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My OB > Quiz 4 > Flashcards

Quiz 4 Flashcards

1
Q

Gestational Diabetes risks: (FOAM-H)

A
  • Family history of DM
  • Obesity
  • Advanced maternal age
  • More prevalent in 2nd and 3rd trimesters
  • History of stillbirth, neonatal death, fetal malformation or macrosomia
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2
Q

Gestational Diabetes associated with:

A
  • gestational HTN
  • polyhydramnios
  • C/S
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3
Q

patients taking NPH can have

A

Protamine sulfate anaphylaxis

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4
Q

Despite ________ anesthetic concentrations administered to obese women they achieved _____ sensory blockade with no differences in pain scores.

A

lower

higher

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5
Q

Most common medical issue during pregnancy

A

HTN

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6
Q

Maternal DBP > ____ is associated with ↑ risk of placental abruption and fetal growth restriction.

A

110

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7
Q

HTN – sustained BP increase to SBP>____ or DBP>___

A

140

90

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8
Q

HTN Resolves ___ wks postpartum

A

12

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9
Q

Preeclampsia criteria, along with:

A
  • New onset HTN
  • After 20 weeks of gestation, or
  • Early post-partum, previously normotensive
  • Resolves within 48 hrs postpartum
  • Proteinuria > 300 mg/24hr
  • Oliguria or Serum-plasma creatinine ratio > 0.09 mmol/L
  • Headaches with hyperreflexia, eclampsia, clonus or visual disturbances
  • ↑ LFTs, glutathione-S-Transferase alpha 1-1, alanine aminotransferase or right abdominal pain
  • Thrombocytopenia, ↑ LDH, hemolysis, DIC
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10
Q

Risk factors for Preeclampsia (FAP-B-CRAFT-D)

A
  • First pregnancy
  • Age younger than 18 or older than 35
  • Prior h/o preeclampsia
  • Black race
  • Chronic HTN
  • Renal disease
  • Anti-phospholipid syndrome
  • Family history
  • Twins
  • Diabetes
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11
Q

look at slide 20 OB7. NEED TO KNOW

A

.

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12
Q

Symptoms of preeclampsia (HERR-V)

A
  • Headache
  • Epigastric pain
  • Rapidly increasing or nondependent edema - may be a signal of developing preeclampsia
  • Rapid weight gain - result of edema due to capillary leak as well as renal Na and fluid retention
  • Visual disturbances
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13
Q

Look at slides 25-30 OB7

A

.

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14
Q

Fetal complications of preeclampsia (APII)

A
  • Abruptio placentae
  • Premature delivery
  • IUGR
  • Intrauterine fetal death
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15
Q

HELLP Syndrome symptoms

A
  • Hemolysis
  • Elevated Liver enzymes
  • Low Platelets
  • < 36 wks
  • Malaise (90%), epigastric pain (90%), N/V (50%)
  • Self-limiting
  • Multi-system failure
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16
Q

HELLP Syndrome coags

A
  • Hemostasis is not problematic unless PLT < 40,000
  • Rate of fall in PLT count is important
  • Regional anesthesia – contraindicated -> fall is sudden
  • PLT count -> normal within 72 hrs of delivery
  • Thrombocytopenia may persist for longer periods.
  • Definitive cure is delivery*
17
Q

Rx of choice for preeclampsia

A

MgSO4

18
Q

risk of cyanide toxicity in the fetus

A

Nitroprusside

19
Q

MgSO4 Toxicity

A

5-10 mEq/L – Prolonged PR, widened QRS
11-14 mEq/L – Depressed tendon reflexes
15-24 mEq/L – SA, AV node block, respiratory paralysis
>25 mEq/L - Cardiac arrest

20
Q

preferred anesthesia for Preeclampsia

A

Labor Epidural (as long as no coagulopathies)

21
Q

ANTEPARTUM (before childbirth) HEMORRHAGE

A
  • Placenta Previa
  • Abruptio Placentae
  • Uterine rupture
22
Q

“Painless vaginal bleeding” is the most common presentation

A

Placenta previa

23
Q

placenta problems

A

Accreta – does not penetrate entire thickness of myometrium

Increta – invades further into myometrium.

Percreta – completely through myometrium, into serosa, and potentially outside of uterus, with invasion into surrounding structures (e.g. bladder, colon).

24
Q

Placenta accreta is suspected if

A

the placenta has not been delivered within 30 minutes of the fetus delivery

25
Q

Placenta accreta Increased risk with: (PUFT)

A
  • Placenta previa
  • Uterine scar (Asherman’s syndrome): D&C, myomectomy, c-section.**
  • Female gender (?)
  • Thin placental decidua
26
Q

Abruptio Placentae

A
  • Premature separation of a normal placenta.
  • Painful vaginal bleeding.
  • Most common cause of intrapartum fetal death
27
Q

Abruptio Placentae Risk factors include

A
  • Hypertension
  • Trauma
  • Cocaine use
  • Structural uterine abnormality
  • Multiparity
  • Alcohol use
28
Q

Postpartum Hemorrhage

A

-Considered present when postpartum blood loss exceeds 500 cc.

Common associations include:

  • prolonged labor
  • preeclampsia
  • multiple gestation
29
Q

Causes of postpartum Hemorrhage

A
  • Perineal Laceration
  • Retained Placenta
  • Uterine inversion
30
Q

Amniotic Fluid Embolism S/S

A
  • sudden tachypnea
  • cyanosis
  • shock
  • generalized bleeding
31
Q

A-OK for amniotic fluid embolism:

A
  • Atropine
  • Ondesteron
  • Ketoralac
32
Q

Absence of short and long term variability may indicate

A

fetal distress.

33
Q

Vagal response to head compression, not associated with distress

A

early deccelerations

34
Q

Uteroplacental insufficiency. Decreased O2 supply, combined with lack of short term variability is ominous for fetal distress

A

Late deccelerations

35
Q

variable deccelerations

A

-cord compression

Associated with fetal asphyxia when they are:

  • greater than 70 bpm
  • longer than 60 sec
  • occur in a pattern persisting for more than 30 min.
36
Q

pH

A

7.20

37
Q

If HR <60 or 60-80 and not rising at birth, start ________________ and _______

A

chest compressions

intubate

My OB (4 decks)

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