OB Flashcards

1
Q

MAC requirement decrease or increase with pregnancy?

A

Decrease 40%

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2
Q

Do MV and TV increase or decrease with pregnancy

A

Increase

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3
Q

Does CO increase with pregnancy

A

Yes

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4
Q

non-reassuring fetal status

A

Tachy >160 for >10min

Brady <110 for >10min

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5
Q

Early decels

A

associated with head compressions during contractions
resolves at end of contraction
benign

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6
Q

Variable decels

A

cord compression or in later stage of labor fetal hypoxia

decreased O2 available to fetus

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7
Q

Late decels

A

uteroplacental insufficiency

fetal hypoxia

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8
Q

Following CSE, uterine hypertonic is seen on tonometer with associated FHR changes. What is the cause of increased uterine activity following Neuraxial anesthesia?

A

Circulating epi levels decrease
Decreased B-adrenergic activity
increased uterine perfusion
increased uterine contractility

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9
Q

Treatment for uterine hypertonus

A

Terbutaline

Sublingual NTG

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10
Q

“70% effaced”

A

Effacement means that the cervix stretches and gets thinner
A cervix that’s 70 percent effaced is 70 percent of the way toward becoming short and thin enough to allow your baby to pass through the uterus

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11
Q

“-3 station”

A

During the last month, your doctor will estimate how far the baby’s head has moved down into (engaged) the pelvis. This is measured in “stations.” A baby is at –3 station when the head is above the pelvis and at 0 station when the head is at the bottom of the pelvis (fully engaged).

An imaginary line is drawn between the two bones in the pelvis (known as ischial spines). This is the “zero” line, and when the baby reaches this line it is considered to be in “zero station.” When the baby is above this imaginary line it is in a minus station. When the baby is below, it is in a “plus” station. Stations are measured from -5 at the pelvic inlet to +4 at the pelvic outlet.

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12
Q

PPH

A

Blood loss of more than 500mL SVD and 1000mL C-section
within 24h delivery = primary PPH (early)
after 24h = secondary PPH (late)

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13
Q

Contributing factors PPH

A
advanced maternal age 
multiple gestations 
increased C-section rate 
HCT <30 
fetal demise 
infection 
prolonged labor 
<200mg/dL fibrinogen = hypofibrinogenemia
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14
Q

Gravida

A

Gravidity is defined as the number of times that a woman has been pregnant.

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15
Q

Parity

A

Parity is defined as the number of times that she has given birth to a fetus with a gestational age of 24 weeks or more, regardless of whether the child was born alive or was stillborn.

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16
Q

normal PLT count

A

A normal platelet count ranges from 150,000 to 450,000 platelets per microliter of blood

17
Q

normal PLT count pregnancy

A

In the first trimester, the normal count is around 250,000 and decreases to about 225,000 at delivery.

18
Q

Normal Hb

A

men, 13.5 to 17.5 grams per deciliter

women, 12.0 to 15.5 grams per deciliter.

19
Q

Normal Hct

A
men = 41%-50%
women = 36%-44%
20
Q

Causes of PPH - 5 T’s

A
  1. TONE - uterine tone
  2. TISSUE - retained placenta
  3. TISSUE - placenta accreta
  4. TURNED INSIDE OUT - uterine inversion
  5. TRAUMA - placental abruption, genital trauma
21
Q

uterine atony

A

failure of the uterus to contract after delivery of placenta and fetus. Maternal oxytocin and PGs cause contraction and primary mechanism for controlling BL after delivery

Uterine atony is the most common indication for blood transfusion and most common cause of intrapartum and postpartum hemorrhage

22
Q

Methergine dose

A

Methylergovine
0.2mg IM
Contra HTN pre-e

23
Q

Hemabate dose

A

Carboprost
PGF-2a
0.25mg IM
contra asthma

24
Q

cytotec dose

A

Misoprostol

600-1000mcg rectal

25
Q

TXA dose

A

cyklokapron
1g in 100mL of NS IV over 10-20min
need to give within 3h of delivery

26
Q

TXA prophylaxis

A

synthetic derivative lysine binds plasminogen
keeps fibrin intact and clot stable
reduces risk bleeding

27
Q

TRAAP2 study

A

TXA for prevention of BL after c-section

5% difference in TXA group

28
Q

TXA MOA

A

antifibrinolytic agent prevents conversion of plasminogen to plasmin resulting in inhibition of plasmin activation and clot breakdown

29
Q

contraindications to TXA

A

relatively contra in renal dysfunction - reduce dose

30
Q

TXA does all of the following

A
reduces seizure threshold 
inhibit NMDA receptors - neural excitation 
improved wound healing 
modulates inflammation 
inhibits hyperfibrinolysis
31
Q

which clotting factors increase in pregnancy

A

1,2,5,7,8,9,12 and fibrinogen

32
Q

what does fibrinogen increase to

A

it goes from 250-400mg/dL to 600mg/dL in late pregnancy/labor

33
Q

what level of fibrinogen predicts severe PPH and how to correct

A

<200mg/dL

correct with FFP, cryo, fibrinogen concentrate

34
Q

recombinant factor VIIa

A

can be used in severe PPH refractory to transfusion

risk thrombosis and $$$

35
Q

hypofibrinogenemia

A

<200
most predictive biomarker for severe PPH
use viscolestography to detect
can treat with FFP and cryo

36
Q

PRBCs

A

300mL/U increases Hb 1g/dL and HCT 3-4%

37
Q

FFP fresh frozen plasma

A

need to thaw
250mL/U increases fibrinogen 7-10mg/dL and CF 5-7%
corrects coagulopathy

38
Q

PLTs

A

50mL/U increases 5000-10,000

39
Q

cryoprecipitate

A

40mL/U increases 10-15mg/dL