Week 4 OB Complications & VBAC - Exam 2 Flashcards Preview

SUM'20 - Advanced Principles > Week 4 OB Complications & VBAC - Exam 2 > Flashcards

Flashcards in Week 4 OB Complications & VBAC - Exam 2 Deck (135)
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31

primary headaches are how many times more common than secondary headaches in first week pp?

20 times

32

Primary headaches:

Migraine
Tension-type headache
Trigeminal autonomic cephalagias
Cluster headache
Other primary headaches

33

Secondary headaches:

Headache attributed to:
Head and/or neck trauma
Cranial or cervical vascular disorder
Nonvascular intracranial disorder
A substance or its withdrawal
Infection
Disorder of homeostasis
Disorder of the cranial structures (e.g., eyes, ears, nose, sinuses, teeth, mouth)
Psychiatric disorder
Lesions of cranial neuralgias and other facial pain
Other headache disorders

34

Secondary headaches:

Headache attributed to:
Head and/or neck trauma
Cranial or cervical vascular disorder
Nonvascular intracranial disorder
A substance or its withdrawal
Infection
Disorder of homeostasis
Disorder of the cranial structures (e.g., eyes, ears, nose, sinuses, teeth, mouth)
Psychiatric disorder
Lesions of cranial neuralgias and other facial pain
Other headache disorders

35

The hallmark of a PDPH is

this postural component.

36

Contraindications to the administration of an epidural blood patch are related to complications of placing a needle in the central neuraxis or the injection of blood into the epidural space; they include

(1) known coagulopathy (e.g., concurrent pharmacologic anticoagulation)
(2) local cutaneous infection or untreated systemic infection
(3) increased ICP caused by a space-occupying lesion
(4) patient refusal.

37

Transient bradycardia has been observed after administration of an epidural blood patch, and some anesthesia providers may choose to establish intravenous access

and monitor the electrocardiogram in selected patients.

* also may give fluid bolus as well

38

Transient bradycardia has been observed after administration of an epidural blood patch, and some anesthesia providers may choose to establish intravenous access

and monitor the electrocardiogram in selected patients.

* also may give fluid bolus as well

39

Frank breech—

lower extremities flexed at the hips and extended at the knees

40

Complete breech—

lower extremities flexed at both the hips and the knees

41

Incomplete breech—

one or both of the lower extremities extended at the hips

42

Incomplete breech—

one or both of the lower extremities extended at the hips

43

With chorioamnionitis, a combination _______ should cover most relevant pathogens and is the recommended primary antibiotic regimen. 

of ampicillin and gentamicin 

44

The most common source of postpartum infection is the 

genital tract. 

45

in parturients with active lesions HSV infection what is recommended?

cesarean delivery

46

traditionally _________ has been thought to be a risk factor for preterm birth

A history of cervical surgery,

47

Criteria for the diagnosis of preterm labor include

gestational age between 20 0/7 and 36 6/7 weeks’ gestation and

regular uterine contractions accompanied by a

change in cervical dilation, effacement, or both (or initial presentation with regular contractions and cervical dilation of 2 cm or more).

48

The ACOG has stated that evidence supports the use of tocolytic treatment WHAT MEDICATIONS are okay to use for short-term prolongation of pregnancy (up to 48 hours) to allow for antenatal maternal corticosteroid administration.

-beta-adrenergic receptor agonist therapy,
-calcium entry–blocking agents, or
-NSAIDs

49

Betamethasone

nice to know

12 mg IM

Every 24 h × 2

50

Dexamethasone

nice to know

6 mg IM

Every 12 h × 4

51

Conventional wisdom holds that the preterm fetus is more vulnerable than the term fetus to the depressant effects of analgesic and anesthetic drugs, for the following reasons:

(1) less protein available for drug binding, leading to a reduction in protein-drug affinity
(2) higher levels of bilirubin, which may compete with the drug for protein binding
(3) greater drug access to the central nervous system (CNS) because of the presence of an incomplete blood-brain barrier
(4) decreased ability to metabolize and excrete drugs
(5) a higher incidence of acidosis during labor and delivery

52

The most significant update is introduction of clinical signs and symptoms that may be used in the absence of proteinuria as diagnostic criteria for preeclampsia

i.e., thrombocytopenia [platelet count < 100,000/μL -- lead to DIC
renal insufficiency [serum creatinine > 1.1 mg/dL],
pulmonary edema, or
cerebral or visual symptoms

53

thrombocytopenia

[platelet count < 100,000/μL]

can lead to DIC

54

The hallmark of preeclampsia is an

abnormal placentation-implantation.

55

Magnesium sulfate is administered for

seizure prophylaxis.

Magnesium 4–6 g IV followed by 1–2 g/h IV as a continuous infusion (goal is to maintain serum concentrations of 2.0–3.5 mEq/L)

56

Magnesium sulfate is the anticonvulsant of choice because

it is more effective and has a better safety profile than benzodiazepines, phenytoin, or lytic cocktails.

57

The standard IV regimen is a loading of magnesium sulfate is

2 g every 15 minutes to a maximum of 6 g.

*If a patient develops seizures while receiving a magnesium infusion for seizure prophylaxis, administration of a 1- to 2-g bolus is recommended, after which a plasma magnesium level should be measured

58

Factors associated with a lower rate of successful VBAC include

-socioeconomic,
-ethnic, and
-medical factors.

59

contraindications for VBAC: (5)

1. previous classic or T-shaped incision or extensive trasnsfundal uterine surgery

2. preveious uterine rupture

3. medical or obstetric complication that precludes vaginal delivery

4.Inability to perform emergency c/s delivery b/c of unavailable surgeon, anesthesia provider, sufficient staff, or facility

5. two prior uterine scars and no vaginal deliveries

60

ECV is most likely to be successful if

**(1) the presenting part has not entered the pelvis
(2) amniotic fluid volume is normal
***(3) the fetal back is not positioned posteriorly
(4) the patient is not obese
(5) the patient is parous
**(6) the presentation is either frank breech or transverse