.AdvPrin B - Sum25 > Complicated OB pt1 > Flashcards

Complicated OB pt1 Flashcards

(38 cards)

Study These Flashcards
1
Q

When is optimal timing to attempt ECV (External Cephalic Version)?

A

36-37 weeks

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2
Q

A fetus is unlikely to revert from breech presentation after ECV after ____ weeks.

A

37

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3
Q

What medication(s) should be given prior to ECV?

A

Tocolytic agents: to relax contractions

Terbutaline
NTG

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4
Q

ECV is commonly unsuccessful if the mom is feeling ____.

A

pain (make sure mom is comfortable)

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5
Q

What is done to treat the pain of ECV?

A

Neuraxial analgesia/anesthesia

spinal or epidural (epidural lasts longer)

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6
Q

What dermatome level is targeted with ECV?

A

T6

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7
Q

What complications can occur with ECV?

A
  • Placental abruption
  • Preterm labor
  • Non-reassuring FHT’s

be prepared for urgent/emergent Cesarean

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8
Q

_______ _____ is characterized by abnormal placenta implantation on the lower uterine segment.

A

Placenta Previa: covers the cervical internal os

normal placenta implants in upper uterine segment

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9
Q

What are the four subcategories of placenta previa?

A
  • Low Lying - doesn’t infringe on cervical os.
  • Marginal - touches but doesnt cover top of cervix.
  • Partial - partially covers cervix
  • Complete - covers top of cervix completely.
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10
Q

what are risk factors for placenta previa?

A
  • Older maternal age (>35)
  • Multiparity
  • Hx of smoking
  • Previous c-section / uterine surgery
  • Hx of placenta previa
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11
Q

What is the classic sign of placenta previa?

A

Painless vaginal bleeding in 2ⁿᵈ or 3ʳᵈ trimester.

bleeding may be sudden and severe and may stop spontaneously

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12
Q

How is placenta previa treated with stopped bleeding and premature baby?

A
  • administer tocolytics (terbutaline)
  • betamethasone to promote fetal lung maturation
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13
Q

How is placenta previa treated with ongoing/continuous bleeding?

A

Cesarean section

set up for both during placenta previa exam

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14
Q

What should be done for anesthesia management of placenta previa?

A

Hemorrhage Risk Setup

  • Type and crossmatch (typically expires every 72hrs)
  • x2 Large Bore IV or CVC
  • possible A-line
  • Fluid warmer, rapid transfuser, pressure bags
  • MTP activation
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15
Q

What is the universal donor for blood products? Universal recipient?

A

Universal Donor: Type O negative
Universal Recipient: Type AB positive

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16
Q

In abruptio placentae (placental abruption), bleeding occurs from exposure of ______ vessels at the _________ interface.

Study These Flashcards
A

decidual : decidual-placental

17
Q

How is abruptio placentae defined?

Study These Flashcards
A

Premature separation of the placenta (can be complete or partial).

leads to prevention of constriction of vessels and continued bleeding

18
Q

What are the consequences of placental abruption on the fetus?

Study These Flashcards
A

Reduced gas-exchange due to loss of placental-uterine interface area (fetal asphyxia) Leads to:

  • bradycardia
  • late or variable decels
  • decreased / absent variability
19
Q

What are some of the risk factors for placental abruption?
Which of these are the greatest?

Study These Flashcards
A
  • HTN
  • Cocaine abuse
  • Advanced maternal age
  • Smoking
  • Trauma
  • Multiple gestation/parity
  • Pre-eclampsia
  • Chorioamnionitis
20
Q

The classic sign of placental abruption is characterized by ________ vaginal bleeding.

Study These Flashcards
A

Painful vaginal bleeding

21
Q

What is couvelaire uterus?
When does it occur?

Study These Flashcards
A
  • Blood forced through uterine wall into uterine serosa (outer layer of uterus).
  • occurs with serious placental abruption.
22
Q

What is the primary risk associated with placental abruption?

Study These Flashcards
A

Hypovolemic / hemorrhagic shock

may be concealed retroplacental hematoma where bleeding is not apparent

23
Q

What causes consumptive coagulopathy on placental abruption patients?

Study These Flashcards
A
  • Activation & usage of circulating plasminogen
  • Placental thromboplastin
24
Q

Placental abruption anesthetic management includes what?

Study These Flashcards
A
  • consider preloading/coloading with PRBCs
  • General anesthesia
  • Hemorrhage Setup:
25
Uterine rupture is most commonly associated with ______.
TOLAC (Trial of Labor after Cesarean) *Separation/dehiscence of a uterine scar intra or postpartum*
26
Risk factors for uterine rupture include?
* Previous C-section uterine scar * Weakened uterine musculature * multiparity/gravida * Prolonged labor with augmentation (pitocin) * trauma
27
What is the *most consistent* clinical feature of uterine rupture?
Fetal bradycardia
28
What clinical features are seen with uterine rupture?
- **Fetal bradycardia** - Vaginal bleeding - Severe abdominal pain (breakthrough neuraxial analgesia) - Shoulder pain - Hypotension
29
What is uterine blood flow at term gestation?
700 - 900 mL/min uterine blood flow
30
Uterine rupture anesthetic management includes what considerations?
* GETA most common * neuraxial not likely * Hemorrhage setup:
31
What is the most common cause of maternal mortality worldwide?
Postpartum Hemorrhage
32
What are the types of cases with the highest incidence of anesthetic recall?
* Obstetrics * Trauma * Cardiovascular surgery
33
Primary postpartum hemorrhage occurs within _____ hours of delivery.
24 *Has a higher maternal morbidity & mortality*.
34
Secondary postpartum hemorrhage occurs from _____ to _____ weeks post partum.
1 day to 6 weeks postpartum *can be slow bleeding events*
35
Postpartum hemorrhage is defined as blood loss ≥ _____ mls or blood loss with signs of symptoms of hypovolemia within ____ hours of delivery.
* Blood loss > 1000 mls * Blood loss with hypovolemia within 24 hours postpartum *Defined by ACOG (American College of Gynecology)*
36
What are some common causes of postpartum hemorrhage?
- *Uterine atony* (most common) - Retained placenta - Cervical/vaginal lacerations
37
Failed release of _____ and ______ is the typical cause of uterine atony.
oxytocin & prostaglandins (endogenous uterotonics: promote contraction)
38
Atonic uterus may hold how much blood volume?
>1000 mL Blood
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