Brainscape's Knowledge GenomeTM


Top Flashcards (Certified)
All Flashcards

Advanced Principles B > Complicated OB Part 1 - Exam 1 > Flashcards

Complicated OB Part 1 - Exam 1 Flashcards

(129 cards)

Start Studying
1
Q

ECV:

A

External Cephalic Version
* converts breech/shoulder to vertex presentation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Antepartum period:

A

conception to onset of labor

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Intrapartum period:

A

onset of labor to delivery of placenta

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

PPROM

A

Preterm Premature Rupture of Membranes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Optimal timing for ECV:

A

36-37 weeks

before baby is too big or too small

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What drug should be given before ECV?

A

Tocolytic agent
* Terbutaline/NTG

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What drug class is Terbutaline?

A

B2 agonist
* makes uterus more relaxed for manipulation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

SAB dosing for ECV:

A

Bupivacaine 2.5-7.5 mg
* +/- opioids/precedex

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What dermatome level is required for ECV?

A

T6

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

2 Complications of ECV:

A
  1. Nuchal cord - fetal brady (non-reassuring FHTs)
  2. placental abruption/preterm labor
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Where does the normal placenta implant in the uterus?

A

Upper uterine segment

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Antepartum Hemorrhage

What is placenta previa?

A

Abnormal implantation of the placenta in the uterus
* cervical internal os partially or totally covered by placenta (baby can’t come out)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Antepartum Hemorrhage

What is a common cause of placenta previa?

A

usually exact cause unknown
* prior uterine surgery

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Antepartum Hemorrhage

What is a low lying placenta previa?

A
  • placenta does not infringe on cervical os
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Antepartum Hemorrhage

What is a marginal placenta previa?

A
  • placenta touches but does not cover the cervical os
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Antepartum Hemorrhage

What is partial placenta previa?

A
  • placenta partially covers the cervical os
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Antepartum Hemorrhage

What is complete placenta previa?

A
  • placenta completely covers the cervical os
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Antepartum Hemorrhage

What are 5 risk factors for Placenta Previa? (MAPPS)

A

Multiparity
Advanced maternal age
Previous uterine sx or c/s
Previous placenta previa
Smoking

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Antepartum Hemorrhage

Most common ways placenta previa is diagnosed:

A
  1. MRI
  2. Transvaginal ultrasound
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Antepartum Hemorrhage

Classic sign placenta previa:

A

painless vaginal bleeding (2nd or 3rd trimester)
* bleeding may stop spont.
* can be sudden & severe

may be bleeding internally w/ complete occlusion

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Antepartum Hemorrhage

Tx for placenta previa

A
  1. stop bleeding & keep baby in
  2. tocolytics (Terbutaline)
  3. Betamethasone 12mg IM Q24 x 2
  4. Emergent c/s for ongoing bleeding
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Antepartum Hemorrhage

What type of anesthetic set up is needed for placenta previa?

A
  • double setup
  • vaginal & c/s
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Antepartum hemorrhage

With placenta previa - there is a risk of ________ ________. This leads to ________ insufficiency.

A
  • placental separation
  • uteroplacental
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

Antepartum Hemorrhage

When is a neuraxial anesthetic appropriate for placenta previa?

A

If hypovolemia is not suspected
* may decrease EBL/QBL

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
What are the 2 most common types of **placental problems?**
1. Placenta Previa 2. Placental Abruption
26
# Antepartum Hemorrhage What is placental abruption?
premature separation of placenta (complete or partial)
27
What causes the bleeding w/ placental abruption?
* exposure of decidual vessels & decidual-placental interface ## Footnote * abruption prevents the constriction of vessels
28
What can form b/w the placenta & uterine wall w/ continued bleeding in abruption?
* hematoma that forces things apart
29
Why is there *reduced* gas exchange in **placental abruption?**
* loss of placental-uterine surface area * hemorrhage & impaired perfusion
30
What are the 2 most common risk factors for **Placental Abruption?**
1. HTN 2. Cocaine abuse
31
What are other risk factors for **Placental Abruption?**
* advanced maternal age * multiparity * smoking * trauma * PROM * multiple gestation (twins) * pre-eclampsia * chorio
32
***Classic sign*** for Placental Abruption:
* **PAINFUL** vaginal bleeding
33
Other s/s for **Placental Abruption:**
1. hypertonic uterus - frequent contractions 2. uterus tender/tense 3. vaginal bleeding may be absent - **concealed abruption** 4. Couvelaire uterus
34
# Placental Abruption What is a Couvelaire Uterus?
* hemorrhage from the placental blood vessels infiltrates the uterine lining * then dissects into myometrum * can extend to uterine serosa & peritoneal cavity
35
What is the ***primary*** risk to the mom w/ **Placental Abruption?**
* hypovolemic/hemorrhagic shock
36
# Placental Abruption What causes consumptive coagulopathy?
1. activation of circulating plasminogen - breaks down fibrin clots 2. placental thromboplastin - binds factor VII/VIIa & activates X - triggers extrinsic pathway ## Footnote **They use all their clotting factors**
37
Dx of **Placental Abruption:**
1. clinical - PAINFUL vaginal bleeding 2. US guidance
38
# Anesthesia & Placental Abruption Neuraxial vs. GETA
* **neuraxial:** lower EBL, co-loading w/ PRBCs * **GETA:** EBL more ## Footnote *combined technique*
39
# Anesthesia & Placental Abruption What should we have available when preparing for coagulopathy & uterine atony?
* extra pitocin * cryo, FFP, plts * TXA, PCC (clotting factors)
40
What is uterine rupture & when can it happen?
* separation of uterine scar/dehiscence * intrapartum or postpartum
41
Causes of **Uterine Rupture:**
1. **uterine scar from c/s** 2. rapid labor progression 3. prolonged induction (Pit) 4. IOL 5. trauma 6. weak uterine muscles (# of pregnancies) 7. TOLAC 8. Classical uterine incision scar rupture 9. forceps delivery
42
What uterine rupture has the highest m&M?
**classical uterine incision scar rupture** * **more vascular** * may have also have placental separation
43
What is the *most consistent* clinical feature of **Uterine Rupture?**
* fetal bradycardia
44
Other s/s of **Uterine Rupture:**
1. vaginal bleeding 2. Tearing abdominal pain - can develop compartment syndrome 3. shoulder pain 4. HoTN
45
# Uterine Rupture Maternal morbidity associated w/ what 2 things?
1. cesarean (peripartum) hysterectomy 2. high rate of blood loss/transfusion ## Footnote **increased in pts w/o uterine scar or caused by trauma**
46
Tx of Uterine Rupture:
1. EMERGENT delivery 2. avoid hysterectomy - REBOA, IR
47
# Uterine Rupture & Anesthesia GETA or Neuraxial?
* usually GETA - pulmonary & mental status changes
48
What is the most common cause of maternal mortality worldwide?
Postpartum Hemorrhage
49
When does primary PPH usually happen?
within 24hrs of delivery
50
When does secondary PPH usually occur?
24hrs - 6 weeks Postpartum ## Footnote *retained placenta*
51
# PPH ACOG definition of **PPH:**
1. blood loss >/= 1000mL 2. blood loss w/ s/s of hypovolemia within 24hrs of delivery
52
# PPH Causes of PPH (3):
1. **uterine atony - most common** 2. Retained placenta 3. cervical/vaginal lacerations
53
# PPH What causes **uterine atony?**
1. failed release of endogenous uterotonic agents (Oxytocin & Prostaglandins) ## Footnote *supplement*
54
# PPH S/S of **uterine atony:**
1. soft/boggy, oversized, poorly contracting uterus 2. **painless** vaginal bleeding (Postpartum) 3. tachy, HoTN 4. Hypovolemia
55
# PPH How much blood can an atonic uterus hold?
>/= 1000mL ## Footnote **PPH may not be obvious**
56
# PPH Management of Uterine Atony PPH:
**prevention first** * uterine massage - analgesia * oxytocin admin
57
# PPH What is the **first line agent** for PPH? 1/2 life?
Oxytocin (Pitocin) * 1/2 life: 3-5min
58
# PPH Management - Pitocin Dosing (Prevention) Rule of 3s for Pitocin Admin:
* 3 units IV loading dose * infusion @ 3 units/hr for 5 hours * assess uterine tone every 3 min * can re-dose 3 units IV for inadequate uterine tone (can repeat x1)
59
# PPH Management Pitocin SE:
* Tachy * HoTN * Coronary vasoconstriction/myocardial ischemia * hyponatremia * seizures = coma
60
# PPH Management What is the *second line agent* for PPH?
* Methergine - Methylergonovine **only tx uterine atony!**
61
# PPH Management MOA Methergine
**Ergot Alkaloid** * partial agonist @ alpha-adrenergic, tryptaminigeric, dopaminergic receptors
62
# PPH Management Methergine Dose: Onset: Duration:
0.2mg **IM** available as 0.2mg/mL * onset: < 10 min * duration: 2-4hrs ## Footnote **kept refrigerated**
63
# PPH Management Methergine repeat timing: max dose:
* every 2 hrs * max: 4 times, 0.8mg
64
# PPH Management Contraindications to Methergine (4):
1. HTN 2. pre-eclampsia 3. peripheral vascular dz 4. ischemic heart dz
65
# PPH Management Methergine SE:
* CV: vasoconstriction, HTN - ischemia/infarct d/t coronary vasospasm * Neuro: CVA, seizures (intracranial HTN) * GI: n/v (decreased gastric BF) Death ## Footnote NTG & Sodium Nitroprusside to manage HTN
66
# PPH Management What is the *third line agent* for PPH?
Carboprost (Hemabate) * 2nd line in HTN or pre-eclampsia, or cardiac dz
67
# PPH Management Hemabate Dose:
250mcg IM or Intrauterine every 15-90 minutes **max 2mg** ## Footnote *kept in fridge*
68
# PPH Management Hemabate SE CV: Pulm: Others:
* CV: increased SVR * Pulm: bronchospasm, V/Q mismatch, shunt, hypoxia, increased PVR * Others: fever, chills, n/v/d
69
# PPH Management Hemabate Cautions:
* caution in reactive airway dz * avoid in cardiac dz or pulm HTN
70
# PPH Management What drug can be given upfront to help induce labor but may also be given after delivery to help w/ contractions?
Misoprostol (Cytotec) - Prostaglandin E1 Analogue
71
# PPH Management Cytotec Dose: Routes: SE:
Dose: 600-1000 mcg Route: oral, SL, **vaginal**, rectal SE: fever, chills, n/v/d
72
# PPH Management What 2 systems can be used by an OB for **PPH?**
1. Bakri Balloon - intrauterine balloon tamponade 2. Jada System - vacuum that induces physiologic uterine contraction
73
# PPH What is **retained placenta?**
Failure to deliver placenta completely within **30 min** of delivery ## Footnote ***one of the biggest reasons for delayed PPH***
74
# PPH How is **retained placenta** treated?
1. manual removal by OB - painful/uterine relaxation needed - done in OR 2. Tx uterine atony/hemorrhage
75
# PPH Anesthesia & Retained Placenta
1. BZDs + IV Ketamine (0.1mg/kg) 2. no epidural = opioids 3. convert LEA to surgical epidural 4. GETA
76
# Spinal Anesthetic Dosing Lido 5% dose range: DOA:
60-80mg * DOA: 45-75 min
77
# SAB dosing Bupivacaine 0.5-0.75% Dosing: DOA:
* dose: 7.5-15mg * DOA: 60-120 min
78
# SAB Dosing Ropivacaine 0.5% Dose: DOA:
* dose: 15-25mg * DOA: 60-120 min
79
# SAB Dosing Tetracaine 0.5-1% Dose: DOA:
* dose: 12-16mg * DOA: 70-90 min
80
# SAB dosing Fent Dose: DOA:
* dose: 10-25mcg * DOA: 180-240 min
81
# SAB dosing Sufenta Dose: DOA:
* dose: 2.5-5mcg * DOA: 180-240 min
82
# SAB Dosing Morphine Dose: DOA:
* dose: 100-200mcg * DOA: 720-1440min
83
# SAB Dosing Meperidine Dose: DOA:
* dose: 60-70mg * DOA: 60 min
84
# SAB dosing Epi dose
100-200mcg
85
# SAB dosing Dexmedetomidine dose:
5-10mcg
86
# Epidural Dosing Lido 2% w/ Epi (5mcg/mL) Dose: DOA:
* dose: 300-500mcg * DOA: 75-100 min
87
# Epidural Dosing 2-Chloroprocaine 2-3% Dose: DOA:
* dose: 450-750mg * DOA: 40-50min
88
# Epidural Dosing Bupivacaine 0.5% Dose: DOA:
* dose: 75-125mg * DOA: 120-180 min
89
# Epidural Dosing Ropivacaine 0.5% Dose: DOA:
* dose: 75-125mg * DOA: 120-180min
90
# Epidural Dosing Fent Dose: DOA:
* dose: 50-100mcg * DOA: 120-240 min
91
# Epidural Dosing Sufenta Dose: DOA:
* dose: 10-20mcg * DOA: 120-240 min
92
# Epidural Dosing Morphine Dose: DOA:
* dose: 1.25-3.75 mg * DOA: 720-1440min
93
# Anesthesia & Retained Placenta What 3 drugs can we give to induce uterine relaxation?
1. Nitroglycerin 25-50mcg IV (more control) 2. NTG spray 400mcg 3. VA - dose dependent decrease in uterine tone
94
# PPH What is placenta accreta?
* the placenta invades the uterine wall
95
# PPH Risks for **placenta accreta**: (6)
1. Hx c/s 2. placenta previa w/ or w/o uterine surgery 3. Hx myomectomy - uterine fibroid surgery 4. non-OB surgery 5. Asherman syndrome - scar tissue in uterus/cervix 6. advanced maternal age
96
# PPH Dx of **placenta accreta**
* Ultrasound/MRI ## Footnote **more likely to have accreta if they also have previa**
97
# PPH OB Tx of **placenta accreta**:
* definitive - cesarean hysterectomy * pre-op ureteral stents * internal iliac artery balloon catheter (supplies uterine arteries) * REBOA
98
# PPH Anesthesia & Placenta Accreta
* GETA
99
# PPH Placenta Increta
placenta invades myometrium
100
Placenta Percreta
**most invasive** * placenta invades through myometrium into serosa * may invade adjacent organs
101
1st degree uterine inversion:
Uterus inverted in the abdomen
102
2nd degree uterine inversion:
uterus inverted down to the point of occluding the cervical os
103
3rd degree uterine inversion:
uterus is protruding through the cervical os
104
4th degree uterine inversion:
uterus is protruding through the vagina
105
What is considered a complete uterine inversion?
if the fundus passes through the cervix
106
5 causes of **uterine inversion:**
1. overzealous fundal pressure - too much uterine tone 2. umbilical cord traction 3. uterine anomalies 4. uterine atony 5. placenta accreta
107
s/s **uterine inversion:**
1. severe hemorrhage 2. vagal mediated brady (glycco)
108
Dx of **uterine inversion**:
* poss. missed if not 3rd/4th degree
109
Tx of **Uterine Inversion**
1. d/c uterotonic admin (PP pit) 2. OB replaces uterus 3. uterine relaxation - **NTG 200-250mcg IV or SL (Higher doses)** 4. Transfusion
110
What is definitive tx for **unresponsive PPH?**
Peripartum hysterectomy
111
What 3 things can make a **peripartum hysterectomy** more procedurally challenging?
1. large uterus - scar tissue 2. increased blood flow (700-900mL/min) 3. engorged vessels & friable
112
What are 2 risks of **manual compression of the aorta?**
1. lactic acidosis 2. hemodynamic instability when compression is released
113
# Anesthesia & Peripartum Hysterectomy Why is there more pain & n/v?
Intraperitoneal manipulation
114
# Anesthesia & Peripartum Hysterectomy GETA or Neuraxial?
**GETA** * better pulm control * increased risk of bleeding
115
# Anesthesia & peripartum hysterectomy What dermatome level is needed if doing neuraxial?
t4
116
# Hemorrhage S/S to look for when deciding to **transfuse:**
1. tachy 2. decreased PP 3. tachypnea 4. decreased UOP 5. AMS 6. Hgb 7.0-8.0 g/dL
117
# Transfusion What % of EBL can a parturient tolerate before seeing sxm or change in v/s?
15% ## Footnote **HoTN late sign - dilute blood vol**
118
# Transfusion What is TACO?
Transfusion Associated Circulatory Overload
119
S/S TACO:
* HTN * acute dyspnea * coughing * HA * peripheral edema * low EF, rales, S3
120
Prevention/Tx of TACO
1. slow down transfusions 2. concentrated products 3. lasix
121
What is TRALI?
Transfusion Related Acute Lung Injury **commonly in 1st 6 hrs** ## Footnote * usually from FFP/Plts
122
Criteria for Dx of TRALI:
1. acute hypoxemia 2. P:F < 300, SpO2 < 90% on RA 3. BL inflitrates 4. **NO overload** 5. fever common
123
Management of TRALI:
* stop transfusion * ventilation - PEEP/ECMO
124
5 other risks of Transfusion:
1. bacterial contamination 2. transfusion rxn 2. hypothermia 3. hypocalcemia 4. hyperkalemia
125
Give cryo to maintain fibrinogen at:
> 150-200 mg/dL ## Footnote **fibrinogen rapidly consumed in hemorrhage**
126
How much does 1 unit of platelets increase plt count?
5,000-10,000/mm3
127
Elevated levels of what 2 labs indicates fibrinolysis?
* D-dimer * Plasmin-antiplasmin complexes ## Footnote **caution in pregnancy/inflammation relying on d-dimer**
128
TXA MOA Dose:
**Tranexamic Acid** - antifibrinolytic * 1gm IV w/i 3hrs of PPH recognition * repeat 1gm in 30 mins if still bleeding * consider 2gm as IV initial dose
129

Advanced Principles B (3 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2025 Bold Learning Solutions. Terms and Conditions