Quiz 4 Flashcards
Gestational Diabetes risks: (FOAM-H)
- Family history of DM
- Obesity
- Advanced maternal age
- More prevalent in 2nd and 3rd trimesters
- History of stillbirth, neonatal death, fetal malformation or macrosomia
Gestational Diabetes associated with:
- gestational HTN
- polyhydramnios
- C/S
patients taking NPH can have
Protamine sulfate anaphylaxis
Despite ________ anesthetic concentrations administered to obese women they achieved _____ sensory blockade with no differences in pain scores.
lower
higher
Most common medical issue during pregnancy
HTN
Maternal DBP > ____ is associated with ↑ risk of placental abruption and fetal growth restriction.
110
HTN – sustained BP increase to SBP>____ or DBP>___
140
90
HTN Resolves ___ wks postpartum
12
Preeclampsia criteria, along with:
- 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
Risk factors for Preeclampsia (FAP-B-CRAFT-D)
- 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
look at slide 20 OB7. NEED TO KNOW
.
Symptoms of preeclampsia (HERR-V)
- 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
Look at slides 25-30 OB7
.
Fetal complications of preeclampsia (APII)
- Abruptio placentae
- Premature delivery
- IUGR
- Intrauterine fetal death
HELLP Syndrome symptoms
- Hemolysis
- Elevated Liver enzymes
- Low Platelets
- < 36 wks
- Malaise (90%), epigastric pain (90%), N/V (50%)
- Self-limiting
- Multi-system failure
HELLP Syndrome coags
- 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*
Rx of choice for preeclampsia
MgSO4
risk of cyanide toxicity in the fetus
Nitroprusside
MgSO4 Toxicity
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
preferred anesthesia for Preeclampsia
Labor Epidural (as long as no coagulopathies)
ANTEPARTUM (before childbirth) HEMORRHAGE
- Placenta Previa
- Abruptio Placentae
- Uterine rupture
“Painless vaginal bleeding” is the most common presentation
Placenta previa
placenta problems
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).
Placenta accreta is suspected if
the placenta has not been delivered within 30 minutes of the fetus delivery
Placenta accreta Increased risk with: (PUFT)
- Placenta previa
- Uterine scar (Asherman’s syndrome): D&C, myomectomy, c-section.**
- Female gender (?)
- Thin placental decidua
Abruptio Placentae
- Premature separation of a normal placenta.
- Painful vaginal bleeding.
- Most common cause of intrapartum fetal death
Abruptio Placentae Risk factors include
- Hypertension
- Trauma
- Cocaine use
- Structural uterine abnormality
- Multiparity
- Alcohol use
Postpartum Hemorrhage
-Considered present when postpartum blood loss exceeds 500 cc.
Common associations include:
- prolonged labor
- preeclampsia
- multiple gestation
Causes of postpartum Hemorrhage
- Perineal Laceration
- Retained Placenta
- Uterine inversion
Amniotic Fluid Embolism S/S
- sudden tachypnea
- cyanosis
- shock
- generalized bleeding
A-OK for amniotic fluid embolism:
- Atropine
- Ondesteron
- Ketoralac
Absence of short and long term variability may indicate
fetal distress.
Vagal response to head compression, not associated with distress
early deccelerations
Uteroplacental insufficiency. Decreased O2 supply, combined with lack of short term variability is ominous for fetal distress
Late deccelerations
variable deccelerations
-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.
pH
7.20
If HR <60 or 60-80 and not rising at birth, start ________________ and _______
chest compressions
intubate
