OBGYN & BURN Flashcards
(171 cards)
1
Q
Identify A B C and D
A
A. Normal (Decidua)
B. Increta (17%)
C. Percreta (5%)
D. Accreta (75-78%)
2
Q
Describe what the image shows
A
Placenta Increta
- Placenta invasion to myometrium
- Leads to massive bleeding after delivery
3
Q
Describe what the image shows
A
Placenta Accreta
- Placenta adhesion to uterine myometrium without invasion
- Leads to massive bleeding after delivery
4
Q
Identify A B and C
A
A: Marginal placenta previa.
B: Partial placenta previa.
C: Complete placenta previa.
5
Q
Identify A and B
A
A. Apparent bleeding from premature separation
B. Concealed bleeding from premature separation
6
Q
Placenta adhesion to uterine myometrium without invasion leading to massive bleeding after delivery
A
Placenta Accreta
7
Q
Placenta acreta is likely to occur in patients with a history of?
A
- previous C/S
- placenta previa,
- uterine trauma
8
Q
Placenta invasion to myometrium that leads to massive bleeding after delivery
A
Placenta Increta
9
Q
placenta invasion to myometrium, serosa and adjacent pelvic structures
A
Placenta Percreta
10
Q
There are 3 types of placental abnormal implantations, placenta acreta, increta and percreta. How are they diagnosed and managed
A
Dx: U/S. MRI
Management: C/S or postpartum hysterectomy
11
Q
The two MCC of 3rd trimester bleeding are?
A
Placenta previa and placental abruption
12
Q
Placenta previa is?
A
abnormally implanted placenta on the lower uterine segment and covers or borders on the cervical os.
13
Q
Identify 3 types of placenta previa
A
- Marginal – within 2 cm of os
- Total – completely covers os ( C section)
- Partial – partially covers os ( C section)
14
Q
The Overall incidence and mortality of Placenta previa is?
A
1%
15
Q
What are the risk factors of placenta previa
A
- Large placenta
- Accreta
- Previous C/S
- Multipara
- Malpresentation
- Advance maternal age
16
Q
Do NOT do a vaginal exam for this patient
A
Patient with placenta previa
17
Q
What are the signs and symptoms of a patient with placenta previa and how is it diagnosed?
A
- Painless vaginal bleeding which stops automatically
- Preterm labor
- Maternal hemorrhage with hypotension
- Diagnosed with U/S, MRI
18
Q
This patient should always have a C-section delivery
A
Patient with placenta previa
19
Q
What is the most common cause of neonatal motality and mobidity?
A
Placenta Previa
20
Q
Describe the management of a patient with placenta previa
A
1.Expectant (wait till delivery)
–Hospitalization; bed rest and observation if < 37 weeks with mild to moderate bleeding
–I/V fluids , typing & cross matching
–Maintain crit > 30
–Await lung maturity ( steroid shots)
- Coagulopathy is common; may need replacement
- Delivery
–Do L/S ratio, if immature give steroid to mom
- Always C/S
21
Q
Patient with placenta previa has an abnormal L/S ratio. What would you do?
A
Give steroids to the mother
The lecithin–sphingomyelin ratio is a test of fetal amniotic fluid to assess for fetal lung immaturity
22
Q
What are the complications of Placenta previa
A
- Premature delivery – most common cause of neonatal M&M
- Placenta accreta – do Hystrectomy
- PPH
23
Q
This occurs when the normally implanted placenta separates from decidua basalis prior to delivery, bleeding may be overt or concealed.
A
Abruptio Placenta
24
Q
What are the risk factors of placenta abraptio
A
- Maternal hypertension
- Cocaine , smoking M
- Trauma
- Preterm premature rupture of membranes
- Hypertonic uterus
- Previous history
25
Abruptio Placenta is diagnosed by?
1. Clinical suspicion
2. U/S
26
What is the incidence of abruptio placenta
1/100
27
What are the signs and symptoms of Abruptio placenta?
1. Painful vaginal bleeding; high volume. Concealed vs. revealed
2. Uterine tenderness
3. Hypovolemia
4. Retroplacental hematoma ( 2500 ml !)
5. Contractions- low amplitude , high frequency
6. Abdominal/back pain
7. Fetal bradycardia(fetal distress) −Due loss of maternal gas exchange area
8. Fetal demise- most common cause
9. Maternal coagulopathy- most common cause of DIC −Replacement of clotting factors and platelets
28
The most common cause of fetal demise is?
Abruptio placenta
29
Fetal bradycardia in Abruptio placenta is due to?
loss of maternal gas exchange area
30
What arr the complications of placenta abruptio?
1. DIC ( low platelets, factor V, VIII; high fibrin split products)
2. Shock
3. ARF
4. Loss of fertility- uterine atony secondary to “Couvelaire uterus”
31
Describe the management of a patient with Abruptio Placenta
1. Expectant- preterm fetus without signs of distress; follow coagulation profile
2. C-section- if fetal distress ( fix mother’s coagulopathy first)
3. Massive blood transfusion
4. No delay
5. Replacement of clotting factors, platelets
6. NO EPIDURAL if concerns over volume and coag
32
Compare the incidence of placenta abruption vs placenta Previa
AP: 1/100
PP: 1/200
33
Compare the pathophysiology of placenta abruptio vs placenta Previa
AP: Premature separation of normally implanted placenta
PP: Abnormal implantation near or at os
34
Compare the risk factors of placenta abruptio vs placenta Previa
**AP:** HTN, abd trauma, tobacco or cocaine use
**PP:** Prior C/S, grand multiparous
35
Compare the signs and symptoms of placenta abruptio vs placenta Previa
**AP:** _Painful_ vaginal bleeding , uterine hyperactivity, fetal distres**s**
**PP:** _Painless_ vaginal bleeding
36
Compare the diagnosis of placenta abruptio vs placenta Previa
Transabdominal/transvaginal U/S for both
37
Compare the management of placenta abruptio vs placenta Previa
**Abruptio Placenta**
1. Stabilize the pt with premature fetus; expectant management with frequent monitoring
2. Moderate to severe: immediate delivery
**Placenta Previa**
1. NO vaginal exam!
2. Stabilize
3. Mag sulf
4. Fetal lung maturity
5. Delivery if unstable Bleeding
38
Compare the complications between placenta previa vs abruptio placenta
**_Abruptio Placenta_**
1. DIC
2. Shock
3. Ischemic necrosis of distal organs
4. Fetal anemia
**_Placenta Previa_**
1. Placenta accreta.
2. Fetal anemia
39
Prematurity is Birth before?
37 weeks of gestation
40
Complications of prematumrity are due to immature organs. These include?
1. Respiratory distress syndrome −Give surfactant inhalation
2. PDA
3. Hypoxia or shock −Can cause gut ischemia
4. Infections (CMV following blood transfusion)
5. High bilirubin , hypocalcemia
6. Intracranial hemorrhages
7. Hypothermia
8. Congenital anomalies
9. Retinopathy resulting in visual loss
41
\_\_\_\_\_\_\_\_\_\_ is given to stop premature contraction
B2 agonist e.g. ritodrine
42
Avoid atropine with ritodrine because?
It can cause tachycardia that leads to pulmonary edema
43
What are the side effects of Ritodrine to the mom
1. hypokalemia
2. hyperglycemia
3. tachycardia
44
What are the side effects of ritodrine on the fetus
Same as the mother though tachycardia may be more pronounced or less
45
These drugs are given in prematurity to prevent postanesthetic apnea
Aminophyllin or caffeine
46
This drug may prevent retinopathy of prematurity
Vitamin E
47
Anesthetic considerations in prematurity
1. Airway , fluid and temperature control
2. High risk of postanesthetic apnea
−Give aminophyllin or caffeine
3.Avoid fluctuation in PaO2 level [Normal =60-80 mmHg]
−Monitor pulse ox constantly
−Avoid excessive oxygenation
4. Vit. E may prevent retinopathy
5. Fentanyl with decreased requirement is favored
48
This drug may cause VIII nerve damage
Aminoglycosides
49
This drug may cause Clear cell adenocarcinoma of vagina/Cx, genital abnormalites
Diethylstilbestrol
50
This drug may cause Limb abnormalities (phocomelia) “seal limbs”
Thalidomide
51
This drug may cause Transposition of great vessels, cleft palate
Amphetamine
52
This drug may lead to microcephaly, mental retardation, abnormal face , limb dislocation, heart /lung fistulas
Ethanol
These symptoms describe Fetal alcohol syndrome
53
This drug may cause Congenital goiter, hypothyroidism, mental retardation
Iodide
54
This drug may cause decreased bone growth, small limbs , discoloration of teeth
Tetracycline
55
This drug may lead to Cartilage damage
Fluoroquinolones
56
this teratogen may cause Kernicterus
Sulfonamides
57
This teratogen is used in the treatment of acne and may result in multiple anomalies
Isoretinoin\*
58
Griseofulvin can cause which teratogenic effects
multiple anomalies
59
This teratogen can cause Skeletal and facial abnormalities, mental retardation, stillbirth, IUGR
Warfarin
60
These drugs can cause cleft lip/ palate
Phenytoin, Carbamazapine
61
This teratogen can cause Fetal anticonvulsive syndrome, neural tube defect
Valproic acid
62
Fetal alcohol syndrome
63
What is the most serious risk factor associated with surgery during pregnancy
Uterine asphyxia
64
to avoid supine hypotension in obstetric anesthesia
Uterine displacement
65
Pregant women are more prone to hypoxia due to?
Low FRC
66
\_\_\_\_\_\_\_ substances diffuses rapidly through the placenta
lipid soluble substances
67
Pregnant women are at a high risk of thromboembolism. What is used to prevent DVT
prevent DVT with pneumatic compression stockings during C/S
68
\_\_\_\_\_\_\_ is the most frequent complication of spinal and epidural
Hypotension
69
Hypotension is a complication of spinal and epidural treated by?
Left uterine displacement
IV hydration
ephedrine
70
Decrease the dose muscle relaxants in pregnant women treated with Mag sulfate because?
It increases sensitivity to both depolarizing and non-depolarizing muscle relaxant
71
In prenant women, Lidocaine (in high dose) causes?
uterine vasoconstriction and increased tone
72
Fetal acidosis facilitate ______ while maternal alkalosis favors \_\_\_\_\_\_\_\_
ion trapping
diffusion across placenta
73
Most common cause of polyhydramnios is?
esophageal atresia
74
Most commonly injured verve during abdominal hysterectomy is?
Femoral nerve
75
Foot drop during vaginal hysterectomy
Common peroneal nerve injury
76
The most commonly injured nerve during vaginal delivery is?
Lumbosacral nerve resulting in low back pain
77
\_\_\_\_\_\_\_\_\_\_\_ are the most common cause of anesthesia-related maternal mortality
Airways complications
78
Most common mobidities in pregnant women is?
−Hemorrhage
−Preeclampsia
79
Regionals are preffered to opioids in OB because?
Opioids cross the placental barrier. Regionals are preferred
80
Pregnant women are at high risk for aspiration, apprpriate anesthetic interventions woud be?
1. **Always** consider full stomatch
2. Give H2 blockers and metroclopramide
81
1.Level of block for C/S is?
T4
82
Common problems with GA in OB are ?
Rapid desaturation
laryngeal spasm/edema
aspiration
83
\_\_\_\_\_\_\_\_\_\_ are most common cause of anesthesia-related maternal mortality
Airways complications
84
Epidemiology of burns
1. 2.5 millions burn injuries per year
2. 100,000 hospitalization per year
3. 10,000 deaths per year
85
Types of burns
1. Thermal
2. Electrical
3. Chemical
4. Radiational
86
Deferentiate between first degree, second degree and third degree burn
1. First degree; superficial, limited to epidermis
2. Second degree; partial thickness, extends to dermis
3. Third degree; full thickness-no pain?
87
Inhalation burn injury
−Direct thermal insult =\> pulmonary edema and ARDS
−Smoke
−Deactivation of surfactant =\>atelectasis
−CO poisoning
88
The primary cause of death in burn patients is?
**Infections**
* Loss of skin barrier
* Inhalation injury and pulmonary infection
89
Pathophysiology of burns
1.Inhalation injury
−Direct thermal insult =\> pulmonary edema and ARDS
−Smoke
−Deactivation of surfactant =\> atelectasis
−CO poisoning
2.Hypovolumia / Shock
−Total body edema due to increased permeability
−Pulmonary loss
3. Hyperkalemia due to tissue destruction
4. Infections—primary cause of death
−Loss of skin barrier
Inhalation injury and pulmonary infection
90
Hypovolemia in burns is due to?
−Total body edema due to increased permeability
−Pulmonary loss
91
Hyperkalemia in burns is due to?
tissue destruction
92
Resuscitation of burn patients
−Treat the shock first. If no shock fluid administration aims to replace the deficit and suppy the maintenance fluid.
−Evaluate Total Body Surface (TBSA) Area burned by “rule of nines”.
−3 ml/kg/% BSA burned of crystalloid /24 hrs
* First ½ over 8 hrs
* Second ½ over next 16 hrs
93
Wound care in burns
−Gentle debridment
−Partial thickness
* cover with topical antibiotics
−Complete thickness
* Topical antibiotics
* Excise burn wound to remove necrotic tissues
* Cover with skin graft
* Keep extremities elevated
94
Treatment of infections in burns
−Sputum C/S
−Wound infection
* Resect to viable tissue
* Antibiotics ( tissue injection and IV)
95
Metabolic changes in burns
−Requirement increases – catabolic state
−(25 kcal/kg/day) + (40 kcal /% TBSA burned/day)
−Higher protein : calorie ratio
96
Long term care treatment in burns
−Splints – opposes contractures
−Pressure garments – prevent scar and edema
−Range of motion – prevents contractures
97
Anesthesia Consideration for burn patients
1. Intubate before edema develops
2. Sux is contraindicated due to hyperkalemia =\> cardiac arrest
3. Higher doses of non-depolarizing muscle relaxant
4. Halothane is best avoided if epinephrine is being used to stop bleeding
98
Rule of nine in burns
Head and neck = 9% =(4.5 front + 4.5 back)
Upper extrimities= 18% =2(4.5% front +4.5% back)
Trunk= 36% = 2(18% back + 18% front)
Lower Extrimities= 36% = 2(9% front +9% back)
Perenial = 1%
99
Early deceleration
1. Decelerations ( low FHR) begin and end at approximately the same time as the uterine contraction [normal FHR = 120-160 bpm]
2. Head compression
3. NO fetal distress
100
Late deceleration
1. Persist after contraction is over
2. Associated with fetal hypoxia - decrease uteroplacental perfusion
3. Possibly due maternal hypotension or abruption
4. Assess fetal pH
5. Deliver the baby ASAP when
* Persistent
* Fetal bradycardia
101
Variable deceleration
1. Variable in shape, severity and timing
2. Occur at any time during contraction
3. Umbilical cord compression and low blood flow
4. Associated with fetal hypoxia
5. Respiratory acidosis- with good fetal reserve metabolic acidosis does not occur
6. Occurs in oligohydramnions
7. Change mother position (back to side)
102
VEAL CHOP
103
Incidence of gestational diabetes
3-5%
104
What are the risk factors of gestational diabetes
1. Past history
2. Prior abortions
3. Still births
4. Obesity
5. Maternal age \>30
6. Large fetus
105
History and physical in a patient with gestational diabetes
Asymptomatic
Fetus larger for gestational age
106
Labs for patient with gestational diabetes
1. Glycosuria, fastening hyperglycemia
2. Abnormal GTT (glucose tolerance test)
107
Treatment of gestational diabetes
1. Diet control
2. Insulin
3. Avoid oral hypoglycemic agent (can cause fetal hypoglycemia)
108
Compare maternal vs fetal complications of gestational diabetes
**Maternal Complications**
1. Preterm labor
2. Polyhydramnion
3. C/S for macrosomia
4. Preeclampsia/eclampsia
5. DM type II
**Fetal Complications**
1. Macrosomia
2. Shoulder dystocia
3. Perinatal mortility 2-5%
4. Congenital defects
5. Hypoglycemia
109
Any pregnancy outside the uterine cavity
Ectopic Pregnancy
110
Ectopic Pregnancy Risk factors
1. PID
2. Pelvic surgery
3. IUD
111
Ectopic Pregnancy H&P
1. Abdominal/pelvic pain “knife-like”
2. Abnormal vaginal bleeding
3. Pelvic mass
4. Shock if ruptures
112
Diagnosis of ectopic pregnancy
Elevated HCG w/o an intrauterine pregnancy on U/S
113
Treatment of ectopic pregnancy
Surgery vs. medical (Methotrexate)
114
What are the Complications of ectopic pregnancy?
Shock
Infertility
Maternal death
115
The most common site of ectopic pregnancy is?
Ampullary
116
Hydatidiform Mole
1. Gestational trophoblastic disease (GTD)
2. Growth of an abnormal fertilized egg or an overgrowth of tissue from the placenta
3. Cystic swelling of chorionic villi and proliferation of chorionic epithelium (trophoplast)
4. Abnormal vaginal bleeding
5. Benign GTD (molar pregnancy) 80%
117
Complete molar pregnancy
Result from sperm fertilization of an empty ovum, most commonly have a chromosomal pattern of 46,XX and are completely derived from father
118
Incomplete molar pregnancy
Result when a normal ovum is fertilized by two sperms, have a chromosomal pattern of 69 XXY
119
Malignant GTD consist of?
invasive mole and choriocarcinoma
120
Risk factors of hydatidiform
* Extreme of age
* Folate deficiency
121
History/PE in hyadatidiform mole
1. First trimester painless uterine bleeding
2. passage of molar vesicles
3. uterine size increase and date discrepancy
4. very high BP
5. preeclampsia\*
6. intractable N/V
122
Evaluation of Hydatidiform Mole
Very high b-HCG and “snow storm” appearance on pelvic U/S with no fetus present
123
Treatment of Hyadatidiform Mole
−D&C reveals “cluster-of-grapes” tissue
−Methotrexate with HCG monitoring
−Hystrectomy for invasive disease
124
Complications of Hydatidiform Mole
* Pulmonary mets
* trophoblastic emboli
* ARD
125
Compare and contrast specifics of Complete mole vs Incomplete mole
126
Nonselective termination of pregnancy at \<20 weeks
Spontaneous Abortion
127
Common cause of 1st trimester bleeding
Spontaneous Abortion
128
History /PE of spontaneous abortion
1. Vaginal bleeding and tissue passage
2. Closed vs. open os
129
Evaluation of spontaneous abortion
1. B HCG
2. U/S
3. Culdocentesis
130
Treatment of spontaneous abortion
1. Stabalize
2. D&C =\>Complications e.g. perforation and hemorrhage
3. Antibiotics
4. RhoGAM if appropriate
131
Compare and contrast different types of spontaneous abortion
**Complete abortion**
\<20 weeks’. All products of conception (POC) expelled, Os closed, uterine bleeding
**Incomplete abortion**
\< 20 weeks’ gestation. Some POC expelled
Open os, bleeding
* D&C
**Threatened abortion**
\< 20 weeks. No POC expelled. Intact membrane, os closed, bleeding , viable fetus
Complete REST
**Inevitable abortion**
\<20 weeks’ gestation. No POC expelled, rupture membrane, os open, bleeding with cramps
* Emergent D&C
**Missed abortion**
No fetal heart tone. No POC expelled. Retain fetal tissue. Os closed. No bleeding
Nonviable tissue not expelled in 4 weeks
* Evacuate uterus
* D&C
**Septic abortion**
Infection associated with abortion; endometritis
* D&C, antibiotics
**Intrauterine fetal death**
No fetal heart tone
* D&C
132
Pathological consequences of abnormal entry of fluids, particulate matter or secretions into lower airways
Aspiration Pneumonia
133
S/S of aspiration pna
1. SOB
2. Bronchospasm
3. Fever
4. Pink and frothy sputum
5. Cx: infiltration in lower segments
6. ABG: hypoxia
7. Bacterial infection of lower airways
−Pyopneumothorax, pulmonary necrosis & abscess
134
Treatment of aspitation pna
1. Tracheal suction and lavage
2. Antibiotics
3. Mechanical ventilation
135
Loss of \>500 ml of blood within first 24 hrs of delivery
Postpartum Hemorrhage
136
Complications of postpartum hemorrhage are?
1. Hemorrhagic shock
2. Transfusion related risks
137
Causes of PPH
Uterine Atony is the most common cause
Genital Tract Trauma
Retained Placental Tissue
138
The most common cause of postpartum hemmorhage is?
Uterine atony
139
Comapare and contrast risk factors asscociated with different causes of postpartum haemmorhage
**_Uterine Atony_**
1. Over-distension of uterus ( multiple gestation, macrosomia)
2. Prolong labor
3. Uterine myomas
4. Mag sulf
5. GA
6. Uterine infection
**_Genital Tract Trauma_**
1. Precipitous labor
2. Forceps , vacuum extraction
3. Large infant
4. Inadequate episiotomy repair
**_Retained Placental Tissue_**
1. Placenta accreta/increta/percreta
2. Preterm delivery
3. P. Previa
4. Previous C/S or D&C
5. Uterine leiomyomas
140
Compare and contrast the diagnosis of different causes of PPH
**_Uterin Atony_**: Palpation of a softer, flaccid “boggy” uterus w/o firm fundus
**_Genital Tract Trauma:_** Careful examination, look for laceration
**_Retained Placental Tissue:_** Careful inspection for missing part of placenta. U/S
141
Compare and contrast treatment of different causes of PPH
**_Uterine Atony_**
1. Bimanual uterine message
2. MCC of PPH (90%)
3. Oxytocin infusion
4. Methylergonovine
5. PGF2a if not hypertensive
**_Genital Tract Trauma_**
1. Surgical repair of physical defect
**_Retained Placental Tissue_**
1. Manual removal of remaining placenta. D&C.
2. Placenta accreta/increta/percreta require hystrectomy
142
In OB venous air embolism occurs when?
Occur at the time of placental separation
Lodge in pulmonary arteries
143
What are the signs and symptoms of VAE
1. Mill-wheel murmur
2. Chest pain
3. SOB
4. Decreased end-tidal CO2
5. Elevated CVP
144
Put the patient anti-Trendelenburg position with left lateral tilt of 15° in case of VAE. This is to?
Increases chances of trapping air in right atrium from where air can be sucked out via CV cath
145
Steep Trendelenburg position increases chance of VAE during CS because?
It increases the gradient between heart and surgical field during Cesarean.
146
3rd leading cause of maternal death
Amniotic Fluid Embolism
147
Amniotic Fluid Embolism
* Rare but deadly; 3rd leading cause of maternal death
* Amniotic fluid gets into maternal circulation due to break in the uteroplacental membrane
148
S/S of amniotic fluid emboli
1. Chills
2. sudden onset of dyspnea(PE)
3. hypotension
4. hypoxia
5. coma
6. DIC
7. uterine atony
8. cardiopulmonary arrest
149
Treatment of Amniotic fluid embolism
1. Stabilization
2. Resuscitation
3. NaHCO3
4. Deliver ASAP
5. Dobutamine if LVH
6. Digitalis or frusemide if á CVP
7. Hydrocortisone
8. Check for DIC
150
BP \>140/90 mmHg after 20th week and resolve within 48 hrs after delivery
Pregnancy Induced Hypertension
151
Preeclampsia
* Hypertension (160/110), proteinuria (\> 5 g/day) and edema hand, face, lung
* Oliguria (\< 500 ml /day), headache, visual disturbance , hepatic tenderness, hyperreflexia
152
Eclampsia
(+)Seizures in preeclampsia
153
HELLP syndrome
high maternal and fetal mortality= Call for immediate delivery
**_H_**emolysis, **_E**_levated _**L**_iver enzymes, _**L**_ow _**P_**latelet count
154
Risk factors for PIH
1. Nulliparity
2. Extereme of age (\<15 or \>35)
3. Multiple gestation
4. Vascular disease due to SLE and DM
5. + family history
6. Chronic HTN
7. HELLP syndrome
155
Pathophysiology of PIH
1. Elevated thromboxane A2
2. Decreased PGI2
3. Elevated endothelin-1
4. Decreased NO
5. Elevatd renin
156
This condition mimics PIH
Cocaine abuse
157
What are the signs and symptoms of PIH
* Uterine vasospasm =\> uteroplacental insufficiency , low I/V volume, low GFR, edema , CNS dysfunctions
* Decreased uterine BF
158
The only cure for PIH is?
Delivery of baby
159
The first drug of choice in PIH is?
Labetalol
160
This antihypertensive should be avoided in managent of PIH due to adverse fetal effects
Esmolol
161
High dose of nitropruside will cause cyanide toxicity because?
Nitroprusside metabolism (hydrolysis) results in cyanide ion production. To treat cyanide toxicity give sodium thiosulfate to produce thiocyanate which is less toxic and is eliminated by the kidneys
162
Mag sulfate is used in PIH to?
prevent convulsions (Mag sulf antagonizes calcium)
163
Required level of magnesium in PIH =
4-6 mEq/L
164
Treatment of PIH
1. Only cure is delivery of baby
2. Monitor PT, PTT, platelet, FSP
3. Hydralazine and methyldopa to control HTN. Labetalol is drug of first choice
4. Esmolol should be avoided due to adverse fetal effects. M
5. High dose of nitroprusside =\> (S/E cyanide toxicity) WHY ??
6. Seizures require mag sulf and benzo
7. Mag Sulf to prevent convulsion (Mag sulf antagonizes calcium)
8. Magnesium depresses CNS by decreasing Acetylcholine release
9. Mechanism of action of magnesium
- Prevents Ca++ entry into cell=\> smooth muscle relaxation
Required level of magnesium = 4-6 mEq/L
165
Magnesium toxicity
−Absent deep tendon reflexes
−Ventilatory failure ( requires prompt intubation and ventilation)
−Heart block (Prolong PQ, wide QRS), cardiac arrest
−Hypotension
−Drowsiness and hypoventilation in fetus
−Atonic uterus
166
Treatment of magnesium toxicity
−D/C magnesium
−Intubation and ventilation
−IV calcium gluconate ( calcium antagonizes effects of magnesium)
167
Complications of PIH
1. Pulmonary edema/ cerebral hemorrhages (leading causes of maternal death)
2. DIC
3. Prematurity
4. Prematurity/fetal distress
5. Intrauterine growth retardation
6. Placental abruption
7. ARF, cerebral edema
8. Fetal/maternal death ; leading cause
168
Anesthesia complications of PIH
Avoid katamine as it causes HTN
169
Compare and contrast features of Mild preeclampsia, severe preeclampsia and Eclampsia
170
Compare and contrast management of preclampsis and Eclampsia
**_Management of Preeclampsia_**
1. If term or fetal lung mature; deliver
2. If severe; expedite delivery by induction or C/S
3. Bed rest, monitor BP, reflexes, weight and proteinuria
4. Control BP ; **diastolic \< 90-100**
5. Seizure prophylaxis by mag sulf
**_Management of Eclampsia_**
1. Supplemental O2
2. Mag sulf + benzo
3. Monitor fetal status
4. Initiate steps to delivery
171
The image below shows?
Retinal hemorrhage in HELLP
