Clinical: Obstetric Complications Flashcards Preview

Block I: Reproduction & Sexuality > Clinical: Obstetric Complications > Flashcards

Flashcards in Clinical: Obstetric Complications Deck (46):
1

6 obstetric emergencies

  • Massive obstetric hemorrhage
  • Non-hemorrhagic shock
  • Shoulder dystocia
  • Eclampsia
  • Cord prolapse
  • Malpresentation

2

3 massive obstetric hemorrhages

  • Praevia
  • Abruption
  • PPH

3

2 non-hemorrhagic shocks

  • Amniotic fluid embolism
  • Acute uterine inversion

4

Define massive obstetric hemorrhage

Blood loss requiring replacement of patient's total blood volume

5

3 potential locations of concealed bleeding

  • Uterus (couverlaire uterus of abruption)
  • Broad ligament hematoma
  • Peritoneal cavity

6

What is disseminated intravascular coagulation characterized by?

Activation of the coagulation sequence --> systemic micro-thrombi (sequelae of tissue hypoxia)

7

2 triggering pathways of disseminated intravascular coagulation

  • Release of tissue factor/thromboplastic factors into circulation
  • Widespread endothelial injury

8

2 mechanisms of disseminated intravascular coagulation

  • Activated monocytes --> release IL-1 and TNF alpha --> increase expression of tissue thromboplastic factor on endothelial cels + increase thrombomodulin
  • Consumption of coagulation factors, platelets, and activation of fibrinolytic pathways

9

4 sources of thromboplastic substances that may cause DIC

  • Leukemic cell granules
  • Placenta in obstetric complications
  • Carcinomas (Mucin-secreting adenocarcinomas)
  • Bacterial endo and exotoxins

10

3 organs damaged by micro-thrombi in DIC

  • Kidney
  • Adrenals
  • Brain
  • Heart and anterior pituitary

11

Kidney damage due to micro thrombi

Microinfarcts in the renal cortex (severe - bilateral renal cortical necrosis)

12

Adrenal damage due to micro thrombi

Bilateral adrenal hemorrhage (resembles Waterhouse-Friderichsen syndrome)

13

Brain damage due to microthrombi

Microinfarcts surrounded by foci of hemorrhage

14

DIC clinical manifestation (9)

  • Acute = bleeding tendency (i.e. obstetrical complications and trauma)
  • Chronic = thrombotic complications (i.e. cancer0
  • Minimal to profound shock
  • Renal failure
  • Dyspnea
  • Cyanosis
  • Convulsions
  • Coma
  • Hypotension

15

Lab findings of DIC (4)

  • PT and PTT typically prolonged
  • Thrombocytopenia
  • Low fibrinogen
  • Elevated plasma fibrin split products

16

Define placenta praevia

The placenta covers the internal cervical os completely or partially (0.5% to 1% of all births)

17

4 risk factors of placenta praevia

  • Previous cesarean sectrion (x6)
  • Mulitparity (x2.6)
  • Previous uterine surgery
  • IVF

18

4 different scenarios that predict placenta praevia management

  • Preterm fetus and no indication for delivery (observe)
  • Mature fetus and bleeding does not stop (C section)
  • Patient in labor (C section)
  • Severe bleeding and immature fetus (C section)

19

Management of placental abruption if no symptoms (no bleeding)

Observe mother and fetus

20

Management of placental abruption if severe bleeding and fetus is alive

Cesarean section

21

Management of placental abruption if bleeding and fetus is dead

  • Amniotomy + pakced red cells + coagulatoin factors + labor induction (vaginal birth)
  • If bleeding too severe --> C section

22

When to consider vasa praevia

If bleeding occurs after amniotomy

23

3 points of management of post-partum hemorrhage

  • Detect and treat antenatal anemia
  • Active management of third stage
  • IV access plus collect blood for group and cross match if assessed as at risk

24

3 elements of active management of third stage for post-partum hemorrhage

  • Administration of a prophylactic oxytocic agent
  • Early cord clamping
  • Controlled cord traction of the umbilical cord

25

2 prophlactic oxytocic agents

Ergometrine and Carboprost

26

Define amniotic fluid embolism

Anaphylactic reaction to fetal antigens, mainly during delivery

27

6 risk factors for amniotic fluid embolism

  • Multiparity
  • Abruption
  • Blunt abdominal trauma
  • External version
  • Fetal death
  • Amniocentesis

28

13 clinical manifestations of amniotic fluid embolism

  • Rigors
  • Perspiration
  • Restlessness
  • Coughing
  • Cyanosis
  • Hypotension
  • Bronchospasm
  • Tachypnea
  • Tachycardia
  • Arrhythmia
  • Convulsions
  • MI
  • DIC

29

Diagnosis of amniotic fluid embolism (4)

  • Clinical manifestations
  • Chest X ray
  • ECG
  • Blood gas analysis

30

Usual presentation of amniotic fluid embolism

Sudden coughing attack after cesarean or vaginal birth

31

When might uterus inversion occur?

If the fundal placenta is pulled out incautiously and forcefully

32

Describe the events of shoulder dystocia (4)

  1. Fetal head is born
  2. Contraction ceases --> fetal head slips back into vagina (turtle phenomenon)
  3. Blue livid color of face caused by venous congestion (not hypoxia)
  4. Interruption of arterial perfusion --> fetal hypoxia and cerebral injury

33

Shoulder dystocia management (4 maneuvers)

  • McRoberts maneuver
  • Woods maneuver
  • Jacqumiere maneuver
  • Rubin maneuver

34

Describe the McRoberts maneuver

  1. Flex thighs sharply up onto the abdomen
  2. Suprapubic pressure

35

Describe the Wood Maneuver

The posterior sohulder is rotated 180 degrees in a corkscrew manner so that the anterior shoulder is released

36

Describe the Jacqumiere maneuver

Delivery of the posterior shoulder

37

Describe the Rubin maneuver

The impacted anterior shoulder is rotated in abdomen direction

38

3 methods of management for shoulder dystocia if all 4 maneuvers do not work

  1. Fracture of the clavicula (upward direction)
  2. Zavanelli maneuver
  3. Abdominal rescue after O,Leary & Cuva.

39

Describe Zavanelli maneuver

Put the fetal head into the vagina and cesarean section

40

Describe abdominal rescue

Lap + uterotomy: release the impacted anterior shoulder abdominally and the posterior sohulder vaginal and deliver the fetus vaginally

41

7 risk factors for umbilical cord prolapse

  • Long umbilical cord
  • Breech
  • Transverse lie
  • Small fetus
  • Multiparity
  • Twins
  • Amniotomy

42

8 clinical manifestations of eclampsia

  • Headaches
  • Blurred vision
  • Confusion
  • Severe HTN
  • Proteinuria
  • Edema
  • Hyper-reflexia
  • Eclamptic fit (seizure)

43

6 points of management for eclampsia

  • Turn woman on side
  • Oxygen
  • Magnesion sulphate (IM or IV)
  • Anti-hypertensives (hydrallazine, labetolol)
  • Anti-seizure meds
  • DELIVER THE PLACENTA (and the baby!)

44

6 potential consequences of eclampsia

  • Fetal death
  • Maternal asphyxia
  • Respiratory distress
  • Hemorrhage (thrombocytopenia/DIC)
  • Multi-organ failure
  • ICU

45

2 malpresentations

  • Breech presentation
  • Transverse/oblique lie

46

5 potential consequences of malpresentation

  • Prematurity
  • Multiple pregnancy
  • Obstruction (i.e. fibroids)
  • Fetal malformation (i.e. hydrocephaly)
  • Placenta praevia