Obstetric Hemorrhage, Cardio, Pulmo Flashcards
Happens when there is premature separation of a normally implanted placenta
Abruptio placenta
Immediate event that can cause hemorrhage and subsequent abruptio placenta
Preeclampsia
This dangerous drug can cause vasoconstriction with resultant placental separation
Cocaine
Virchow’s triad in placental abruption
VIA Vaginal bleeding Increased uterine tone Abdominal pain
Diagnostic test for abruptio placenta where you put a blood sample in a test tube and positive if a clot forms within 6 minutes or forms and lyses within 30 minutes
Clot observation test
Most common obstetric cause of DIC
abruptio placenta
This intervention can be diagnostic and therapeutic in abruptio placenta
Amniotomy
What is the boundary threshold for a low lying placenta?
2cm
Most common pathophysiology of placenta previa
Defective decidual vascularization
Management of placenta accreta
Classical CS, hysterectomy
Septic abortion and chorioamnionitis are associated with what coagulation pathway?
Intrinsic pathway (endothelial damage)
Abruptio, amniotic fluid embolism, retained dead fetus and saline induced abortion is associated with what coagulation pathway?
Extrinsic
Syndrome characterized by widespread systemic activation of coagulation
DIC
The combination of nifedipine snd what other tocolytic agent can cause dangerous neuromuscular blockade?
Magnesium sulfate
Only well accepted risk factor of gestational hypertension
Primiparity
Classic presentation of placenta previa
Painless vaginal bleeding
Management of placenta previa is the placental edge is >2cm from os
Trial of labor
Management of placenta previa is the placental edge is <2cm from os
Vaginal delivery if possible
Classification of placenta accreta if it invades the myometrium
Increta
Classification of placenta accreta if it penetrates the myometrium and through the serosa
Percreta
2 most important risk factors in placenta accreta
Placenta previa Prior CS
Hypertension without proteinuria occurring after 20 weeks AOG and BP returns to normal levels 12 weeks postpartum
Gestational hypertension
BP 140/90 prior to pregnancy or before 20 weeks AOG and persists 12 weeks postpartum
Chronic hypertension
What is the underlying etiology of proteinuria is seen with preeclampsia?
Increased capillary permeability
Renal change that occur in gestational hypertension
Glomerular endotheliosis
Mechanism in preeclampsia is placental implantation with replacement of ________ endothelium with trophoblasts
Spiral arteriole
Prevention of preeclampsia syndrome
High dose calcium Low dose aspirin
Management of severe preeclampsia if <34 weeks
- Expectant management <34 weeks
- Admit to hospital at maternal ICU
- Maternal-fetal evaluation for 24 hours
- Magnesium sulfate for 24 hours
- Antihypertensives for BP >160/110 or MAP >125
- Sonological monitoring:
- Assess fetal size by US every 2 weeks
- BPS + AFI at least twice weekly
- Umbilical artery Doppler – once a week
- NST - daily
Management of severe preeclampsia if <23 weeks
Terminate pregnancy
Management of severe preeclampsia if 23-32 weeks
- Steroids (24-34 weeks AOG)
- Betamethasone 12 mg/IM q24 hours for 2 doses
- Dexamethasone 6 mg/IM q12 hours for 4 doses
- Antihypertensives if needed
- daily evaluation of maternal-fetal condition
- Delivery if with indications
- Delivery at 32-34 weeks
Known fetal side effect of hydralazine
Thrombocytopenia
Drug of choice for severe hypertension in pregnancy
Hydralazine
Drug of choice for gestational/chronic hypertension in pregnancy
Methyldopa
Side effect of labetalol
Fetal growth restriction
What is the target magnesium level in eclampsia prophylaxis?
4.8-8.4 mg/dl
Drug of choice for prevention of convulsions in severe preeclampsia
Magnesium sulfate
Preferred mode of delivery for cardiovascular disorders
Vaginal Epidural anesthesia
For patients with congenital heart disease, what is the most common adverse event encountered in pregnancy?
Arrhythmia
Most common etiology of CAP in pregnancy
Strep pneumoniae
Most frequent complication of pneumonia in pregnancy
PROM
Initial monotherapy for CAP
Macrolides
Fetal response to maternal hypoxemia
Decreased CO
Management of severe preeclampsia if >34 weeks
stabilize mother and deliver
- Mode of delivery
- >34 weeks: vaginal delivery if maternal, fetal and cervical conditions are favorable
- <32 weeks: consider CS due to reduced success in induction
