Dunn OB/GYN IV Flashcards
(35 cards)
38yo F G3P2002
- labor and delivery 31 weeks
- significant vaginal bleeding
- abdomen - mobile mass
- no pain
- US - placental over cervical os
placenta previa
placenta tissue over cervical os
placenta previa
painless antepartum bleeding after 20 weeks
US before digital exam - don’t want hemorrhage
severity of placenta previa
total - os totally covered
partial
marginal - edge of placenta at margin of os
low-lying - implanted lower uterus close to os
fetal vessels at cervical os
vasa previa
risk fx placenta previa
previous PP previous C section multi gestation multiparity advanced age infertility tx previous abortion smoking cocaine** male fetus non white
tx of placenta previa
asymptomatic - plan C section
bleeding - emergeny C section possible
vaginal delivery
attempted if placental edge >10mm from internal os
four Ts of post partum hemorrhage
tone - no contraction - bleeding
trauma
tissue
thrombus
tx of uterine atony bleeding
massage
pitocin/cytotec
methergine - no with HTN
hemabate - no with asthma
halogenated anesthetics
cause of uterine atony
second most common cause of PPH
trauma
most common cause of PPH
PPH = post partum hemorrhage
atony
ITP
idiopathic thrombocytopenic purpura
abnormal platelet function
cause of thrombus PPH
also amniotic fluid embolus and vWD
17yo G1P0 at 38 weeks
- feeling dizzy
- edema
- HTN
- HA
- obese
- elevated uric acid
tx - induce labor
preeclampsia
leading cause of maternal and prenatal morbidity and mortality worldwide
preeclampsia
risk fx for preeclampsia
HTN renal disease age >40 or <18 fam hx antiphospholipid antibody syndrome DM multifetal gestation high BMI AA
diagnosis of preeclampsia
systolic >140
diastolic >90
-two occasions at least 4 hours apart after 20 weeks of gestation
proteinuria >0.3g in 24 hr urine
protein/Cr ratio >0.3
dipstick +1
pt with new onset HTN w/out proteinuria
diagnosis of preeclampsia -platelet 1.1 liver transaminases 2x normal pulmonary edema cerebral or visual sx
severe preeclampsia
CNS dysfunction
hepatic abnormality
severe BP elevation >160/110
mild preeclampsia
no end organ damage
BP >140/90
early onset preeclampsia
<34 weeks
high risk of fetal death
late onset preeclampsia
> 34 weeks
preeclampsia indications for delivery
nonreassuring fetal heart sounds rupture membrane uncontrollable BP oliguria Cr >1.5 pulmonary edema SOB or chest pain and pulse ox <94% HA RUQ pain HELLP syndrome
severe HA, visual abnormality, RUQ tenderness, epigastric pain
severe preeclampsia
need urgent delivery
