Casefiles Flashcards
(34 cards)
What is the cause of the bacteria involved in septic abortion? What type of bacteria?
Ascended from lower genital tract (vagina), usually polymicrobial, particularly anaerobes
What are the two most common complications of spontaneous abortions?
Hemorrhage and infection
What are the four parts of treatment of septic abortion?
- Maintain BP; 2. Monitor BP, O2, urine output; 3. Start antibiotic therapy; 4. Uterine curettage
What antibiotics are used for septic abortion?
Gentamicin and clindamycin
Why is monitoring urine output in septic abortion important?
Oliguria is an early sign of septic shock
A 22 yo F had a septic abortion, was treated with 48 hr triple Abx and D&C of the uterus. After 48 hrs she is still not improved, CT scan reveals pockets of air within the muscle of the uterus. What is the likely cause? Treatment?
Necrotizing metritis with gas-forming bacteria such as Clostridial species. Hysterectomy should be performed.
What level does the urine protein/creatinine ratio need to exceed for the diagnosis of preeclampsia?
A urine protein/creatinine ratio >0.3
What are the key labs to draw in preeclampsia?
CBC (with plt count), LFTs, and serum creatinine
What is the definition of chronic hypertension in pregnancy?
BP of 140/90 before pregnancy or at less than 20 weeks gestation, or persisting more than 12 weeks postpartum
What is the definition of gestation hypertension?
Hypertension without proteinuria (or other features of preeclampsia) at >20 weeks’ gestation persistent for at least 4 hours
In the absence of proteinuria, what other findings can suffice in the diagnosis of preeclampsia?
HTN with thrombocytopenia, impaired LFTs, renal insufficiency, pulmonary edema, cerebral disturbances, or visual impairment
What is posterior reversible encephalopathy syndrome? What is seen on MRI?
Cliniconeuroroadiological syndrome with HA, encephalopathy, seizure, cortical visual disturbances; MRI shows enhancement in the posterior parietal areas
How is posterior reversible encephalopathy syndrome treated?
Antihypertensives, anti-epileptics, ICU monitoring
What is the underlying pathophysiology of preeclampsia?
Vasospasm and “leaky vessels” - vasospasm and endothelial damage
What are the complications of preeclampsia?
Placental abruption, eclampsia, coagulopathies, renal failure, hepatic sub-capsular hematoma, hepatic rupture, uteroplacental insufficiency
What are the risk factors for preeclampsia?
Nulliparity, extremes of age, African-American race, PH or FH of severe preeclampsia, CHTN, CKD, obesity, antiphospholipid syndrome diabetes, multifetal gestation
Why is dyspnea important to monitor in a patient on Mg sulfate?
SE of Mg sulfate is pulm edema
What are the first signs of magnesium toxicity?
Hyporeflexia
What are the common DDx for abnormal liver function tests in pregnancy?
Acute fatty liver of pregnancy, preeclampsia, HELLP, intrahepatic cholestasis of pregnancy
What are the signs and symptoms of intrahepatic cholestasis of pregnancy?
Generalized itching, mildly elevated LFTs, elevated bile salts
What are the signs and symptoms of acute fatty liver of pregnancy?
Nausea, vomiting, icteric, hypoglycemia, coagulopathy
What are the first line agents for acute onset severe hypertension in pregnancy?
IV labetalol, IV hydralazine, or oral nifedipine
What is the most common cause of maternal death due to eclampsia?
Intracerebral hemorrhage
When is the greatest risk for occurrence of eclampsia?
Just prior to delivery, during labor, and within the first 24 hrs postpartum
