Preeclampsia, DM, PIH, Obesity, Hemorrhage, & Baby Resuscitation - Quiz 4 Flashcards
What is the most common medical problem of pregnancy?
Diabetes - hyperplasia of pancreatic beta-cells
What is the difference b/t Gestational Diabetes & Diabetes?
Gestational is when DM is first diagnosed in Pregnancy
What factors contribute to Gestational Diabetes?
Older Mom
Obesity
Family DM History
Hx of Stillbirth, Baby Death, Fetal Malformation , or Big Baby
Which trimester is Gestational Diabetes more prevalent?
2nd & 3rd Trimesters
Back to Normal after Delivery w/ High Recurrence rate
What are the Acute Complications of Gestational Diabetes?
DKA
Hyperglycemic NonKetotic State
Hypoglycemia
What are the Chronic Complications of Gestational Diabetes?
Macrovascular
(Coronary, Cerebrovascular, Peripheral Vascular)
Microvascular
(Retinopathy, Nephropathy)
Neuropathy
(Autonomic, Somatic)
What other conditions are associated w/ Gestational Diabetes?
HTN
Superimposed Preeclampsia
Polyhydraminios - excess amniotic fluid
C-Section
Nephropathy
Placental Insufficiency
What is the best way to Prevent Fetal Structural Abnormalities in regards to Gestational Diabetes?
Early Glycemic Control
Target A1c: 4-6%
> 6.5% = Vascular Disease
Type 1 Diabetes may cause Stiff Joint Syndrome, what do these patients look like?
Short Stature
Contractures
Tight Skin
Difficult Airway
How should Insulin be managed for Gestational Diabetes?
Preggos need more insulin in the 2nd & 3rd trimesters & less once labor starts and after delivery
Give Half of NPH + Sliding Scale or Insulin Drip
What can Diabetic Autonomic Neuropathy cause?
HTN
Ortho Hypotension
Painless MI
Decreased Response to Atropine & Propranolol
Neuro Bladder
Gastroparesis
What should be done for Protamine Sulfate Anaphylaxis from NPH?
Stop Protamine & Give Epinephrine
How does DKA affect the fetus?
Ketones cross placenta & decreases fetal oxygenation
True/False? Obese parturients require less Local Anesthetic and achieve higher blocks w/ no difference in pain?
True
What is the Third leading cause of Maternal Mortality?
Hypertension
What are the categories of Hypertension during Pregancy?
Chronic HTN
PIH
Preeclampsia-Eclampsia (Seizure)
Superimposed Preeclampsia
At what Diastolic BP does the risk of Placental Abruption & Fetal Growth Restriction increase?
DBP > 110
What BP is considered Pregnancy Induced Hypertension?
> 140/90 mmHg
Resolves 12wks postpartum
No Renal/Systemic Involvement
What is Preeclampsia?
New Onset HTN > 20 wks gestation or Early Postpartum
Resolves 48hrs Postpartum
Renal/Systemic Involvement
What can develop w/ Preeclampsia when there is Renal/Systemic Involvement?
Proteinuria
Oliguria
Headaches
Clonus
↑LFTs
Thrombocytopenia
DIC
What are the Risk Factors of Preeclampsia?
First Pregnancy
Black < 18 yo & > 35 yo
Prior History & Fam. History
DM, Renal Disease, HTN, Anti-Phospholipid
Twins
What are Preeclampsia Symptoms?
Vision Problems
Headache
Epigastric Pain
Increasing Edema & Weight
How can Preeclampsia cause a Difficult Airway?
Upper Airway Edema
Laryngeal Edema
Airway Obstruction
How does Preeclampsia affect the CV system?
↑CO
↑SVR
↑CVP or No Change
↓Plasma Volume
What are the Pulmonary Effects of Preeclampsia?
↓Oncotic Pressure
Capillary Leak
Vasoconstriction
↑PAWP
What are the Liver problems associated w/ PIH or Preeclampsia?
Periportal Hemorrhage
Ischemic Legion
Swelling
Epigastric Pain
What are the Renal Effects of Preeclampsia?
Proteinuria
ARF w/ Oliguria
↑BUN
↓GFR & Clearance
How does Preeclampsia affect the Uterus?
↑Activity
Oxytocin Sensitivity
PTL
↑Abruption Risk
↓UBF
What is the leading cause of Maternal Death relating to PIH?
Intracranial Hemorrhage
What are Fetal Complications of Preeclampsia?
Abruptio Placentae
IUGR
PTL
Death
What is HELLP Syndrome?
Hemolysis
Elevated Liver Enzymes
Low Platelets
What are symptoms of HELLP Syndrome?
Malaise
Epigastric Pain
N/V
Mutli-System Failure
Self-Limiting
What type of Anesthesia is Contraindicated in HELLP Syndrome?
Regional
What should be closely monitored in HELPP Syndrome?
Platelet count
Hemostasis not a problem til < 40,000
What is the Definitive Cure for HELLP Syndrome?
Delivery
Platelets will normalize 72 hrs after
What is the drug of choice for treating Preeclampsia?
Mag Sulfate - narrow therapeutic index - used to prevent seizure
Mag goal of 4 - 6 mmol/L
What is the concern when using Sodium Nitroprusside to control HTN in the parturient?
Fetal Cyanide Toxicity
What should be given for Mag Sulfate Toxicity?
Calcium Gluconate IV
What happens w/ a Mag Level of 5-10?
Wide PR & QRS
What happens w/ a Mag Level of 11 - 14?
Depressed Tendon Reflexes
What happens w/ a Mag Level of 15 - 24?
SA, AV Block & Resp. Paralysis
At what level of Magnesium will the patient go into Cardiac Arrest?
> 25 mEq/L
What meds can be given to Blunt the Laryngeal Response?
Hydralazine
Nitroglycerin
Labetalol
How does Magnesium Sulfate affect NMBs & Pressors?
Enhances all NMBs
&
Inhibits catecholamine release and blunts pressor response
What is Placenta Previa?
Painless Vaginal Bleeding
Complete Previa = Full Cervical Os Coverage by Placenta
Are Regionals contraindicated for Placenta Previa?
No. Ok for Regional if patient is stable
What is Placenta Accreta?
When Placenta is attached abnormally deep thru the endometrium to the myometrium
Whats the difference b/t Accreta, Increta, and Percreta?
Accreta: no myometrium penetration
Increta: further into myometrium
Percreta: all the way thru myometrium into the serosa
After the baby has been delivered, there is still no delivery of the placenta after 30 minutes, what should you suspect?
Placenta Accreta
What factors increase the risk for Placenta Accreta?
Placenta Previa
Uterine Scar d/t D&C, C/S, Myomectomy
Asherman’s Syndrome
Thin Placental Decidua
How is Placenta Accreta treated?
C-Section
Hysterectomy
Myometrium Resection*
Pelvic Artery Embolization*
Balloon Tamponade*
(*utereus-sparing)
What is the most common cause of Intrapartum Fetal Death?
Abruptio Placentae - premature separation of placenta w/ painful vaginal bleed
What are the risk factors associated w/ Abruptio Placentae?
HTN
Trauma
Cocaine & ETOH
Abnormal Uterine Structure
Multiparity
What are risk factors for Uterine Rupture?
Prior C/S
Hx Myomectomy
Prolong Labor w/ Oxytocin
Big Uterus
What are signs and symptoms of Uterine Rupture?
Sudden Severe Fetal Distress
Severe Abd. Pain even w/ Epidural
Bleeding
What should be done once a Uterine Rupture has been identified?
Restore Volume
&
Emergent Lapartomy under GA
How much blood loss would be considered Postpartum Hemorrhage?
> 500 cc
What causes Postpartum Hemorrhage?
Uterine Atony
Uterine Overdistension d/t Twins or Polyhydramnios
Uterine Inversion
Perineal Laceration
Retained Placenta
How is Uterine Atony treated?
- Oxytocin IV
- Methylergonovine (Methergine) IM - can cause HTN IV
- Hemabate - prostaglandin IM - can cause Bronchospasm
Which condition is sometimes referred to as an Anaphylactoid Syndrome of Pregnancy?
Amniotic Fluid Embolism that can happen b/t labor & postpartum where amniotic fluid gets into mom’s circulation
85% Mortality
What are signs & symptoms of an Amniotic Fluid Embolism?
Sudden Tachypnea
Cyanosis
Shock
Generalized Bleeding (DIC)
Uterine Atony
What is the normal Fetal Heart Rate?
120 - 160 bpm
< 120 = Asphyxia
What is Short Term Variability for Fetal Heart Rates?
3 - 6 bpm
Reduced by CNS Depressants
What is Long Term Variability in Fetal Heart Rates?
15 - 40 Accelerations per hour w/ fetal movement
Decreases w/ Fetal Sleep
What kind of Fetal Heart Decelerations are NOT associated w/ Fetal Distress?
Early Decelerations from Vagal Response d/t head compression
What kind of Fetal Heart Decelerations signify Uteroplacental Insuffiency & Decreased O2 Supply?
Late Decelerations - Fetal Distress
_____ decelerations are related to cord compression
Variable Decelerations
>70 bpm & > 60 secs = Fetal Asphyxia
What is the Normal ABG for a Neonate?
pH: 7.25 - 7.35
pCO2: 40 - 50 mmHg
pO2: 20 - 30 mmHg
Base: < 10
How is a baby’s Apgar Scored?
Respirations
Crying
Reflex
Irritability
Skin Color
Muscle Tone
@1 Minute & @5 Minutes
What should be done if the Apgar is < 7 @ 5 Minutes?
Repeat Apgar q5 min for 20 min or until two successive Apgars of 7 or more
When resuscitating the neonate, what should be done?
- Suction Muconium
- BMV w/ 40 peep initially, the keep pressure < 30 cm H20 after
- RR should be 30 - 60 /min
- HR should be > 100 bpm
- Start CPR & Intubate if HR at 60-80 and not rising
What is the Normal Neonate BP?
For 1-2 kg
50/25
>3 kg
70/40
If Low BP, give fluids @ 10cc/kg
What can cause Hypotension in the Neonate?
Hypoglycemia
Hypermagnesemia
Hypocalcemia
True/False: Dosing is the same when giving meds through an ETT for both Pediatric & Neonatal Resuscitation?
FALSE
Pediatric Resuscitation needs higher dose thru ETT
Higher doses thru ETT NOT recommended for Neonatal Resuscitation