Obstetrics Flashcards
What bp is considered preeclampsia in pregnant women?
greater than 140/90. They usually have vision problems too
What is seizures in pregnancy called?
Eclampsia (if they result from high blod pressure) I.e. Gestatational proetinuric hypertension (GPH).
What is the most common cause of seizures in pregnant women?
Epilepsy
What is placenta Previa?
Where the placenta is lying across the cervix (the opening to the uterus)
What are the signs of placenta previa?
Uncontrolled frank blood PV bleed
Usually painless
May present with shock (will need to be transported)
What are the changes to a womans body during pregnancy?
Increased oxygen consumption Raised diaphragm/ribs (so harder to compensate with breathing) Increased cardiac output increased blood volume Increased coagulation Uterus grows Uterus may compress inferior vena cava Skeletal ligaments and muscles relax increased skin pigmentation Kidneys work harder Gut slows down Gestational diabetes Increase in oestrogen and progestrone
What are causes of bleeding in non pregnant women?
Abnormally heavy menstrual bleeding (menorrhagia)
Traumatic injuries
Infection/sexually transmitted diseases
What are causes of PV bleeding up to 20 weeks?
Threatened spontaneous abortion
Inevitable spontaneous abortion
Complete spontaneous abortion
Ectopic pregnancy
What is an ectopic pregnancy?
An embryos implants itself at a site outside of the uterus
Embryo implants in Fallopian tube
Leads to death of fetus and is life threatening to the mother
Growing fetus may cause the Fallopian tube to rupture at around 5-7 weeks
Pain, massive blood loss
What is spontaneous abortion?
Miscarriage
Generally prior to 24 weeks gestation
When does spontaneous abortion require transport?
When:
Pain is significant
Pain is different to that of menstrual pain
Bleeding is clinically significant
What is antepartum haemorrhage?
PV bleeding from 20-40 weeks pregnancy
All patients should be transported to hospital
What is placental abruption?
Bleeding due to premature separation of the placenta from the uterine wall.
Although bleeding can be significant, it can be concealed in the uterus in 20% of cases.
May be present with pain an PV bleeding
How may placental abruption present?
Over 20 weeks pregnant May be PV bleeding Pain Shock Sepsis Fetal compromise
How do we recognise shock in pregnant women?
Pregnant women have an increased blood volume and can lose more than one litre of blood without showing signs of shock.
If they are showing signs of shock then by definition it is already severe.
What is hypertension in pregnancy?
Blood pressure greater than 140/90mmHg (or a 20mmHg rise in bp)
What is GPH?
Gestational Proteinuric Hypertension
What is placental abruption?
Bleeding due to premature separation of the placenta
Massive bleeding
Can be partial or complete
Pain/PV bleeding (bright red blood)
Massive maternal haemorrhage, shock, sepsis, fetal compromise
Bleeding can be internal so important to look for signs of shock
What is preeclampsia (GPH)?
Hypertension with protein in the urine, with or without generalised oedema.
Associated with liver and renal failure, cerebral ischemia and fetal growth restrictions.
How are seizures associated with GPH?
Preeclampsia may progress to where seizures occur.
Seizures with GPH can lead to fetal or maternal death or permanent CNS damage.
How do we manage GPH?
Manage airway, breathing and circulation and call for back up.
Keep noise and stimuli to a minimum.
How do we manage premature labour?
Transport immediately to hospital.
Prepare for neonatal resuscitation.
What is premature labour?
Onset of labour prior to 37 weeks gestation.
What is supine hypotension?
Low blood pressure while lying supine. Commonly occurs in pregnant women as the weight of the baby impedes venous return through the vena cava.