obstetrics Flashcards
What is preclampsia
pregnancy-induced HTN
triad of preclampia
HTN, protein urea, edema
Clinical signs of preclampsia
SBP > 140
DBP >90
Proteinuria
edema to hands/feet
oliguria
headache, visual disturbances, RUQ pain
risks of preclampsia
over 40 yrs
twins
diabetes
family hx
chronic HTN
renal disease
DIC
what is eclampsia
Convulsions that occur during pregnancy , associated with HTN, no other cause
Pre hospital Treatment for eclampsia
**delivery is definitive treatment **
magnesium sulfate
4-6g over 20mins
if seizure persists, can give 4g IV over 5mins
followed by 1-2g per hour
if patient still seizing consider midazolam
What is definition of HELLP syndrome
life threatening complications of pregnancy ancy which can be a variant of preclampsia
occurs in later stages of pregnancy and sometimes 24-48 hours after
acronym of HELLP
Hemolytic anemia
Elevated Liver (enzymes)
Low Platelets
3 stages of labour
stage 1: contractions gradually open cervix
stage 2: active delivery
stage 3: delivery of placenta
how long after delivery should placenta deliver?
10 mins
risks of shoulder dystocia
gestational diabetes
post date pregnancies
abnormal pelvic anatomy
Post pardum hemorrhage- the 4 Ts
Tone
Trauma
Tissue
Thrombin
PPH - causes of “tone”
caused by uterine atony
most common cause of PPH?
uterine atony
causes of PPH - Trauma
cervical, vaginal, peroneal lacerations, pelvic hematoma, uterine inversion
causes of PPH - Tissue
retained tissue and placental acceta, abnormally deep attachment of placenta
causes of PPH - thrombin
coagulopathies, vonwillebrand disease, hemophillia
what is the foreman ovale and what is its function
hole in inter-atrial septum to shunt blood from right to left atria
-allows blood coming from umbilical vein via inferior vena cava to bypass the pulmonary circulation
ducts arteriosus
blood vessel connecting the main pulmonary artery to the proximal descending aorta that allows most of the blood from right ventricle to bypass the fetus’s fluid-filled non-,functioning lungs
ductus venosus
shunts a portion of the left umbilical vein blood flow directly into the inferior vena cava. Oxygenated blood bypasses the liver.
what type of breech birth is most common
frank breech - legs extended at hip, could have foot presenting
what type of breech birth is LEAST common?
complete breech presentation - where baby’s bottom faces the cervix
does preclampsia only occur during pregnancy?
no, it can occur post pardom. usually within 48 hours can be 6 weeks of longer after
true or false: in premature delivery breech delivery is more common
true
what 4 components make up tetrology of fallot
ventricular septal defect
over riding aorta
pulmonary stenosis
right ventricular hypertrophy
What is given to keep ductus arteriosus open in neonate
prostsglandin E1
What is croactation of the aorta
congenital defect- narrowing of the aorta
What is patent ductus arteriosus
the ductus remains open after birth. Between aorta and pulmonary artery
what are the acyanotic congenital defects
atrial dental defect
ventricular septal defect
patent ductus arteriosus
left to right shunts
increased pulmonary blood flow
what are cyanotic congenital defects
tetrology of fallot
transposition of the great arteries
persistent truncus arteriosus
where do you measure pre ductile o2 sat?
the right hand
Patho of eclampsia
Not well understood, but thought to result from vasogenic or cytotoxic edema and endothelial dysfunction secondary to abnormal cerebral autoregulation
- results in hyper or hypo perfusion stemming from hypertension
What is the most common MAJOR congenital anomaly?
congestive heart failure
Define truncus arteriosus
there is one large blood vessel leading out of the heart instead of 2
what are the 2 major issues caused by truncus arteriosus?
- oxygen poor blood mixes withoxygrn rich blood, reducing the amount of oxygenated blood delivered to the body
- increases amount of blood sent to thr lungs
Which other condition do babies with truncus arteriosus usually have ?
ventricular septal defect
true or false:
lesions that depend on the ductus arteriosus for pulmonary or systemic circulation typically present with cyanosis and shock within the first week of life as the ductus closes. Lesions that result in pulmonary overcirculation leading to CHF more often present in the 2nd or 3rd month of life as falling pulmonary vascular resistance increases left-to-right shunting, resulting in pulmonary edema.
true
what is the common presentation of uterine rupture?
-hypotension
-vaginally bleeding
-hematuria
-sudden drop in fetal heart rate
- sudden abdominal pain
What is definitive treatment of eclampsia?
delivery
what is uterine rupture?
complete division of all 3 layers of the uterus
what does TOLAC stand for?
trial of labour after cesarean
true or false: women who decide to have TOLAC are at higher risk of uterine rupture
true
