Week 5 Flashcards
what are the 2 categories of maternal death?
direct and indirect
What is direct maternal death?
deaths are those resulting from obstetric complications of pregnancy or its management
What is indirect maternal death?
Indirect maternal deaths are those resulting from diseases or conditions that were not due to a direct obstetric cause, but were aggravated by the physiologic effects of pregnancy
define parity
Parity refers to a woman’s number of previous pregnancies, excluding the current pregnancy, carried to a viable gestational age (usually 20 weeks).
how much more common is VTE in pregnant woman than women in general?
10x
What is VTE?
Venous Thromboembolism
What are some risk factors for VTE?
Age >35 Obesity Parity >4 History of thromboembolism Prolonged travel Operative delivery Instrumental vaginal delivery Prolonged labour >12 hours >4 days bed rest (immobility)
How would you manage a patient with PE or VTE?
Consult PIPER/clinician MICA early Upright position Oxygen Rapid transport with notification
what happens in amniotic fluid embolism?
Usually during labour or procedure: amniotic fluid/debris enters maternal circulation
Anaphylaxis or activation of the complement cascade (or both!)
Progression is in 2 phases
what are the s&s for amniotic fluid embolism?
Normal scenario is: women has acute resp distress then collapses often after doing a big push during labour or after delivery.
Common “premonitory” symptoms:
- breathlessness
- chest pain
- cold and light headed
- restless-panicked and distressed
- pins and needles in fingers
- nausea and vomiting
what should always be a differential in a pregnant patient with ATYPICAL chest pain?
- especially if pain is interscapular with hypertension
Aortic dissection
What should be suspected if there is sever headache during pregnancy or post natal period?
Intercranial haemoorhage
What is associated with hypertensive diseases in pregnancy?
intercranial haemorrhage
What are risk factors for genital tract sepsis?
- obesity
- vaginal discharge
- vaginal trauma during birth
- anaemiaq
what are some causes of sepsis prior to birth?
- miscarriage
- termination of pregnancy
- cervical suture
- ruptured ectopics
what are some causes of sepsis post to birth?
- retained products
- postoperative infections
what is the mortality rate of sepsis in pregnant patients?
20-40%
What is a differential for placental abruption
Sepsis
What are S&S for sepsis in pregnancy?
- everything you’d expect in a non
- pregnant patient +
- vaginal discharge
- Abdo pain
- D & V
what are some minor disorders of the digestive system seen in pregnancy?
Morning sickness Heart burn Constipation Ptyalism (excessive salvation) Pica (cravings)
How do you treat morning sickness?
dry biscuits and fluid
What complications can arise from morning sickness?
–Hyperemesis
•leading to Weight loss;
–Dehydration;
–Electrolyte imbalances
Whats the cause of heartburn in prego patients?
progesterone relaxes cardiac sphincter
- usually occurs in late pregnancy
how do you manage heartburn in pregnant patients?
Avoid bending over
Small meals
Sleep semi-recumbent or right side
If severe → antacids
What causes constipation in pregos?
Progesterone relaxes bowel
Bowel displaced by growing uterus
Iron supplements
Occurs throughout the pregnancy
How do you treat constipation?
Hi fibre diet & water +++
Moderate exercise
Aperients last resort
How do you treat Ptyalism & Pica?
Effective reassurance if uncomfortable
Craving may be potentially dangerous
–Requires further investigation
what are some minor disorders of the circulatory system seen in pregnancy?
Anaemia
Fainting
Varicosities
Supine Hypotension
WHat causes Anaemia in oregnancy?
Circulating blood/plasma volume ↑’s 50%
Red blood cells ↑18%
Considered normal
–unless physiologically compromised
What causes fainting in pregnancy?
1.Vasodilatation & poor return to heart
•May occur throughout pregnancy
2.Supine Hypotension
•Later in pregnancy: middle of 2nd trimester to birth
How do you treat fainting in pregnancy?
- Avoid long periods of standing if vasodilation
2. Avoid lying on back later in pregnancy
What causes varicosities - varacose veins
Progesterone relaxes sooth muscle
↑’ing weight & pelvic congestion
How do you manage varacose veins?
Leg exercises
Raising legs when able
Support stockings
Reassure will cease a few months after delivery
what are some minor musculosketal disorders seen in pregnancy?
Back aches Sciatica Sublaxations & dislocations Cramps Pelvic floor damage
What causes back aches/sciatica/sublaxations?
Progesterone (& relaxin later) muscle relaxant
Change in centre of gravity of growing uterus
–occurs any time but usually in 3rdtrimester
How do you manage cramps in pregnancy?
Elevate feet slightly
Moderate exercise & leg movements
Warm bath prior to sleep
What causes pelvic floor damage?
- Cause
- Progesterone
- ↑’ing weight on pelvis
what are some minor disorders seen in genitourinary system during pregnancy?
- frequency of urine
- leucorrhoea
What causes an increase in frquency of urination in pregnancy?
Bladder competes for space in pelvis with growing uterus & later with foetal head
UTI’s more common in pregnancy
What is Leucorrhea?
Increased benign white vaginal discharge
what causes carpal tunnel syndrome in pregnancy?
Oedema and pressure on the median nerve
Occurs most commonly in the morning
what is Linea Nigra?
line from belly button to pelvis
what IS CHLOASMA?
butterfly shaped pigmentation on face
how much blood can a pregnant patient lose without showing symptoms?
30-50%
What are some potential complications with trauma in a pregnant patient?
- Placental abruption
- Cardiorespiratory arrest
- Labourand birth
- Preterm labour
- Spontaneous abortion
- Uterine rupture
- Pelvic fractures
- Haemorrhageand shock
- Prematurity and low birth weight
what is the acronym for possible causes of maternal cardiac arrest?
BEAUCHOPS
What does BEAUCHOPS stand for?
B- Bleeding/DIC
E - Embolism cardiac/pulmonary/amniotic fluid
A - Anaesthetic complications
U - Uterine atony
C - Cardiac disease: MI/ischemia/aortic dissection/cardiomyopathy
H - Hypertension/preeclampsia/eclampsia
O - Other -Review standard ACLS guidelines (Hs and Ts)
P - Placental abruptio, previa
S - Sepsis
WHat are the 4 H’s & T’s for causes of cardiac arrest?
- hypoxia
- hypothermia
- hyperkalaemia
- hypovolaemia
- tamponade
- TPT
- thrombosis
- toxins
