Pregnancy Complications Lecture Powerpoint Flashcards
3 obstetrical hemorrhage causes of death
- abruption
- laceration
- uterine atony
Placental abruption
Premature separation of normally implanted placenta, may be external or concealed, separation can be complete or partial, occurs in 1/200 deliveries, not always detected on ultrasound as it can be mistaken for the placenta itself, tends to be maternal blood
Placental abruption etiology (3)
- idiopathic
- prior abruption places at increased risk
- hypertensive disorders
Placental abruption clinical presentation (4)
- vaginal bleeding
- uterine tenderness
- fetal distress
- shock
Placental abruption management (3)
- if term or near term then deliver
- if hypovolemic shock deliver and save mother
- severe prematurity and hemodynamically stable mother then conservative management
Placenta previa
Painless hemorrhage in the late 2nd trimester diagnosed by sonography, the bleeding tends to be more fetal blood, total previa when internal os is totally covered requires C section, partial or marginal can potentially get vaginal birth
Vasa previa
condition in which fetal blood vessels cross or run near the internal opening of the uterus. These vessels are at risk of rupture when the supporting membranes rupture, as they are unsupported by the umbilical cord or placental tissue, hard to spot on ultrasound but if spotted prior then prognosis is muchbetter
Previa management
- localize by ultrasound
- deliver those in labor, mature fetus, or hemorrhage so severe as to mandate delivery (typically 36-37 weeks)
Postpartum hemorrhage, what qualifies as it thru vaginal vs cesarean delivery?
Hemorrhage following delivery either from placenta implatantion site, trauma to genitalia, or both, recognized as >500mL vaginal delivery and >1000mL cesarean delivery
Postpartum hemorrhage etiology (6)
- uterine atony
- third stage bleeding (post placental delivery)
- placental accreta, increta, and percreta
- inversion of the uterus
- lacerations
- rupture of uterus
Uterine atony
Refers to flaccid uterine muscle preventing it from acting as a tourniquet to cut off blood leakage from vessels
Drugs for uterine atony (4)
- oxytocin IV
- methergine (uterine contractor)
- misoprostol
- prostaglandin
Can use multiple
Bakri balloon
Saline filled balloon that uses a tampanode effect to treat uterine atony and stop bleeding
Alternative treatments for uterine atony (3)
- bakri balloon
- b lynch suture
- hysterectomy
Consumptive coagulopathy (DIC)
Complication of underlying pathological process in which treatment must be directed to reverse fibrination, often seen with excessive bleeding at sites of modest trauma as well as hypofibrinogenemia, thrombocytopenia, and prolongation of PT and PTT, can occur because of placental abruption as well as other complications
DIC management (3)
- fluid volume replacement
- blood product replacement
- fix the underlying cause
Third leading cause of maternal death
Puerperal fever
Puerperal fever, what is it caused by, what is it treated by (2)
Uterine infection causing persistent fever after childbirth ocurring 30% after vaginal delivery and 70% after C section but typically after prolonged labor, typically mixed infection group A and B sterp and chlamydia, treated with clindamycin and gentamicin and ampiclillin (triple therapy) or dilation and curetage
Puerperal fever differential diagnosis (3)
- respiratory engoregement
- respiratory infection
- pyelonephritis
Postterm pregnancy
Pregnancy beyond 42 weeks or 294 days of start of last menstrual period, has increased risk of meconium and aspiration, shoulder dystocia (difficulty delivering shoulder due to size), etc.
Post term baby skin appears…
….dry, cracked, and peeling
Postmaturity syndrome
An infant that is delivered post term and due to failure of the placenta around 40 weeks becomes hypoxic and chronically ill, has wrinkled peeling skin and a long thin body suggestive of wasting, typically meiconium stained
If the placenta is failing, then how does this cause oligohydramnios?
The fluid going into the baby is decreased so the baby becomes dehydrated and stops peeing
Macrosomia
s used to describe a newborn who’s significantly larger than average. A baby diagnosed with fetal macrosomia has a birth weight of more than 8 pounds, 13 ounces (4,000 grams), regardless of his or her gestational age
Asymmetrical vs symmetrical fetal growth retardation
Asymmetrical has an abnormally large head compared to body while symmetrical sees consistent proportion
Risk factors for intrauterine growth restriction (6)
- small mothers
- poor weight gain and nutrition
- tobacco and alcohol use
- fetal infection (TORCH)
- congenital malformations
- chromosome abnormalities
Doppler velocimetry
A further study if an ultrasound indicates the estimation of fetal weight is below 10% as there is normally flow during diastole in the umbilical artery that can be measured, absent or reversed end diastolic flow associated with increased perinatal mortality
When to deliver based on doppler velocimetry
Normal doppler:38 to 39 weeks
Decreased end-diastolic flow: 36 weeks
Absent end-diastolic flow: 34 weeks
Reversed end-diastolic flow: 32 weeks
Macrosomia risk factors (7)
- pre-pregnancy maternal obesity
- excessive gestational weight gain
- maternal interpregnancy weight gain
- maternal NON smokers
- maternal age less than 17
- diabetes
- prolonged gestation
Infants of diabetic mothers, regardless of birth rate, are at increased risk for… (3)
Shoulder dystocia, claviuclar fracture, and erbs palsey (brachial nerve damage)
Macrosomia diagnosis (3)
Experienced OB followed by mother (compared to her previous pregnancy) followed by sonogram
Macrosomia prevention (1)
- control of maternal hyperglycemia
- otherwise none
Prophylactic cesarean section is considered in what macrosomic patients?
Those >5000 g nondiabetic, and 4500 diabetic
Suspected >4500g baby and prolonged seconds tage or arrest of descent in the 2nd stage is indication for…
….cesarean section
