Ob/Gyn Emergencies Flashcards
Describe first trimester bleeding:
Common – 30-40%
50% will miscarry
What are some of the causes of first trimester bleeding?
Causes: Spontaneous abortion Incomplete abortion Blighted ovum Ectopic pregnancy Molar pregnancy Normal pregnancy Cervical polyps Infections Cervical erosions Cervical cancer
Most miscarriages are due to _____.
a genetic anomaly
What are the signs of a spontaneous abortion?
- intrauterine pregnancy at <20 weeks
- low or falling levels of hCG (hCG should normally double every 2-3 days in pregnancy)
- Bleeding, midline cramping pain
- open cervical os
- complete or partial expulsion of products of conception
If someone has had an abortion, then what do you need to check on in that states of the mother?
Rh status. If Rh neg, give Rho-gam
What are signs of ectopic pregnancy?
- amenorrhea or irregular bleeding and spotting
- pelvic pain, usually adnexal. SUDDEN ONSET, DOES NOT RADIATE.
- adnexal mass by clinical examination or U/S
- failure of serum level of beta-hCG to double EVERY 48 HOURS.
- no intrauterine pregnancy or transvaginal u/s with serum beta-hCG >2000 mu/mL
How do you treat ectopic pregnancy?
stable patient= watch and give methotrexate
unstable= hospitalize and surgery
What is placenta previa?
placenta grows into the opening of the mother’s cervix. PAINLESS vaginal bleeding in the 3rd trimester is placenta previa until proven otherwise. bleeding may stop on own, otherwise weigh considerations.
What is placenta abruption?
The placenta tear away from the lining of the uterus and can deprive the baby of oxygen. Vaginal bleeding in the presence of abdominal pain or back pain with a firm, tender uterus. Sometimes, hemorrhage is concealed. DIC can occur. If abruption is severe enough, then a c-section is indicated.
What is pre-eclampsia?
newly elevated blood pressure and proteinuria during pregnancy.
Blood pressure > 140/90 after 20 weeks
Proteinuria of >.3 gm in 24 hours.
Describe severe pre-clampsia?
BP >160/110 protineuria >5g in 24 hours thrombocytopenia HELLP pulmonary edema IUGR
What is the cure for pre-eclampsia?
the only true cure is delivery of the fetus
what are the 6 areas of the body that pre-eclampsia effects?
- CNS
- kidney
- liver
- hematologic
- vascular
- fetal-placental unit
What is eclampsia?
the occurrence of seizures with the other features of pre-eclampsia.
What is HELLP syndrome?
hemoloysis
elevated liver enzymes
low platelets
How are you going to prevent seizures in the mom with eclampsia?
you must give MgSO4
If BP increases, give hydrazine or Nifedipine
give IV D5 1/2 NS TRA 100-250 cc/hr with accurate I’s and O’s
What is postpartum hemorrhage?
It is the most common maternal morbidity
Major cause of death worldwide
traditionally define as blood loss >500ml
What are some risk factors for postpartum hemorrhage?
Antepartum: history of PPH, fetal macrosomia, multiple pregnancies
Intrapartum: prolonged third stage, episiotomy, c-section
How should PPH be managed?
- await placental separation
- leave cord uncut until pulsation stops
- allow spontaneous placental delivery
- give oxytocin
What are the 4 T’s of PPH?
- tone= soft, boggy uterus
- trauma= genital tract tear, inversion of uterus
- tissue= placenta retained
- thrombin= blood not clotting
What is the most common cause of PPH?
loss of tone
How do you manage loss of tone in regards to PPH?
bimanual uterine massage and compression
give oxytocic agents:
1. oxytocin
2. PG
What are some of the causes of trauma that cause PPH?
- uterine inversion: suspect if shock is disproportionate to blood loss, replace uterus immediately
- uterine rupture: risk is prior uterine surgery/no vaginal delivery. fetal bradycardia is first sign.
- vaginal or cervical lacerations
- hematoma
What are some of the reasons “tissue” can cause PPH?
- retained placenta that is not delivered within 30 minutes.
- invasive placenta (accreta)
