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Patient Evaluation > Selected Obstetric complications - infant / maternal > Flashcards

Selected Obstetric complications - infant / maternal Flashcards

1
Q

Selected Obstetric complications - infant examples ?

A

Meconium aspiration

Gastroschisis

Respiratory Distress
Syndrome

Necrotizing Enterocolitis

Retinopathy of Prematurity

Polycythemia

Hyperbilirubinemia

Conjunctivitis

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2
Q

meconium ?

A

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

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3
Q

gastroschisis patho ?

A

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

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4
Q

gastroschisis: Omphalocele ?

A

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

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5
Q

Respiratory distress syndrome (RDS) causes ?

A

Premature infants and with diabetic mothers

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6
Q

Respiratory distress syndrome (RDS) aka ?

A

Formerly known as hyaline membrane disease

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7
Q

Respiratory distress syndrome (RDS) patho ?

A

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

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8
Q

Respiratory distress syndrome (RDS) Tx. ?

A

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

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9
Q

Respiratory distress syndrome (RDS) risks ?

A

chronic lung disease

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10
Q

RDS limit what ?

A

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

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11
Q

Necrotizing enterocolitis (NEC) mostly seen in ?

A

premies

10% of cases in term babies

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12
Q

Necrotizing enterocolitis (NEC) etiology ?

A

UKN

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13
Q

Necrotizing enterocolitis (NEC) occurs less in ?

A

breastfed babies

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14
Q

Necrotizing enterocolitis (NEC) presentation / S & S ?

A

Variable presentation

Abdominal distention, emesis, bloody stools or

Apnea, temp fluctuation, lethargy

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15
Q

Necrotizing enterocolitis (NEC) hallmark ?

A

intestinal pneumatosis on abd x-ray

bacteria in bowel wall producing hydrogen

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16
Q

Necrotizing enterocolitis (NEC) Tx. ?

A

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

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17
Q

Necrotizing enterocolitis (NEC) prognosis ?

A

Free air = perf = surgery

75% survive, but many complications

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18
Q

Retinopathy of prematurity (ROP) seen in ?

A

premies

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19
Q

Retinopathy of prematurity (ROP) patho ?

A

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

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20
Q

Retinopathy of prematurity (ROP) prognosis ?

A

80-90% spontaneously resolve

Rare – retinal detachment

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21
Q

Retinopathy of prematurity (ROP) Tx. ?

A

Serial exams to watch for need for surgery

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22
Q

Second most common cause of blindness in children ?

A

ROP

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23
Q

Retina usually vascularized by ?

A

36-40 weeks

Early delivery = avascular regions

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24
Q

Polycythemia is when HcT is at ?

A

When central venous Hct is >65%

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25
Q

Polycythemia Etiology ?

A

↑ in utero erythropoiesis, usually 2⁰ to placental insufficiency

Maternofetal or twin-twin transfusion

26
Q

Polycythemia patho ?

A

↑ blood viscosity

Can cause CHF from volume overload

27
Q

polycythemia problems ?

A

Impaired blood flow, ↓ oxygen supply

Risk of thrombotic stroke

28
Q

polycythemia Tx. ?

A

If >70%, partial exchange transfusion with isotonic saline to ↓ viscosity

IV hydration if Hct not too severe and not symptomatic

29
Q

polycythemia goal ?

A

55% Hct

30
Q

hyperbilirubinemia prevalence ?

A

Common – 60-70% of infants have elevated levels

31
Q

hyperbilirubinemia most cases are ?

A

benign and resolve

32
Q

hyperbilirubinemia patho ?

A

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

33
Q

hyperbilirubinemia physiology ?

A

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

34
Q

hyperbilirubinemia causes: Increased hemolysis

?

A

G6PD deficiency

Morphology changes

Rh incompatibility

Sepsis

35
Q

hyperbilirubinemia causes: Decreased rate of conjugation ?

A

Inborn errors of metabolism

Enzyme defects

36
Q

hyperbilirubinemia causes: Impeded excretion ?

A

Obstructed biliary flow

GI obstruction

37
Q

Hyperbilirubinemia PE ?

A

Infants are jaundiced

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

38
Q

Hyperbilirubinemia: Check total serum bilirubin ?

A

conjugated or not

39
Q

Hyperbilirubinemia: conjugated ?

A

Check for biliary obstruction or hepatocellular damage or sepsis

40
Q

Hyperbilirubinemia: unconjugated ?

A

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

41
Q

Hyperbilirubinemia: Tx: Phototherapy ?

A

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

42
Q

Hyperbilirubinemia: Tx: exchange transfusion ?

A

When TSB continues to rise despite phototherapy

43
Q

Hyperbilirubinemia summary ?

A

Early elevations in bili –worrisome

Continued or late elevations – often physiologic

44
Q

conjunctivitis information - whole slide ?

A

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

45
Q

Selected Obstetric complications - mother examples ?

A

Amniotic Fluid Embolism

Disseminated Intravascular Coagulation

Also, shock, PE, ARDS, MI, etc.

46
Q

Amniotic fluid embolism prevalence ?

A

Rare complication of delivery

47
Q

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

A

1-2 mL

48
Q

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

A

embolism

49
Q

Amniotic fluid embolism: what, possibly meconium into maternal bloodstream

A

Fetal debris, lanugo, vernix

50
Q

Amniotic fluid embolism aka ?

A

“Anaphylactoid syndrome of pregnancy”

51
Q

Amniotic fluid embolism S&S ?

A

Sudden resp distress, CV collapse, coagulopathy

52
Q

Amniotic fluid embolism prevention ?

A

Unpreventable

53
Q

Amniotic fluid embolism Tx. ?

A

supportive, maintain O2 and BP and manage coagulopathies

54
Q

Amniotic fluid embolism prognosis ?

A

Mortality rates 26-80%

25% die within first hour

80% die within first 9 hours

55
Q

Disseminated intravascular coagulation (DIC) patho ?

A

Inappropriate activation of coagulation and fibrinolytic systems

56
Q

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

A

Placenta abruption (most common obstetric cause)

Placenta previa

Pre-eclampsia, eclampsia

Retained dead fetus

HELLP syndrome

Amniotic fluid embolism

57
Q

Disseminated intravascular coagulation (DIC) physiology ?

A

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.

58
Q

Disseminated intravascular coagulation (DIC) S&S ?

A

generalized bleeding,

purpura,

petechiae,

fever,

proteinuria,

hypotension

59
Q

Disseminated intravascular coagulation (DIC) Tx. ?

A

In most cases, termination of the pregnancy

Supportive therapy

60
Q

Disseminated intravascular coagulation (DIC) prognosis ?

A

Guided more by the cause than the coagulopathy

Most moms will improve with delivery or evacuation of the uterus

Patient Evaluation (29 decks)

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