S11C104 - Emergencies after 20w of pregnancy and the postpartum period

Question 1

u/s for DVT

Answer 1

95% Sn

96% Sp

Question 2

Tx of VTE in pregnancy

Answer 2

• UFH

- LMWH

Question 3

Gestational HTN

Answer 3

-tx: labetalol, methyldopa, nifedipine

Question 4

Preeclampsia

Answer 4

• assoc with IUGR, premature labor, low BW, abruptio placentae
• SBP >140 or DBP >90 PLUS proteinuria >0.3g AND >20w GA
• severe preeclampsia - >160 SBP or >110 DBP 2 reading 6h apart
• risk factors: nulliparity, previous hx, DM, GTD, obesity, FmHx, connective tissue dz

Question 5

Eclampsia

Answer 5

->20w GA or

Question 6

Vaginal bleeding in second half of pregnancy

Answer 6

-ddx: abruptio placentae, placenta previa, premature labor, lesions/lacerations of vagina or lower genital tract

Question 7

Placental abruption

Answer 7

• Sx: painful vag bleed, severe uterine pain an dhypertonicity, HoTN, n/v
• complications: hemorrhagic shock, DIC, uterine rupture
• order: CBC, coag panel, fibrinogen level
• if DIC give: RBC, FFP, cryoprecipitate, platelets
• RF: age, cocain use, black, trauma, HTN, hx of c/s

Question 8

Trauma past 24w

Answer 8

-fetal monitor for 6h

Question 9

Placenta previa

Answer 9

• placenta near or over cervical os

- painless vag bleed

Question 10

Vasa previa

Answer 10

• rare cause of late-pregnancy bleeding
• velamentous insertion of umbilical cord into uterine lower segment
• vessels tear as fetus descends
• immediate c/s required

Question 11

pPROM

Answer 11

-give steroids if

Question 12

PPH - postpartum hemorrhage

Answer 12

-can occur up to 6w postpartum
-causes: uterine atony, retained product, laceration, uterine rupture, uterine inversion, coagulopathy
-tx: fluids, TFN, bimanual ocmpression, examine for lacerations, u/s for retained products, empty bladder!!
Rx: oxytocin 10mg IM or IV
ergot 0.2mg IM (contraindicated in HTN/preeclampsia)
misoprostol 600mcg SL?
carboprost (prostaglandin) 250mcg IV (SE: bronchospasm, HTN, n/v/d)

Question 13

Uterine Rupture

Answer 13

• RF: malpresentation, labor dystocia, hypertensive d/o, bicornuate uterus, grand multiparity, hx of connective tissue d/o, scarred uterus, induction
• Sx: abdo pain, vag bleed, loss of fetal station, fetal distress/bradycardia
• tx: fluids, TFN, c/s +/i hysterectomy

Question 14

Amniotic Fluid Embolus

Answer 14

• embolus of fluid, fetal cells/hair, debris into maternal circulation
• Sx: resp distress, pulmonary edema, hypoxia, altered mental status, Sz, cardiovascular collapse, DIC, death, fetal distress
• mortailty rate 80% with 85% of survivors having neurologic sequelae
• RF: agae, multiparity, abnormal placental implantation, uterine rupture, eclampsia
• tx: O2, fluids, prsesors, L lateral decubitus, intubation, immediate delivery of fetus

Question 15

Perimortum c/s

Answer 15

Should be initiated w/in 5min of cardiac arrest for neonatal survival

Question 16

Peripartum Cardiomyopathy

Answer 16

• dilated CM
• can occur at any stage of gestation, usually 36w to 5mo post partum
• RF: previous hx, multiparity, age, gestational HTN, multifetal gestation, preeclampsia, EtOH, black
• 50% mortality
• Sx: dyspnea, orthopnea, cough, palpitations, c/p
• Px: edema, rales, JVD, 3rd/4th heart sounds
• ECG, CXR, CBC, lytes, Cr, TSH
• echo
• avoid nitroprusside if still pregnant
• heparin
• ACEi if post partum

Question 17

Postpartum endometritis

Answer 17

-fever >38, foul smelling lochia, leukocytosis, tachycardia, uterine tenderness
-RF: c/s, multiple gestation, young age, long duration of labor/membrane rupture, internal fetal monitoring, low SES, digital exam, HIV
-pathogens: gm+/gm- aerobes, anaerobes, myoplasma hominis, CT, NG, gardnerella vaginalis
-Tx:
cefoxitin or cefotetan or cefotaxime or clinda
or amox plus gentamicin
or flagyl plus ampicillin
-if mild dz can give PO abx (clinda 300mg TID x10d or doxy BID x10d) (no doxy if BFing)