Obstetric Emergencies

Question 1

What is the risk of uterine rupture with a previous LTCS?

Answer 1

0.5 - 0.9%

Question 2

What is the risk of uterine rupture with a previous classical cesarean section?

Answer 2

4-9%

Question 3

What is the risk of uterine rupture with a previous T shaped incision?

Answer 3

1 - 7%

Question 4

In a shoulder dystocia what is the rate of pH decrease per minute?

Answer 4

0.04 unit/min

Question 5

In a shoulder dystocia, how long does it take for the pH to go from 7.2 –> 7.0

Answer 5

5 minutes

Question 6

What percent of shoulder dystocias are resolved with the McRoberts maneuver alone?

Answer 6

42%

Question 7

What is the definition of the woodscrew maneuver?

Answer 7

anterior pressure applied to the posterior shoulder, abducts the shoulder

Question 8

What is the definition of the Rubin maneuver?

Answer 8

posterior pressure applied to the anterior shoulder, adducts the shoulder

Question 9

What is the Zavanelli maneuver?

Answer 9

replacement of the fetal head into the uterus, delivery by cesarean section

Question 10

What maneuver has the highest rate of success compared to other maneuvers during shoulder dystocia?

Answer 10

Delivery of the posterior arm, 85% successful

Question 11

What are the initial maneuvers that should be attempted during a shoulder dystocia?

Answer 11

McRoberts, Suprapubic pressure

Question 12

What is the average blood loss at time of SVD?

Answer 12

500

Question 13

What is the average blood loss at the time of CS delivery?

Answer 13

1000

Question 14

What is the average blood loss at the time of planned cesarean hysterectomy (Accreta)?

Answer 14

1400

Question 15

What is the average blood loss at the time of emergent cesarean hysterectomy?

Answer 15

3000 - 3500

Question 16

What is the most common cause of PPH?

Answer 16

Uterine atony 70 - 80%

Question 17

What is the dose and timing that you can give Methergine during a PPH?

Answer 17

0.2 mg IM q 2-4 hrs

Question 18

What is the dose and timing that you can give hemabate during a PPH?

Answer 18

0.25mg IM q 15 minutes

Question 19

What is the dose and timing that you can give Misoprostal during a PPH?

Answer 19

600 - 1000mcg PO, PR, SL

Question 20

What is the incidence of Accreta with history of 0 prior CS delivery and known placenta previa?

Answer 20

3%

Question 21

What is the incidence of Accreta with 1 prior CS delivery and known placenta previa?

Answer 21

11%

Question 22

What is the incidence of Accreta with history of 2 prior CS delivery and known placenta previa?

Answer 22

40%

Question 23

What is the incidence of Accreta with history of 3 prior CS delivery and known placenta previa?

Answer 23

61&

Question 24

What is the incidence of Accreta with history of >4 prior CS delivery and known placenta previa?

Answer 24

67%

Question 25

What is the incidence of Accreta with history of >5 prior CS delivery and no known placenta previa?

Answer 25

4.7%

Question 26

TXA is what type of medicine?

Answer 26

Antofibrinolytic

Question 27

How do you dose TXA?

Answer 27

1g IV infusion over 10 minutes

Question 28

What risk does TXA reduce?

Answer 28

reduces PPH related death by 20 - 30% when given within 3 hrs of delivery

Question 29

In setting of hemorrhage, in what ratio should you give crystalloid to blood loss?

Answer 29

3:1 ratio to EBL

Question 30

What is the typical volume of 1 U PRBCs

Answer 30

300 cc

Question 31

1 unit PRBC increases the hgb by ____ and the HCT by ____.

Answer 31

1, 3 %

Question 32

What is the typical volume of 1 Unit of platelets

Answer 32

50 cc

Question 33

What is the typical volume of a 6 pack of platelets

Answer 33

300 cc

Question 34

1 unit increases the plt count by ____

Answer 34

75K

Question 35

a 6 pack of plts increases the plt count by

Answer 35

45K

Question 36

What are the indications to transfuse plts following vaginal delivery?

Answer 36

plts < 20 or DIC

Question 37

What are the indications to transfuse plts following a CS?

Answer 37

plts < 50 or DIC

Question 38

What is the typical volume of 1 U FFP?

Answer 38

250 cc

Question 39

What are the components of FFP?

Answer 39

Fibrinogen, antithrombin, factors V, XI, XII

Question 40

1 unit of FFP increases the fibroinogen level by _____

Answer 40

5-10mg/dL

Question 41

What are the indications to give FFP?

Answer 41

DIC (Fibrinogen < 200), Coagulopathic liver disease, wafarin reversal

Question 42

What is the typical volume of 1 unit of Cryoprecipitate?

Answer 42

40 cc

Question 43

What are the components of cryoprecipitate?

Answer 43

Fibrinogen, vWF, factor VIII, XIII

Question 44

What is the current recommended ratio of PRBC:plt: FFP during a massive transfusion?

Answer 44

1:1:1

Question 45

What is the mortality rate associated with maternal amniotic fluid embolism?

Answer 45

80%

Question 46

What is the pathophysiology of an amniotic fluid embolism?

Answer 46

Anaphylactic reaction to fetal cells/amniotic fluid that enter maternal circulation