OB complications Flashcards

(92 cards)

1
Q

What 3 races are more likely to die from pregnancy-related causes

A
  • African American
  • American Indian
  • Alaska Native
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2
Q

Most common causes GLOBALLY of maternal death (3)

A
  • hemorrhage
  • HTN disorders
  • sepsis
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3
Q

Most common causes of maternal death in the developed world (3)

A
  • HTN disorders
  • embolic disorders
  • Hemorrhage
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4
Q

More things that lead to maternal death globally(7)

A
  • Anemia
  • Obstructed labor
  • HIV/AIDS
  • unsafe abortion
  • early marriage??? hahahha what does this mean - prob that they make 12 yr olds have babies :( ok now i feel bad for laughing :(.. this class depresses me on so many levels ~this class makes me want to die~ i have to add to this card everytime i come across it :) i feel like i am dying a slow, painful death. i feel that.
  • high parity birth
  • advanced maternal age
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5
Q

Preterm delivery (weeks?)

A

prior to 37 weeks

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6
Q

What % of deliveries in the U.S are preterm?

Other countries?

A

12-13%

5-9% in other developed countries

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7
Q

Demographic characteristics that increase the risk for preterm labor (9)

*trigger warning* long-ass list on the other side

A
  • non-caucasian
  • extremes of age<17 or >35
  • low socioeconomic status
  • low pre-pregnancy BMI
  • history of preterm delivery
  • inter-pregnancy interval <6mon
  • abnormal uterine atony
  • trauma
  • abdominal surgery during pregnancy
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8
Q

Obstetric Factors that increase risk of preterm delivery (7)

*trigger warning

A
  • vaginal bleeding
  • infection
  • short cervical length
  • multiple gestation
  • assisted reproductive technologies
  • preterm premature rupture of membranes
  • polyhydraminos
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9
Q

What procedure is performed to help prevent preterm labor

A

cervical cerclage

BIG ouch, no thx

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10
Q

What 3 drugs are discussed for the potential prevention of preterm labor

A
  • prophylactic antibiotics
  • prophylactic beta-agonists
  • progesterone
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11
Q

What is used for pain management for cervical cerclage

A

neuraxial andddd maybe a smidge of versed if you ask v nicely

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12
Q

What is given to the mother to help babies lung maturation in the event of preterm delivery

A

corticosteroids: betamethasone or dexamethasone

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13
Q

What 2 drugs are given to reduce contractions

A
  • mag sulfate
  • terbutaline
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14
Q

What kind of muscle is the myometrium

A

smooth

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15
Q

What is the incidence of pregnancy-related thromboembolic events

A

1-1.7 per 1000 pregnancies

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16
Q

At what stage/period in the pregnancy are moms at highest risk for embolus

A

postpartum (specifically, highest risk in 1st week postpartum)

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17
Q

two most important modifiable risk factors for thromboembolism

A
  • obesity
  • immobility
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18
Q

What complication mimics normal pregnancy symptoms

A

DVT

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19
Q

Symptoms of DVT

A

lower leg edema and pain

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20
Q

What is used to diagnose PE

A

U/S

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21
Q

Are D-dimers elevated in normal pregnancies

A

yup

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22
Q

If you suspect PE and the patient does NOT have DVT symptoms what is the next step

A

CXR

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23
Q

If you suspect PE, No DVT symptoms, CXR normal then what

A

V/Q scan

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24
Q

If you suspect PE, No DVT symptoms, CXR abnormal then what test do you order

A

CTA

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25
When suspecting PE what 2 tests prompt treatment if positive
- CTA - V/Q scan also CUS ( i think this is just for DVT not PE)
26
If you suspect PE and DVT symptoms are present what test should be performed
Compressional U/S (CUS)
27
If CUS is negative what should be performed next in the presence of suspected PE
CXR
28
What 2 drugs are used to anticoagulate when thromboembolism is diagnosed
- LMWH - unfractionated heparin
29
At what volumes can venous air embolism become lethal
200-300mL
30
What symptoms intraoperatively could indicate a venous air embolism (5)
* chest pain * SOB * sudden hypoxemia * hypotension * arrhythmia
31
What actions help prevent further air entrainment
- flood field with saline - lower surgical field relative to the heart
32
For Airway management during VAE what actions should be taken (4)
* Administer 100% oxygen * d/c nitrous * intubate * support ventilation
33
CV interventions for VAE
* chest compressions * IV volume expansion * vasopressors
34
In a VAE situation should delivery be expedited
yup
35
What should be considered after VAE event
* evaluate for intracerebral air * consider hyperbaric oxygen therapy
36
Confirmatory test for AFE
there isn't one
37
AFE airway management
100% FiO2 intubate
38
CV support for AFE management
* LUD * fluids & vasopressors * large bore IV * consider A-line * chest compressions
39
Should you monitor the fetus and expedite delivery during AFE event
obviously
40
heme management during AFE event
* MTP * send coags electrolytes * normothermia
41
What unit do moms go to after AFE
ICU
42
The umbilical cord protrudes ahead of the fetus
prolapsed cord
43
What are we concerned about with prolapsed umbilical cord
cord compression
44
Most common cause of maternal mortality worldwide
hemorrhage (25%)
45
What accounts for 12.5% of pregnancy-related deaths in the US
hemorrhage
46
Are most adverse outcomes related to hemorrhage considered preventable
yup
47
Failure to do what 3 things has contributed to hemorrhage-related adverse outcomes
* recognize risk factors * accurately estimate blood loss * initiate treatment in a timely fashion
48
What is the primary mechanism for controlling blood loss during delivery
uterine contraction (due to oxytocin)
49
Uterine contractions constrict which vessels
spiral arteries and placental veins
50
coagulation mechanisms after disruption of vascular integrity
1. platelet aggregation and plug formation 2. local vasoconstriction 3. clot polymerization 4. fibrous tissue fortification of the clot
51
What 2 things are considered LATE signs of hemorrhage especially in young healthy patients
* tachycardia * hypotension
52
As blood loss increases does the reliability of EBL increase or decrease
decrease
53
When the placenta implants near/on the cervix
Placenta Previa
54
Incidence of placenta previa
4:1000
55
Complication associated with placenta previa
antepartum hemorrhage
56
If a patient is known placenta previa and is having elective/non-urgent CD, is there still a significant risk for hemorrhage
yup
57
With placenta previa is there an increased or decreased risk for placenta accrete
increased
58
Which form of anesthesia for placenta previa cases is associated with more stable hemodynamics and lower transfusion rates
epidural anesthesia
59
Is it okay to use 50% nitrous to limit volatile agents in a active bleeding Previa patient
yup
60
When the placenta separates from the uterus prior to delivery
placental abruption
61
What populations have been found to have an increased risk for placental abruption
* African American women * patients hospitalized for acute and chronic respiratory disease
62
Obstetric Conditions associated with placental abruption (5)
* advanced maternal age * multiparity * preeclampsia * premature rupture of membranes * chorioamnionitis
63
maternal comorbidities associated with placental abruption (5)
* HTN * resp illness (acute or chronic) * substance abuse * cocaine use * tobacco use
64
Which type of trauma direct or indirect is associated with placental abruption
both do :(
65
Anesthesia management considerations for placental abruption vaginal delivery
* neuraxial * treat hypovolemia * sympathectomy can increase risk to extend abruption * consider PCA
66
Placental abruption anesthesia management for CD
* General preferred * aggressive volume resuscitation * uterine atony requires uterotonic drugs
67
Risk factors for Uterine rupture (7)
* prior uterine surgery * induction of labor * high dose oxytocin * connective tissue disorder * forceps * internal podalic version * excessive fundal pressure
68
what volume is considered Postpartum hemorrhage for vaginal delivery
\>500ml
69
What volume is considered postpartum hemorrhage for CD
\>1000 mL
70
Common causes of postpartum hemorrhage
* uterine atony * retained placenta * genital trauma * uterine inversion * placenta accreta
71
Most common cause of severe postpartum hemorrhage (80%)
uterine atony
72
First-line drug for prophylaxis and treatment of uterine atony
oxytocin
73
side effects of oxytocin
* tachycardia * hypotension * myocardial ischemia
74
What other intervention is recommended besides uterotonic agents to help prevent uterine atony
uterine massage
75
2 treatments for uterine atony besides oxytocin
- Ergot alkaloids-fungus-methergine (wut) - prostaglandins-hemobate
76
Least common hematoma seen with genital trauma
retroperitoneal
77
retained placenta
failure to completely deliver placenta
78
What can be given to help relax the uterus in the presence of retained placenta
- high-dose volatile - nitroglycerin
79
What serious OB condition is associated with concurrent vagal reflex mediated bradycardia
Uterine Inversion
80
What dose of Nitroglycerin may be needed to relax the uterus for uterine inversion
200-250mcg (larger dose)
81
Placenta accreta
placenta that invades the uterine wall and is inseparable from it
82
accreta vera
adherence of the basal plate of the placenta to the myometrium
83
chorionic villi invade the myometrium
Increta
84
invasion through the myometrium, into serosa and maybe other organs
percreta
85
with what OB complication may an Internal iliac artery balloon catheter be necessary
placenta accreta
86
in 2/3 of cases of placenta accreta blood loss exceeds
2000cc
87
in 15% of placenta accreta blood loss exceeds
5000cc
88
in 6.5% of placenta accreta cases, blood loss exceeds
10,000cc (holy shit) is there even that much blood in there rip
89
What 3 OB complications trigger DIC
- retention of dead fetus - placental abruption - AFE
90
What often accompanies DIC
- circulatory shock - renal failure
91
Label the degree of Previa: Marginal, Total, or Partial
A. Total B. Partial C. Marginal
92