Obstetric Patient Part 3 Flashcards
Postpartum hemorrhage is defined as EBL greater than
500 mL for vaginal delivery
1000 mL for C-section
PPH is the result of
uterine atony (80%) uterine abnormalities placental retention lacerations uterine inversion coagulation abnormalities
Uterine atony is associated with
multiparity
prolonged oxytocin infusion
polyhydramnios
multiple gestation
PPH treatment includes
uterotonics
surgical intervention
intrauterine balloon
Uterotonics are used to treat PPH because
they stimulate uterine contractions
Uterotonics used to treat PPH include
oxytocin
methergine- 0.2 mg IM
prostaglandins (hemabate, carboprost)- 250 mcg IM or into uterus
Misoprostal- 800-1000 mcg
Additional postpartum hemorrhage treatments may include
antifibrinolytics- TXA
massive transfusion protocol- cell salvage
surgical intervention- retained placenta, nitroglycerin, hysterectomy
intrauterine balloon- tamponade
Preeclampsia occurs in _____ % of pregnancies
5-7%
incidence increased >25% in past 20 years
Preeclampsia is characterized by
systolic HTN >140 mmHg (after 20 weeks gestation)
diastolic HTN >90 mmHg (after 20 weeks gestation)
proteinuria
platelet count <100,000
impaired liver function and/or severe RUQ pain
renal insufficiency
pulmonary edema
cerebral or visual disturbances
Etiology of preeclampsia is
not well understood- failure of normal angiogenesis resulting in decreased placental perfusion
Preeclampsia results in
increased vascular tone & sensitivity to catecholamines
pronounced upper airway edema during labor
CNS effects- HA, hyperexcitability & hyperreflexia
thrombocytopenia
hepatocellular necrosis
Management of preeclampsia is directed at
avoiding uteroplacental hypoperfusion
Management of preeclampsia includes
magnesium sulfate
hypertension management- decrease intracranial hemorrhage myocardial ischemia
Magnesium sulfate is used to treat preeclampsia as it works to
reduce incidence of seizures
tocolytic
venous dilation
reduction in uterine activity
The only way to end disease process of preeclampsia is
delivery
-regional preferred to general anesthesia
______ is a complication of preeclampsia
HELLP
HELLP results in
hemolysis
elevated liver enzymes
low platelet count
HELLP is associated with
progressive and sudden deterioration in maternal & fetal condition
Signs of HELLP include
hypertension
proteinuria
N/V
Obesity leads to an increased risk for
hypertension
diabetes
complicated labor- fetal macrosomia, failed induction/progression, difficult or failed neuraxial techniques, prolonged procedures, infectious complications
Abnormal placental implantation includes
placenta previa
placenta accreta
placenta abruption
Placenta previa occurs when the placenta
implants on lower uterine segment and covers opening to the cervix
S/S of placenta previa includes
painless vaginal bleeding
-hemodynamically significant blood loss
-increases risk in postpartum bleeding
Cesarean section indicated
Placenta accreta is when the placenta
implants into the myometrium (normally implants into endometrium)
Placenta increta describes growth
through the myometrium and into surrounding organs
Placenta accreta is associated with
massive hemorrhage
-uterine artery embolization
Cesarean hysterectomy
Placenta abruption is the
separation of placenta form the uterus during delivery
Placenta abruption occurs more frequently in women with
hypertension & preeclampsia
Signs of placenta abruption include
hemorrhage
uterine irritability
abdominal pain
fetal hypoperfusion & distress
Open venous sinuses allows amniotic fluid to enter circulation in placenta abruption resulting in
increased incidence of DIC
An amniotic fluid embolus is a
rare event that can occur during
- labor, vaginal delivery, or C section
- occasionally associated with placenta abruption
Signs of amniotic fluid embolus include
anxiety, dyspnea, hypoxia, hypotension, cardiovascular collapse & coagulopathy
Treatment of amniotic fluid embolus is
supportive
Prematurity is considered to be
L&D before 37 weeks gestation
- significant cause of morbidity
- 50% of all perinatal deaths
_____ gestation accounts for 70% of all premature births
34-36 weeks
Birth weight below ______ is associated with long-term complications
1500 g
Complications of low birth weight includes
respiratory distress syndrome
intracranial hemorrhage
hyperbilirubinemia
1-2% of pregnant women will require
surgery for non-obstetric cases
Surgery is avoided in _______ when possible
first trimester due to teratogenicity
Anesthetic management considerations of the parturient for nonobstetric cases includes
alterations in maternal physiology
maintenance of uterine perfusion
prevention of premature labor
maternal/fetal mediation considerations
Describe apgar scoring system.
8-10 normal
4-7 moderate distress or impairment
0-3 need for immediate resuscitation
______ often results in spontaneous respiration
tactile stimulation
15% of newborns require
resuscitation
-vast majority require assisted ventilation only
