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Flashcards in Obstetrics Deck (197)
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1
Q

Complete Placenta Previa. How much hemorrhage to expect ?

A

Even with the modest cervical dilatation, copious hemorrhage would be anticipated

2
Q

What are the types of premature separation of the placenta ?

A

Apparent bleeding type and

Concealed bleeding type

3
Q

Partial placental Previa and Complete abruptio have internal or external hemorrhage ?

A

External Hemorrhage

4
Q

Explain the mechanism of concealed hemorrhage.

A

Extensive placenta abruptio but the periphery of the placenta and the membranes still adherent , result in completely CONCEALED hemorrhage.

5
Q

What happens to the fetus in placental abruption

A

Fetus is now dead

6
Q

Placenta Accreta means

A

Placenta adhesion TO uterine MYOMETRIUM WITHOUT invasion

Massive bleeding AFTER deliver

7
Q

Accreta

A

Adhesion to myometrium without inversion

Bleed after delivery

8
Q

Placenta Increta

A

Invision to myometrium

Increta=>Invasion

Massive bleeding after delivery

9
Q

Placenta Percreta

A

Invision to myometrium , serous and adjacent structures .

Li Perce => Percreta

10
Q

Invasion to myometrium

A

Increta

11
Q

Adhesion to myometrium with no invasion

A

Accreta

12
Q

Invasion to myometrium, serosa and adjacent structures

A

Percreta

13
Q

What percentage of Accreta

A

75- 78%

14
Q

What is the percentage of Increta ?

A

17%

15
Q

What is the percentage of Percreta ?

A

5%

16
Q

Placenta Accreta : placenta adhesion to uterine myometrium without invasion = massive bleeding after delivery . What history accompanies this type ?

A

H/O previous C/S, placenta Previa, uterine trauma

17
Q

Placenta Increta :

A

Placenta invasion to myometrium =>massive bleed after delivery

18
Q

Placenta Percreta

A

Placenta invasion of myometrium, serosa, and adjacent pelvic structures

19
Q

How to diagnose the abnormal placental implantations?

A

Ultrasound
Or
MRI

20
Q

What is the management of placental implementations ?

A

C- Section
or
Postpartum Hysterectomy

21
Q

What are the two MCC of 3rd trimester bleeding ?

A

Placenta Previa
and
Placental abruption

22
Q

What is placenta Previa ?

A

Abnormally implanted on the lower uterine segment
and
covers or borders on the cervical os

23
Q

What are the 3 Types of placenta Previa ?

A

Marginal
Total
Partial

24
Q

What is Marginal Placenta Previa ?

A

Within 2 cm of Os

25
Q

What is Total Placenta Previa ?

A

Total is completely covering the OS

26
Q

What is partial Placenta Previa ?

A

Partially covering the OS

27
Q

What is the incidence of Placenta Previa ?

A

Incidence and mortality of 1%

28
Q

What are the risk factors for Placenta Previa ( 6)

A
Accreta 
Advanced Maternal Age 
Large Placenta 
Multipara
Malpresentation
Previous C/S
29
Q

How do you diagnose Placenta Previa ?

A

Ultrasound
MRI

NO VAGINAL EXAM

30
Q

Signs and Symptoms of Placenta Previa ?

A

PAINLESS vaginal bleeding which stops automatically

Preterm labor

Maternal hemorrhage with hypotension

31
Q

What is the management of Placenta Previa ?

A
  1. Expectant ( wait until delivery )
    - Hospitalization with bed rest and OBSERVATION if <37 weeks with mild to moderate bleeding.
    -IV fluids , T&C matching
    -Maintain crit > 30
    Await lung maturity (steroids shots)
  2. Coagulopathy is common ; may need replacement
  3. Delivery
    Do Lecithin/Sphingomyelin, ratio if immature give steroid to mom
    ALWAYS C/S
32
Q

What are the steps taken when an expectant with placenta Previa is awaiting delivery ?

A

Hospitalization, bedrest with observation if < 37 weeks with mild to moderate bleeding
IV fluids, T&C matching
Maintain HCT > 30
Await lung maturity ( steroid shots)

Coagulopathy s common , may need replacement

33
Q

What are the steps taken for placenta Previa at delivery ?

A

Do a lecithin/sphingomyelin ratio and if immature give steroid to the mother .
Always deliver via C/S

34
Q

What are the complications associated with Placenta Previa (3)

A

Premature delivery - MCC of neonatal Morbidity and Mortality

Placenta Accreta - so a hysterectomy

PPH ( Post partum Hemorrhage )

35
Q

The 3 P’s complication of Placenta Previa

A

PPH
Premature delivery
Placenta Accreta

36
Q

What is Placenta Abruptio?

A

When the normally implanted placenta separates from Decidua Basalis prior to delivery

37
Q

Describe the location of the bleeding in placenta abruptio

A

It can be concealed or overt.

38
Q

What is the incidence of Placenta Abruptio

A

1/100

One in 1 hundred

39
Q

6 risk factors of Placenta Abuptio

A
  1. Smoking* or Cocaine
  2. Maternal HTN
  3. Trauma
  4. Preterm Premature Rupture of membrane
  5. Hypertonic Uterus
  6. Previous History
40
Q

Smoking, Cocaine/ Maternal HTN/ Previous Hx/Hypertonic Uterus/ Trauma/ Preterm PROM are risk factors for

A

Placenta Abruptio

41
Q

Placenta Abruptio Risk Factors in alphabetical order ..lol…

A
Cocaine, Smoking
Hypertonic Uterus 
Maternal HTN 
Previous Hx 
Preterm Premature Rupture of Membrane 
Trauma
42
Q

How do you Dx Placenta Abruption

A

Clinical Suspicion

Or

MRI

43
Q

9 S/S of placenta Abruptio

A
  1. Painful vaginal bleeding; Large volume; Concealed Vs revealed
  2. Uterine Tenderness
  3. Hypovolemia
  4. Retroplacental Hematoma ( 2500ml )
  5. Contractions - low amplitude , high frequency
  6. Abdominal/ back pain
  7. Fetal bradycardia ( fetal distress)
    - due to loss of maternal gas exchange area
  8. Fetal Demise - Most common cause
  9. Maternal Coagulopathy- MC of DIC
    - Replacement of clotting factors and platelets .
44
Q

4 Complications of Placenta Abruptio

A

DIC
SHOCK
ARF
Loss of Fertility - uterine stony secondary to “couvelaire uterus”

45
Q

6 Management of Placenta Abruptio

A
  1. Expectant- preterm fetus without signs of distress ; follow coagulation profile .
  2. C-section - if fetal distress ( fix mother’s coagulopathy first )
  3. Massive blood transfusion
  4. No delay
  5. Replacement if clotting factors, Platelets
  6. NO EPIDURAL If concerns over volume coag
46
Q

Placental abruptio + placental separation

A

Prompt delivery

47
Q

Placental abruption + Maternal hemorrhage

A

Vigorous transfusion and prompt deliver

48
Q

Placental Abruptio + Fetal hemorrhage

A

Immediate delivery and Infant transfusion

49
Q

Placental abruption + Uterine Hypertonus

A

Prompt delivery

50
Q

Compare pathophysiology of placenta abruptio vs placenta previa

A

Abruptio = premature separation of normally implanted placenta

Placenta Previa = Abnromal implantation near or AT os

51
Q

Incidence of abruptio vs Previa

A

Abruptio = 1/ 100

Previa = 1/200

52
Q

Risk factors of abruption vs Previa

A

Abruptio : HTN, Abd trauma , Tobacco, Cocaine

Previa: Prior C/S, grand multiparous

53
Q

Symptoms of previa vs abruptio

A

Abruptio = PainFUL vaginal bleeding m interior hyperactivity, fetal distress

Previa = PainLESS vaginal bleeding

54
Q

Diagnosis of Abruptio vs Previa

A

Abruptio = Transabdominal / Transvaginal Ultrasound

Previa = Transabdominal/ Transvagibnal US ????

55
Q

Management of ABruption vs Previa

A

Abruptio: Stabilize the pt with premature fetus; EXPECTANT MANAGEMENT with frequent monitoring
And moderate to severe = immediate delivery

Previa: NO VAGINAL exam , Stabilizem Mag Sulf, Fetal lung maturity , Delivery if unstable , Bleeding

56
Q

Complications abruptio vs Previa

A

Abruptio = DIC, Shock, Ischemis necrosis of distal organs, Fetal anemia

Previa = Placenta Accreta, Fetal anemia

57
Q

What is Prematurity

A

Birth before 37 weeks of gestation

58
Q

What are the 9 complications due to immature organ ( in prematurity )

A
  1. Respiratory Distress Syndrome
  2. PDA
  3. Hypoxia or Shock
  4. Infections
  5. High bilirubin, hypoglycemia
  6. Intracranial Hemorrhage
  7. Hypothermia
  8. Congenital anomalies
  9. Retinopathy = visual loss
59
Q
Congenital anomalies
Infection ( CMV following blood tx)
Intracranial Hemorrhage 
Hypothermia 
Hypoxia or Shock ( cause gut ischemia ) 
High Bilirubin and hypocalcemia 
PDA
Resp. Distress syndrome ( give surfactant ) 
Retinopathy = visual loss 
Are complications due to
A

Immature organs

60
Q
  1. treatment in prematurity
A
  1. B2 agonist i.e. ritodrine to stop contraction
61
Q

What are the 2. S/E of ritodrine in

Mom and fetus

A

Mom: Hypokalemia, Hyperglycemia , tachycardia

Fetus : Hypokalemia , Hyperglycemia , tachycardia ( +/-)

62
Q

What medication to avoid with ritodrone and why ?

A

Avoid atropine

Can cause tachy»> Pulmonary edema

63
Q

5 anesthetic consideration in Prematurity

A
  1. Airway, Fluid and Temperature control
  2. High risk of Postanesthetic apnea ( give aminophylline or caffeine )
  3. Avoid Fluctuation in PaO2 level ( Normal = 60-80 mmHg ) = Monitor pulse ox constantly, avoid excessive oxygenation .
  4. Vitamine E prevent retinopathy
  5. Fentanyl with low requirement is favored
64
Q

Early Deceleration 💣

A
  1. Decelerations begin and end at approximately the same time as the uterine contraction
  2. HEAD COMPRESSION
  3. NO fetal distress
65
Q

Late declaration

A
  1. Persist after contraction is over
  2. Associated with fetal hypoxia - decrease Uteroplacental perfusion
  3. Possibly due to maternal hypotension or abruption
    4.Assess fetal pH
    5.Deliver the baby ASAP when
    A) persistent
    B) Fetal Bradycardia
66
Q

Possibly due to maternal hypotension or abruptio, Late or early Decel

A

Late

67
Q

NO fetal distress. Early or Late Decel ?

A

Early

68
Q

Persist After contraction is over . Early or Late Decel

A

Late Decel

69
Q

The deceleration begin and end at approx the same time as the uterine contraction

A

Early Decel

70
Q

Associated with fetal hypoxia - decrease Uteroplacental perfusion . Early or Late Decel ?

A

Late Decel

71
Q

The Decel is persistent and fetal bradycardia is present , what must be done ASAP ?

A

Deliver the baby

Late Decel

72
Q

In which deceleration do we assess fetal pH ?

A

Late

73
Q

Variable Decelaration (7)

A
  1. Variable in shape , severity and timing
  2. Occur at any time during contraction
  3. Umbilical cord compression and low blood flow
  4. Associated with fetal hypoxia
  5. Respiratory acidosis - with good fetal reverse, metabolic acidosis does not occur.
  6. Occurs in oligohydromnios
  7. Change mother position back to side
74
Q

Incidence of gestational diabetes

A

3- 5 %

75
Q

Gestitional Diabetes Risk factors are (6)

A
  1. Large fetus
  2. Obesity
  3. Past Hx
  4. Prior abortions
  5. Still births
  6. Maternal age >30
76
Q

What do you see on H&P of Gestational Diabetes ?

A

1) Asymptotic,

2) fetus larger for gestational age

77
Q

What lab abnormalities accompany Gestational Diabetes?

A

Glycosuria
Fastening Hyperglycemia
Abnormal Glucose Tolerance Test

78
Q

What is the treatment for Gestational Diabetes?

A

Diet control
Insulin
Avoid oral hypoglycemia agent = fetal hypoglycemia

79
Q

What are the maternal complications with gestational diabetes?

A
C/S for macrosomia 
DM type II
Preterm Labor 
Polyhydramnios 
Preeclampsia/eclampsia
80
Q

What are the Fetal complications with gestational diabetes?

A
Congenital defects
Hypoglycemia 
Macrosomia 
Perinatal mortality 2-5 % 
Shoulder dystocia
81
Q

Ectopic Pregnancy is

A

Any pregnancy outside the uterine cavity

82
Q

3 risk factors for ectopic pregnancy

A

Pelvic Inflammatory Disease
Pelvic surgery
IUD

83
Q

H&P in patients with ectopic pregnancy

A

Abdominal/ pelvic pain “knife-like”
Abnormal vaginal bleeding
Pelvic Mass
Shock if ruptures

84
Q

How to diagnose to ectopic pregnancy ?

A

Elevated HCG w/o intrauterine pregnancy on US

Surgery vs Medical with methotrexate

85
Q

What are the complications with ectopic pregnancy ?

A

Shock
Infertility
Maternal Death

86
Q

What is the normal FHR ?

A

120 to 160

87
Q

Head compression

A

Early deceleration

88
Q

Hydatidiform Mole

A

V

89
Q

Rule of nine anterior and posterior head and neck

A

9%

  1. 5% anterior
  2. 5 posterior
90
Q

Anterior and posterior upper limbs

A

18%

Ant 9
Post 9

91
Q

Anterior and posterior trunk rule of nine

A

36%

Anterior 18%
Posterior 18%

92
Q

Perineum rule of nine

A

1%

93
Q

Anterior and posterior lower limbs

A

36%

Right anterior 9%
Left anterior 9%
Right Posterior 9%
Left Posterior 9%

94
Q

pediatric rule of nine . Head

A

9% ant

9% posterior

95
Q

Upper limbs pediatrics rule of nine

A

18%

Right anterior 4.5%
Right posterior 4.5%
Left anterior 4.5 %
Left anterior 4.5%

Right limb 9%
Left limb 9%

96
Q

Upper trunk peds rule of nine

A

36%

18% anterior trunk
13 % back
each buttock 2.5 % ( 5% Bc x2)

97
Q

Rule of nine peds lower limbs

A

Anterior right 7%
Posterior left 7%

Anterior left 7%
Posterior right 7%

98
Q

Burn injury per year

A

2.5 millions

99
Q

burn hospitalization per year

A

100,000

100
Q

Burns deaths per year

A

10,000

101
Q

How types of burns

A

Thermal
Chemical
Radiational
Electrical

102
Q

First degree

A

superficial, limited to epidermis

103
Q

Second degree

A

Partial thickness

Extends to the dermis

104
Q

Third degree

A

Full thickness

No pain

105
Q

Inhalation injury ;direct insult thermal insult leads to

A
  • Pulmonary edema and ARDS
  • Smoke
  • Deactivation of surfactant leads to atelectasis
  • CO poisoning
106
Q

Hypovolemia and shock due to burns

A

Total body edema due to increase permeability

pulmonary loss

107
Q

Burn ; Hyperkalemia due to

A

tissue destruction

108
Q

What is the primary cause of death in burn ?

A

Loss of skin barrier

Inhalation injury and pulmonary infection

109
Q

Initial treatment in burns

A
Thermal = roll or cover 
chemical = profuse irrigation 
Electrical = remove the source
110
Q

Resuscitation in burns

A

Treat the Shock first.

If no Shock fluid administration aims to replace the DEFICIT and SUPPLY the maintenance fluid.

Evaluate Total Body Surface Area burned by rule of nines

111
Q

Formula for burn fluid replacement

A

3ml/kg/%BSA burned. Of crystalloid/ 24 hr

40% burn, 70kg
3mlx70x40 = 8400 ml in 24 hrs
First 1/2 over 8 hrs
2nd 1/2 over 16 hrs

112
Q

Wound care of burns

A

Gentle debridement
partial thickness - cover with topical antibiotics
Full thickness :
Topical antibiotics
Excise burn wound to remove necrotic tissues
Cover with skin graft
Keep extremities elevated

113
Q

Complete thickness

A

Topical antibiotics
exice burn wound to remove necrotic tissues
Cover with skin graft
keep extremities elevated

114
Q

Infections in burn

A

Sputum c/s

Wound infection : respect the viable tissue . And antibiotics injected in the tissue and IV.

115
Q

Metabolic changes

A

Requirement is increased. Bc catabolic state.

116
Q

What is formalu for calories to meet metabolic changes in burns

A

25kcal/kg/day + 40kcal/% bsa burned/day

Higher protein : calorie ratio

117
Q

Long term care of burns (3)

A

Splints- opposes the contracture
Pressure garment - prevent scars and edema
Range of Motion - prevent contracture

118
Q

anesthesia consideration

A

Intubate before edema develops

Sux is contraindicated due to hyperthermia = cardiac arrest

Higher doses of non depolarizing muscle relaxant

Halothane is best avoided If epinephrine is being used to stop bleeding

119
Q

Complete Mole

A

46 XX all from father

HCG = increase increase increase increase

Uterine size = Increase

2% convert choriocarcinoma

No Fetal parts

2 Sperms + empty egg

Risk of complications : 15 - 12% malignant trophoblastic disease

120
Q

Complete Mole uterine size

A

Increased

121
Q

Incomplete Mole Uterine size

A

Does not increase

122
Q

Complete Mole HCG

A

Increase increase increase increase

123
Q

Incomplete mole HCG

A

Increase ( 1)

124
Q

Fetal parts in Complete Moles ?

A

NO

125
Q

Fetal Parts in incomplete mole ?

A

Yes

126
Q

< 5 % in malignancy, which mole

A

Incomplete Mole

127
Q

Malignant Trophoblastic Disease , which mole

A

Complete Mole

15 - 20 %

128
Q

What is spontaneous abortion ?

A

Non selective termination of pregnancy at < 20 weeks

129
Q

What is a common cause of 1st trimester bleeding ?

A

Spontaneous Abortion

130
Q

What is the H& P of someone having a spontaneous abortion

A

Vaginal bleeding and tissue passage

Closed vs open Os

131
Q

What evaluation for spontaneous abortion?

A

B HCG
U/S
Culdocentesis

132
Q

Treatment for spontaneous abortion

A
  1. Stabilize
  2. D&C
  3. Antibiotics
  4. RhoGAM if appropriate
133
Q

What are the complication of D& C

A

Perforation and Hemorrhage

134
Q

Complete abortion

A

< 20 weeks
All POC expelled
Os closed
Uterine bleeding

135
Q

Incomplete Abortion

A

< 20 weeks gestation
Some POC expelled
Open Os
Bleeding

136
Q

Treatment for incomplete abortion

A

D&C

137
Q

Threatened abortion

A
< 20 weeks gestations 
Intact Membrane 
Os closed 
Bleeding 
Viable Fetus
138
Q

Threatened Abortion treatment

A

Complete rest

139
Q

Inevitable abortion

A
< 20 weeks 
No POC expelled 
Rupture Membrane 
Os open 
Bleeding and cramps
140
Q

Inevitable abortion

A

Emergent D&C

141
Q

Missed abortion

A
No Fetal Heart tone 
No POC expelled
Retain fetal tissue 
Os Closed 
No bleeding 
Nonviable tissue not expelled in 4 weeks
142
Q

Missed abortion treatment

A

Evacuate uterus

D&C

143
Q

Septic abortion

A

Infection associated with abortion ; endometritis

144
Q

Septic abortion

A

D&C ; antibiotic

145
Q

Intrauterine Fetal death

A

No Fetal Heart tone

146
Q

Treatment for uterine Fetal death

A

No fetal heart tone

Do a D&C

147
Q

Aspiration Pneumonia

A

Pathological consequences of abnormal entry of fluids particulate matter or secretions into lower airways

148
Q

S/s of aspiration pneumonia

A

SOB
Bronchospasm
Fever
Pink and Frothy Sputum

149
Q

Treatment for aspiration pneumonia

A

Tracheal suction and lavage
Antibiotics
Mechanical Ventilation

150
Q

Postpartum Hemorrhage , how much blood is lost within the first 24 hrs of delivery ?

A

> 500 ml

151
Q

Complications of PPH (2)

A

Hemorrhagic Shock

Transfusion related risks

152
Q

Risk Factors for Uterine Atony

A

Over distention uterus ( multiple gestation , Macrosomia)

Prolong Labor

Uterine myoma

Mag sulfate

GA

Uterine Infection

153
Q

Diagnosis of Uterine atony

A

Palpation of a softer , flaccid , boggy w/o a fundus

154
Q

Treatment Uterine Atony ?

A
MCC of PPH ( 90%)
Bimanual uterine message 
Oxytocin infusion 
Methylergonovine 
PGF2a if not hypertensive
155
Q

Genital Tract Trauma Risk Factors are :

A

Precipitous labor
Forceps , Vaccum
Large INFANT
Inadequate episiotomy repair

156
Q

Diagnosis of Genital Tract Trauma

A

Careful examination

Look for laceration

157
Q

Genital Tract Trauma

A

Surgical repair of physical defect

158
Q

Retained Placental Tissue

A

Placenta Accreta/Increta/Percreta

Preterm delivery

Placenta Previa

Previous C/S or D&C

Uterine Leiomyomas

159
Q

Diagnosis of retained Placental Tissue

A

Careful inspection for missing part of placenta U/S.

160
Q

Treatment for retained placental tissue

A

Manual removal of remaining placenta

D&C

Placenta acreta/Increta/Percreta require hysterectomy

161
Q

Venous Air Embolism occurs when ?

A

Occurs at the time of placental separation

162
Q

Where is the venous embolism in OB patients ?

A

It lodges in the pulmonary arteries

163
Q

5 s/s of VAE

A

1.Mill - wheel murmur
2. Chest Pain
3. SOB
4. Low end tidal CO2
5 Elevated CVP

164
Q

What position when patient has VAE

A

Anti - Trendelenburg position
Left lateral with a tilt of 15º

Why ?
Increased chances of trapping air in right atrium with a CV cath

165
Q

Amniotic Fluid embolism , what is it ?

A

Rare but deadly ; 3rd leading cause maternal death

166
Q

Amniotic Fluid gets into maternal circulation due to break in the Uteroplacental membrane . True or False

A

True

167
Q

S/S of amniotic fluid embolism

A
Chills
Sudden onset of dyspnea 
Hypotension 
Hypoxia 
Coma 
DIC 
Uterine atony 
Cardiopulmonary arrest
168
Q

Treatment for Amniotic Fluid embolism

A
  1. Stabilize
  2. Resucitation
  3. Delivery ASAP
  4. DObutaime
  5. Lasix
  6. Check for DIC
  7. Hydrocortisone
  8. NaHCO2
169
Q

Effects of valorous acid

A

Fetal anticonvulsant syndrome , neural tube defect

170
Q

Phenytoin, carbamazapine

A

Cleft lip/ palate

171
Q

Warfarin

A

Skeletal and facial abnormalities , mental retardation , stillbirth , IUGR

172
Q

Isoretinoin

A

Multiple anomalies

173
Q

Griseofulvin

A

Multiple anomalies

174
Q

Sulfonamides effect

A

Kernicterus

175
Q

Amniglycosides effects

A

VIII nerve damage

176
Q

Fluroquinolones effects

A

Cartilage damage

177
Q

Tetracycline effects

A

Decreased bone growth , small limbs , discoloration of teeth

178
Q

Iodide effects

A

Congenital goiter , hypothyroidism , mental retardation .

179
Q

Ethanol Effect?

A

Fetal alcohol syndrome :

Microcephaly , mental retardation, abnormal face, limb dislocation, heart/lung fistulas

180
Q

AMphetamine

A

Transposition of great vessels , cleft palate

181
Q

Thalidomide

A

Limb abnormalities ( PHOCOMELIA) “seal limbs “

182
Q

Diethylstilbestrol

A

Clear cell adenocarcinoma of vagina/ Cx , genital abnormalities

183
Q

Most serious risk factor associated with surgery:

A

Uterine asphyxia is the during pregnancy

  1. Placental transfer - lipid soluble substances diffused rapidly
  2. Thromboembolism-prevent DVT with pneumatic compression stockings during C/S
  3. Hypotension is the most frequent complication of spinal and epidural; treated by
    - Left Uterine displacement, IV hydration and ephedrine
184
Q

Delayed gastric emptying -

A

prophylaxis with antacids

185
Q
  1. Uterine displacement is to
A

To avoid supine hypotension

186
Q

Preeclampsia has 8 s/s

A
  1. HTN
  2. Proteinuria
  3. Edema
  4. Oliguria
  5. Headache
  6. Visual Disturbance
  7. Hepatic Tenderness
  8. Hyperreflexia
187
Q

Preeclampsia s/s with the numbers

A
HTN ( 160/110 ) 
Proteinuria  >5g/day 
Edema : face,hand, and lung
Oliguria <500ml/day 
Headache 
Visual disturbance 
Hepatic tenderness 
Hyperreflexia
188
Q

Eclampsia

A

Seizures In preeclampsia

189
Q

HELPP syndrome

A
High maternal and fetal mortality 
Call for immediate delivery 
Hemolysis 
Elevated 
Liver enzyme 
Low 
Platelet
190
Q

Risk Factors Pregnancy Induced Hypertension.

A
Nulliparity 
Extreme age <15 or > 35 
Multiple gestation 
Vascular disease due to SLE and DM 
\+ family history 
Chronic HTN 
HELLP Syndrome
191
Q

Pathophys of PIH

A
Increased : 
Thromboxane A2 
Endothelin 1 
Renin 
Decreased : 
NO 
PGI2
192
Q

S/S of PIH are

A

1.Uterine vasospasm&raquo_space; Uteroplacental insufficiency
Low I/V volume
Low GFR, edema , CNS dysfunctions

2.Low uterine BF

193
Q

Treatment PIH

A
  1. Only cure is delivery
  2. Monitor PT,PTT,Platelet, FSP
  3. Hydralazine and methyldopa to control HTN. Labetalol is drug of first choice.
  4. Esmolol should be avoided due to adverse fetal effects
  5. High dose of Nitroprusside = S/E cyanide toxicity WHY ??
  6. Seizures require mag sulfate and benzo
  7. Mag Sulf to prevent convulsion ( mag Sulf antagonizes calcium )
  8. Magnesium depresses CNS by decreasing acetylcholine release
  9. MOA of magnesium
    Prevent CA++ entry into the cell= smooth muscle relaxation
  10. Required level of magnesium 4-6 mEq/L
194
Q

Treatment PIH , Mag toxicity : (6)

A

Magnesium Toxicity :

  1. Absent deep tendon reflexes
  2. Ventilatory failure (requires prompt intubation and ventilation )
  3. Heart Block = prolonged PQ, wide QRS , cardiac arrest
  4. Hypotension
  5. Drowsiness and Hypoventilation in fetus
  6. Atonic uterus
195
Q

Treatment for Magnesium Toxicity

A

D/C Mag
Intubate
Ventilate
IV ca ++ gluconate

196
Q

8 complications of Pregnancy Induced Hypertension:

A
  1. Pulmonary edema/ cerebral Hemorrhages ( leading cause of maternal death
  2. DIC
  3. Prematurity
  4. Prematurity/fetal distress
  5. Intrauterine growth retardation
  6. Placental Abruption
  7. ARF, cerebral edema
  8. Fetal/Maternal death; leading cause
197
Q

Mild eclampsia

A

> 140/90
Headache, Somnolence blurred vision

Epi gastric pain
Rapid weight gain

Edema
JV distention

Hyperactive reflexes
Clonus

Proteinuria > 300mg/24 hrs