluid that enter maternal circulation
