Other Obstetrical Complications

Question 1

Umbilical cord prolapse: what is it, and how do you handle it?

Answer 1

Umbilical cord prolapses through the cervix-increased risk with breech. Suspect it when there is a sudden drop in the FHR immediately after membranes are ruptured

I could use a regional technique if epidural catheter is in situ, if not GA is first choice if there is associated fetal compromise. Loss of FHR prior to appropriate level, aslo choose GA

Question 2

Fetal heart rate decelerations: Early: what does it look like and what causes it?

Answer 2

shallow, symmetric, uniform decelerations with a gradual onset and return to baseline-they begin early in the contraction and the nadir coincides with the peak of the contraction and returns to baseline by the time the contaction is over
Cause: fetal head compression=decreased fetal cerebral blood flow, precipitating a vagal reflex with resultant slowing of the FHR

Question 3

Late decels: what does it look like and what causes it? Diagnosis and late decels:

Answer 3

Late: due to uteroplacental insufficiency, excessive contractions, maternal HTN. gradual onset and return to baseline, delayed in timing relative to the contraction
Fetal scalp pH: less than 7.20 is consistent with fetal acidosis

Question 4

Tx of late decels:

Answer 4

Call for help
adminster O2 through a tight fitting face mask
Change maternal position (lateral or knee to chest)
I V bolus with LR
d/c oxytocin

Question 5

Variable decelerations:

Answer 5

Most common decelerations

cord compression-usually has a favorable outcome

Question 6

Molar pregnancy: what is it and what are associated conditions? And what will you do to treat those conditions. Intra op?

Answer 6

absence of intact fetus, vesicular swelling of placental villi
Signs and symptoms: abonormal bleeding in early pregnancy, large uterus for dates
associated complications: anemia, pregnancy induced hypetension, hyperthyroidism, thyrotoxicosis (treat associated hyperthyroidism with IV idodine and beta adrenergic receptor blockers), DIC, PE
Avoid excessive fluid administration to prevent pulmonary edema
Intraop: GA with RSI, Regional not recommeded due to associated DIC
Monitor Pt in ICU for 12-24 ours