Selected Obstetric complications - infant / maternal

Question 1

Selected Obstetric complications - infant examples ?

Answer 1

Meconium aspiration

Gastroschisis

Respiratory Distress
Syndrome

Necrotizing Enterocolitis

Retinopathy of Prematurity

Polycythemia

Hyperbilirubinemia

Conjunctivitis

Question 2

meconium ?

Answer 2

Meconium-stained amniotic fluid in 10-20% of deliveries

Passage in utero often means fetal distress

If active and crying, no intervention needed

If distress, intubate and suction before stimulating to avoid aspiration

Question 3

gastroschisis patho ?

Answer 3

Herniation of abdominal contents through an abdominal wall defect. Intestines are unprotected by peritoneum

Question 4

gastroschisis: Omphalocele ?

Answer 4

defect is the umbilical portion and there IS a peritoneal sac covering the herniated contents
less bad cause still peritineum coverage

Both require emergent care and surgery

Question 5

Respiratory distress syndrome (RDS) causes ?

Answer 5

Premature infants and with diabetic mothers

Question 6

Respiratory distress syndrome (RDS) aka ?

Answer 6

Formerly known as hyaline membrane disease

Question 7

Respiratory distress syndrome (RDS) patho ?

Answer 7

Deficient in surfactant which reduces surface tension in alveoli. ↓ amounts result in microatelectasis, “ground glass” on CXR

Question 8

Respiratory distress syndrome (RDS) Tx. ?

Answer 8

Give corticosteroids to mothers at risk for delivery before 32-34 weeks to help lung maturation

Some may need supplemental O2 or CPAP, too

Preterm babies get prophylactic surfactant before 15 mins of age with extra doses prn

Question 9

Respiratory distress syndrome (RDS) risks ?

Answer 9

chronic lung disease

Question 10

RDS limit what ?

Answer 10

Limit O2 to avoid HYPERoxia. Keep O2 sats in 80’s or low 90’s for premies

Question 11

Necrotizing enterocolitis (NEC) mostly seen in ?

Answer 11

premies

10% of cases in term babies

Question 12

Necrotizing enterocolitis (NEC) etiology ?

Answer 12

UKN

Question 13

Necrotizing enterocolitis (NEC) occurs less in ?

Answer 13

breastfed babies

Question 14

Necrotizing enterocolitis (NEC) presentation / S & S ?

Answer 14

Variable presentation

Abdominal distention, emesis, bloody stools or

Apnea, temp fluctuation, lethargy

Question 15

Necrotizing enterocolitis (NEC) hallmark ?

Answer 15

intestinal pneumatosis on abd x-ray

bacteria in bowel wall producing hydrogen

Question 16

Necrotizing enterocolitis (NEC) Tx. ?

Answer 16

Antibiotics 10-14 days, no P.O. feeds

Question 17

Necrotizing enterocolitis (NEC) prognosis ?

Answer 17

Free air = perf = surgery

75% survive, but many complications

Question 18

Retinopathy of prematurity (ROP) seen in ?

Answer 18

premies

Question 19

Retinopathy of prematurity (ROP) patho ?

Answer 19

unclear, but vessel development stops, then proliferates, especially in HYPERoxia

Question 20

Retinopathy of prematurity (ROP) prognosis ?

Answer 20

80-90% spontaneously resolve

Rare – retinal detachment

Question 21

Retinopathy of prematurity (ROP) Tx. ?

Answer 21

Serial exams to watch for need for surgery

Question 22

Second most common cause of blindness in children ?

Answer 22

ROP

Question 23

Retina usually vascularized by ?

Answer 23

36-40 weeks

Early delivery = avascular regions

Question 24

Polycythemia is when HcT is at ?

Answer 24

When central venous Hct is >65%

Question 25

Polycythemia Etiology ?

Answer 25

↑ in utero erythropoiesis, usually 2⁰ to placental insufficiency Maternofetal or twin-twin transfusion

Question 26

Polycythemia patho ?

Answer 26

↑ blood viscosity Can cause CHF from volume overload

Question 27

polycythemia problems ?

Answer 27

Impaired blood flow, ↓ oxygen supply Risk of thrombotic stroke

Question 28

polycythemia Tx. ?

Answer 28

If >70%, partial exchange transfusion with isotonic saline to ↓ viscosity IV hydration if Hct not too severe and not symptomatic

Question 29

polycythemia goal ?

Answer 29

55% Hct

Question 30

hyperbilirubinemia prevalence ?

Answer 30

Common – 60-70% of infants have elevated levels

Question 31

hyperbilirubinemia most cases are ?

Answer 31

benign and resolve

Question 32

hyperbilirubinemia patho ?

Answer 32

Severe elevations of unconjugated bilirubin can cause neurologic damage (kernicterus)

Question 33

hyperbilirubinemia physiology ?

Answer 33

Hemoglobin breaks down, producing unconjugated bili. This is fat-soluble, but not water-soluble, so it can cross the blood-brain barrier, but cannot be excreted. When bili is carried to the liver, it is conjugated to a water-soluble form But infant’s liver is immature, plus RBC life-span is shorter, plus increased red cell mass, so elevated levels of bilirubin

Question 34

hyperbilirubinemia causes: Increased hemolysis | ?

Answer 34

G6PD deficiency Morphology changes Rh incompatibility Sepsis

Question 35

hyperbilirubinemia causes: Decreased rate of conjugation ?

Answer 35

Inborn errors of metabolism Enzyme defects

Question 36

hyperbilirubinemia causes: Impeded excretion ?

Answer 36

Obstructed biliary flow GI obstruction

Question 37

Hyperbilirubinemia PE ?

Answer 37

Infants are jaundiced **early jaundice if the first day of life is bad but 3rd day of like it is NL no so concerning **

Question 38

Hyperbilirubinemia: Check total serum bilirubin ?

Answer 38

conjugated or not

Question 39

Hyperbilirubinemia: conjugated ?

Answer 39

Check for biliary obstruction or hepatocellular damage or sepsis

Question 40

Hyperbilirubinemia: unconjugated ?

Answer 40

Phototherapy will cause conjugation to a water-soluble form that can be excreted

Question 41

Hyperbilirubinemia: Tx: Phototherapy ?

Answer 41

Causes conjugation Bili can be excreted by kidneys and GI tract Liberal IV fluids needed If infant is well, continue oral feedings **phototherapy ?only helps with unconjugated bilirubin**

Question 42

Hyperbilirubinemia: Tx: exchange transfusion ?

Answer 42

When TSB continues to rise despite phototherapy

Question 43

Hyperbilirubinemia summary ?

Answer 43

Early elevations in bili –worrisome Continued or late elevations – often physiologic

Question 44

conjunctivitis information - whole slide ?

Answer 44

Standard care for newborns to receive erythromycin 0.5% ointment immediately after delivery If discharge is noted (along with erythema, which differentiates it from nasolacrimal duct obstruction), get a culture Chlamydia and gonorrhea – notable causes Gonorrhea can lead to blindness Chlamydia can be associated with pneumonia

Question 45

Selected Obstetric complications - mother examples ?

Answer 45

Amniotic Fluid Embolism Disseminated Intravascular Coagulation Also, shock, PE, ARDS, MI, etc.

Question 46

Amniotic fluid embolism prevalence ?

Answer 46

Rare complication of delivery

Question 47

Amniotic fluid embolism: Normally only _____ of amniotic fluid goes into the maternal circulation during labor

Answer 47

1-2 mL

Question 48

Amniotic fluid embolism: For an ________ to occur, more fluid must transfer (into lacerated cervical or uterine veins, placental implantation site, etc.)

Answer 48

embolism

Question 49

Amniotic fluid embolism: what, possibly meconium into maternal bloodstream

Answer 49

Fetal debris, lanugo, vernix

Question 50

Amniotic fluid embolism aka ?

Answer 50

“Anaphylactoid syndrome of pregnancy”

Question 51

Amniotic fluid embolism S&S ?

Answer 51

Sudden resp distress, CV collapse, coagulopathy

Question 52

Amniotic fluid embolism prevention ?

Answer 52

Unpreventable

Question 53

Amniotic fluid embolism Tx. ?

Answer 53

supportive, maintain O2 and BP and manage coagulopathies

Question 54

Amniotic fluid embolism prognosis ?

Answer 54

Mortality rates 26-80% 25% die within first hour 80% die within first 9 hours

Question 55

Disseminated intravascular coagulation (DIC) patho ?

Answer 55

Inappropriate activation of coagulation and fibrinolytic systems

Question 56

Disseminated intravascular coagulation (DIC) secondary to another event such as ?

Answer 56

Placenta abruption (most common obstetric cause) Placenta previa Pre-eclampsia, eclampsia Retained dead fetus HELLP syndrome Amniotic fluid embolism

Question 57

Disseminated intravascular coagulation (DIC) physiology ?

Answer 57

Pregnancy and puerperium are already hypercoagulable states with increased activity of coagulation factors Event occurs, triggering cascade of clotting factors Small thrombi form in the blood vessels and cut off blood supply to various organs such as the liver, brain, or kidney. These organs will then be damaged and may stop functioning. Over time, the clotting proteins are consumed or "used up“ and patient is then at risk for serious bleeding, even from a minor injury or without injury. This process may also break up healthy red blood cells.

Question 58

Disseminated intravascular coagulation (DIC) S&S ?

Answer 58

generalized bleeding, purpura, petechiae, fever, proteinuria, hypotension

Question 59

Disseminated intravascular coagulation (DIC) Tx. ?

Answer 59

In most cases, termination of the pregnancy Supportive therapy

Question 60

Disseminated intravascular coagulation (DIC) prognosis ?

Answer 60

Guided more by the cause than the coagulopathy | Most moms will improve with delivery or evacuation of the uterus