Pregnancy Complications Lecture Powerpoint

Question 1

3 obstetrical hemorrhage causes of death

Answer 1

• abruption
• laceration
• uterine atony

Question 2

Placental abruption

Answer 2

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

Question 3

Placental abruption etiology (3)

Answer 3

• idiopathic
• prior abruption places at increased risk
• hypertensive disorders

Question 4

Placental abruption clinical presentation (4)

Answer 4

• vaginal bleeding
• uterine tenderness
• fetal distress
• shock

Question 5

Placental abruption management (3)

Answer 5

• if term or near term then deliver
• if hypovolemic shock deliver and save mother
• severe prematurity and hemodynamically stable mother then conservative management

Question 6

Placenta previa

Answer 6

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

Question 7

Vasa previa

Answer 7

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

Question 8

Previa management

Answer 8

• localize by ultrasound

- deliver those in labor, mature fetus, or hemorrhage so severe as to mandate delivery (typically 36-37 weeks)

Question 9

Postpartum hemorrhage, what qualifies as it thru vaginal vs cesarean delivery?

Answer 9

Hemorrhage following delivery either from placenta implatantion site, trauma to genitalia, or both, recognized as >500mL vaginal delivery and >1000mL cesarean delivery

Question 10

Postpartum hemorrhage etiology (6)

Answer 10

• uterine atony
• third stage bleeding (post placental delivery)
• placental accreta, increta, and percreta
• inversion of the uterus
• lacerations
• rupture of uterus

Question 11

Uterine atony

Answer 11

Refers to flaccid uterine muscle preventing it from acting as a tourniquet to cut off blood leakage from vessels

Question 12

Drugs for uterine atony (4)

Answer 12

• oxytocin IV
• methergine (uterine contractor)
• misoprostol
• prostaglandin

Can use multiple

Question 13

Bakri balloon

Answer 13

Saline filled balloon that uses a tampanode effect to treat uterine atony and stop bleeding

Question 14

Alternative treatments for uterine atony (3)

Answer 14

• bakri balloon
• b lynch suture
• hysterectomy

Question 15

Consumptive coagulopathy (DIC)

Answer 15

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

Question 16

DIC management (3)

Answer 16

• fluid volume replacement
• blood product replacement
• fix the underlying cause

Question 17

Third leading cause of maternal death

Answer 17

Puerperal fever

Question 18

Puerperal fever, what is it caused by, what is it treated by (2)

Answer 18

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

Question 19

Puerperal fever differential diagnosis (3)

Answer 19

• respiratory engoregement
• respiratory infection
• pyelonephritis

Question 20

Postterm pregnancy

Answer 20

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.

Question 21

Post term baby skin appears…

Answer 21

….dry, cracked, and peeling

Question 22

Postmaturity syndrome

Answer 22

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

Question 23

If the placenta is failing, then how does this cause oligohydramnios?

Answer 23

The fluid going into the baby is decreased so the baby becomes dehydrated and stops peeing

Question 24

Macrosomia

Answer 24

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

Question 25

Asymmetrical vs symmetrical fetal growth retardation

Answer 25

Asymmetrical has an abnormally large head compared to body while symmetrical sees consistent proportion

Question 26

Risk factors for intrauterine growth restriction (6)

Answer 26

• small mothers
• poor weight gain and nutrition
• tobacco and alcohol use
• fetal infection (TORCH)
• congenital malformations
• chromosome abnormalities

Question 27

Doppler velocimetry

Answer 27

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

Question 28

When to deliver based on doppler velocimetry

Answer 28

Normal doppler:38 to 39 weeks
Decreased end-diastolic flow: 36 weeks
Absent end-diastolic flow: 34 weeks
Reversed end-diastolic flow: 32 weeks

Question 29

Macrosomia risk factors (7)

Answer 29

• pre-pregnancy maternal obesity
• excessive gestational weight gain
• maternal interpregnancy weight gain
• maternal NON smokers
• maternal age less than 17
• diabetes
• prolonged gestation

Question 30

Infants of diabetic mothers, regardless of birth rate, are at increased risk for… (3)

Answer 30

Shoulder dystocia, claviuclar fracture, and erbs palsey (brachial nerve damage)

Question 31

Macrosomia diagnosis (3)

Answer 31

Experienced OB followed by mother (compared to her previous pregnancy) followed by sonogram

Question 32

Macrosomia prevention (1)

Answer 32

• control of maternal hyperglycemia

- otherwise none

Question 33

Prophylactic cesarean section is considered in what macrosomic patients?

Answer 33

Those >5000 g nondiabetic, and 4500 diabetic

Question 34

Suspected >4500g baby and prolonged seconds tage or arrest of descent in the 2nd stage is indication for…

Answer 34

….cesarean section