Obstetrics 5 Flashcards
Which signs are consistent with a diagnosis of preeclampsia?
a. seizures
b. increased thromboxane
c. increased prostacyclin
d. proteinuria
e. vasoconstriction
f. impaired platelet aggregation
b. increased thromboxane
d. proteinuria
e. vasoconstriction
We can classify obstetric hypertensive disorders as
Chronic hypertension
gestational hypertension
preeclampsia
eclampsia
Describe chronic hypertension in the setting of obstetric hypertensive disorders.
occurs before 20 weeks of gestation
does not return to normal after delivery
______ is a risk factor for developing preeclampsia
Chronic HTN
Eclampsia occurs when the mother
with preeclampsia develops seizures
Severe preeclampsia occurs when
the BP exceeds 160/110
Gestational hypertension develops after
20 weeks of gestation
- proteinuria does not occur
The only way to truly diagnose gestation HTN is
after delivery when a return to a normotensive state rules out chronic hypertension
Preeclampsia includes
HTN that develops after 20 weeks gestation
proteinuria is typically present
Describe mild vs. severe preeclampsia
mild= BP >140/90
severe= BP >160-110
The definitive treatment for preeclampsia and eclampsia is
delivery of the fetus and placenta
The presence of _____ differentiates eclampsia from prreclampsia
seizures
_______ is the drug of choice for seizure prophylaxis.
Magnesium sulfate
________ is the treatment for magnesium toxicity
Calcium chloride
Chronic cocaine abuse is associated with
thrombocytopenia (check platelet count before neuraxial anesthesia
Cocaine abuse increases the risk of
spontaneous abortion, premature labor, placental abruption, and low Apgar scores
HELLP syndrome stands for
hemolysis, elevated liver enzymes, and low platelet count
Don’t place a neuraxial block in a patient with a platelet count below
100,000 per microliter of blood
_____________ is a reasonable option for cocaine overdose because of its
labetalol; mixed beta 1 and beta 2 effects
Selectively blocking the beta-1 receptor can cause
heart failure if the SVR is significantly elevated
(causes myocardial depression)
Selectively blocking the beta-2 receptor (impaired vasodilation in muscular beds) can cause
heart failure if the SVR is significantly elevated (it causes SVR to increase further)
In some cases, preeclampsia can exist in the absence of proteinuria if the patient has any of these conditions:
persistent RUQ or epigastric pain
fetal growth restriction
thrombocytopenia
elevated serum liver enzymes
persistent CNS or visual symptoms (headache, hyperreflexia, hyperexcitability and coma)
Preeclampsia is more common in these age groups
<20 years old
>35 years old
Patients with these conditions have the highest rate of developing preeclampsia
chronic renal disease
homozygous for the the angiotensinogen T235 allele
The patient with preeclampsia produces up to 7x more thromboxane than prostacyclin, increased thromboxane favors
vasoconstriction
platelet aggregation
reduced placental blood flow
Key complications of preeclampsia include
heart failure
pulmonary edema
intracranial hemorrhage
cerebral edema
DIC
proteinuria
If symptoms of preeclampsia and eclampsia are mild and the fetus is young, the mother may be managed with
observation and bed rest
The primary reason why we medicate beyond 160/110 for severe preeclampsia is
to prevent a CVA, MI, and placenta abruption
Treatment for acute hypertension includes:
labetalol 20 mg IV
hydralazine 5 mg IV
Nifedipine 10 mg PO
Nicardipine infusion
Describe the seizure prophylaxis with magnesium sulfate.
load: 4 g loading dose over 10 minutes
infusion: 1-2 g/hr
For patients with preeclampsia, neuraxial anesthesia assists with
blood pressure control & provides better uteroplacental perfusion
Patients with preeclampsia have an exaggerated response to
sympathomimetics and methergine
The hemodynamic response to laryngoscopy for patients with preeclampsia can b blunted with
labetalol, esmolol, remifentanil, or magnesium
_________ relaxes the uterus and increases the risk of postpartum hemorrhage
Magnesium
Patients with HELLP are at higher risk for
DIC & Intra-abdominal bleeding from the liver
The definitive treatment for HELLP syndrome is
delivery of the fetus; HELLP syndrome can present though for the first time in the postpartum period
CV risks of cocaine abuse include
tachycardia, dysrhtymias, coronary vasoconstriction, and myocardial ischemia
CNS risks of cocaine abuse include
cerebral vasoconstriction, ischemia, seizures, and stroke
Acute cocaine intoxication and chronic cocaine intoxication affect MAC in the following ways:
chronic- decreases MAC
acute- increases MAC
Labetalol is a reasonable choice for cocaine overdose because it blocks _________
alpha-mediated peripheral vasoconstriction
Hypotension may not respond to ______ in chronic cocaine abusers.
ephedrine (d/t catecholamine depletion)
Neo is the best option for hypotension
What is the antidote for magnesium toxicity?
10 mL of 10% calcium gluconate IV
This is when the placenta attaches to the lower uterine segment
placenta previa
-associated with painless vaginal bleeding
______ occurs when there’s partial or complete separation of the placenta from the uterine wall before delivery.
placental abruption (abruptio placentae)
Placental abruption is associated with
pain and vaginal hemorrhage along with fetal hypoxia
_______ is when the placenta attaches to the surface of the myometrium
placenta Accreta
_____ is when the placenta invades the myometrium
placenta Increta
______ is when the placenta extends beyond (penetrates) the uterus
placenta Percreta
The placenta normally implants into the
decidua of the endometrium
With abnormal placental implantation, uterine contractility is
impaired, and there is a potential for tremendous blood loss
Describe the preferred anesthetic for patients with abnormal placental implantation
although neuraxial anesthesia is safe
GA is preferred
Abnormal placental implantation is associated with
placenta previa & previous C-sections
Risk factors for placenta previa include
previous C-sections
history of multiple births
Placenta previa often requires
C-section
Risk factors for placental abruption include
PIC
preeclampsia
chronic HTn
cocaine use
smoking
excessive alcohol use
