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Summer 2020 - APA Foundations 2 - OB > Preeclampsia, DM, PIH, Obesity, Hemorrhage, & Baby Resuscitation - Quiz 4 > Flashcards

Preeclampsia, DM, PIH, Obesity, Hemorrhage, & Baby Resuscitation - Quiz 4 Flashcards

1
Q

What is the most common medical problem of pregnancy?

A

Diabetes - hyperplasia of pancreatic beta-cells

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2
Q

What is the difference b/t Gestational Diabetes & Diabetes?

A

Gestational is when DM is first diagnosed in Pregnancy

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3
Q

What factors contribute to Gestational Diabetes?

A

Older Mom

Obesity

Family DM History

Hx of Stillbirth, Baby Death, Fetal Malformation , or Big Baby

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4
Q

Which trimester is Gestational Diabetes more prevalent?

A

2nd & 3rd Trimesters

Back to Normal after Delivery w/ High Recurrence rate

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5
Q

What are the Acute Complications of Gestational Diabetes?

A

DKA

Hyperglycemic NonKetotic State

Hypoglycemia

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6
Q

What are the Chronic Complications of Gestational Diabetes?

A

Macrovascular
(Coronary, Cerebrovascular, Peripheral Vascular)

Microvascular
(Retinopathy, Nephropathy)

Neuropathy
(Autonomic, Somatic)

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7
Q

What other conditions are associated w/ Gestational Diabetes?

A

HTN

Superimposed Preeclampsia

Polyhydraminios - excess amniotic fluid

C-Section

Nephropathy

Placental Insufficiency

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8
Q

What is the best way to Prevent Fetal Structural Abnormalities in regards to Gestational Diabetes?

A

Early Glycemic Control

Target A1c: 4-6%

> 6.5% = Vascular Disease

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9
Q

Type 1 Diabetes may cause Stiff Joint Syndrome, what do these patients look like?

A

Short Stature

Contractures

Tight Skin

Difficult Airway

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10
Q

How should Insulin be managed for Gestational Diabetes?

A

Preggos need more insulin in the 2nd & 3rd trimesters & less once labor starts and after delivery

Give Half of NPH + Sliding Scale or Insulin Drip

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11
Q

What can Diabetic Autonomic Neuropathy cause?

A

HTN

Ortho Hypotension

Painless MI

Decreased Response to Atropine & Propranolol

Neuro Bladder

Gastroparesis

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12
Q

What should be done for Protamine Sulfate Anaphylaxis from NPH?

A

Stop Protamine & Give Epinephrine

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13
Q

How does DKA affect the fetus?

A

Ketones cross placenta & decreases fetal oxygenation

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14
Q

True/False? Obese parturients require less Local Anesthetic and achieve higher blocks w/ no difference in pain?

A

True

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15
Q

What is the Third leading cause of Maternal Mortality?

A

Hypertension

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16
Q

What are the categories of Hypertension during Pregancy?

A

Chronic HTN

PIH

Preeclampsia-Eclampsia (Seizure)

Superimposed Preeclampsia

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17
Q

At what Diastolic BP does the risk of Placental Abruption & Fetal Growth Restriction increase?

A

DBP > 110

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18
Q

What BP is considered Pregnancy Induced Hypertension?

A

> 140/90 mmHg

Resolves 12wks postpartum

No Renal/Systemic Involvement

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19
Q

What is Preeclampsia?

A

New Onset HTN > 20 wks gestation or Early Postpartum

Resolves 48hrs Postpartum

Renal/Systemic Involvement

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20
Q

What can develop w/ Preeclampsia when there is Renal/Systemic Involvement?

A

Proteinuria

Oliguria

Headaches

Clonus

↑LFTs

Thrombocytopenia

DIC

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21
Q

What are the Risk Factors of Preeclampsia?

A

First Pregnancy

Black < 18 yo & > 35 yo

Prior History & Fam. History

DM, Renal Disease, HTN, Anti-Phospholipid

Twins

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22
Q

What are Preeclampsia Symptoms?

A

Vision Problems

Headache

Epigastric Pain

Increasing Edema & Weight

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23
Q

How can Preeclampsia cause a Difficult Airway?

A

Upper Airway Edema

Laryngeal Edema

Airway Obstruction

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24
Q

How does Preeclampsia affect the CV system?

A

↑CO

↑SVR

↑CVP or No Change

↓Plasma Volume

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25
Q

What are the Pulmonary Effects of Preeclampsia?

A

↓Oncotic Pressure

Capillary Leak

Vasoconstriction

↑PAWP

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26
Q

What are the Liver problems associated w/ PIH or Preeclampsia?

A

Periportal Hemorrhage

Ischemic Legion

Swelling

Epigastric Pain

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27
Q

What are the Renal Effects of Preeclampsia?

A

Proteinuria

ARF w/ Oliguria

↑BUN

↓GFR & Clearance

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28
Q

How does Preeclampsia affect the Uterus?

A

↑Activity

Oxytocin Sensitivity

PTL

↑Abruption Risk

↓UBF

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29
Q

What is the leading cause of Maternal Death relating to PIH?

A

Intracranial Hemorrhage

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30
Q

What are Fetal Complications of Preeclampsia?

A

Abruptio Placentae

IUGR

PTL

Death

31
Q

What is HELLP Syndrome?

A

Hemolysis

Elevated Liver Enzymes

Low Platelets

32
Q

What are symptoms of HELLP Syndrome?

A

Malaise

Epigastric Pain

N/V

Mutli-System Failure

Self-Limiting

33
Q

What type of Anesthesia is Contraindicated in HELLP Syndrome?

A

Regional

34
Q

What should be closely monitored in HELPP Syndrome?

A

Platelet count

Hemostasis not a problem til < 40,000

35
Q

What is the Definitive Cure for HELLP Syndrome?

A

Delivery

Platelets will normalize 72 hrs after

36
Q

What is the drug of choice for treating Preeclampsia?

A

Mag Sulfate - narrow therapeutic index - used to prevent seizure

Mag goal of 4 - 6 mmol/L

37
Q

What is the concern when using Sodium Nitroprusside to control HTN in the parturient?

A

Fetal Cyanide Toxicity

38
Q

What should be given for Mag Sulfate Toxicity?

A

Calcium Gluconate IV

39
Q

What happens w/ a Mag Level of 5-10?

A

Wide PR & QRS

40
Q

What happens w/ a Mag Level of 11 - 14?

A

Depressed Tendon Reflexes

41
Q

What happens w/ a Mag Level of 15 - 24?

A

SA, AV Block & Resp. Paralysis

42
Q

At what level of Magnesium will the patient go into Cardiac Arrest?

A

> 25 mEq/L

43
Q

What meds can be given to Blunt the Laryngeal Response?

A

Hydralazine

Nitroglycerin

Labetalol

44
Q

How does Magnesium Sulfate affect NMBs & Pressors?

A

Enhances all NMBs

&

Inhibits catecholamine release and blunts pressor response

45
Q

What is Placenta Previa?

A

Painless Vaginal Bleeding

Complete Previa = Full Cervical Os Coverage by Placenta

46
Q

Are Regionals contraindicated for Placenta Previa?

A

No. Ok for Regional if patient is stable

47
Q

What is Placenta Accreta?

A

When Placenta is attached abnormally deep thru the endometrium to the myometrium

48
Q

Whats the difference b/t Accreta, Increta, and Percreta?

A

Accreta: no myometrium penetration

Increta: further into myometrium

Percreta: all the way thru myometrium into the serosa

49
Q

After the baby has been delivered, there is still no delivery of the placenta after 30 minutes, what should you suspect?

A

Placenta Accreta

50
Q

What factors increase the risk for Placenta Accreta?

A

Placenta Previa

Uterine Scar d/t D&C, C/S, Myomectomy

Asherman’s Syndrome

Thin Placental Decidua

51
Q

How is Placenta Accreta treated?

A

C-Section

Hysterectomy

Myometrium Resection*

Pelvic Artery Embolization*

Balloon Tamponade*

(*utereus-sparing)

52
Q

What is the most common cause of Intrapartum Fetal Death?

A

Abruptio Placentae - premature separation of placenta w/ painful vaginal bleed

53
Q

What are the risk factors associated w/ Abruptio Placentae?

A

HTN

Trauma

Cocaine & ETOH

Abnormal Uterine Structure

Multiparity

54
Q

What are risk factors for Uterine Rupture?

A

Prior C/S

Hx Myomectomy

Prolong Labor w/ Oxytocin

Big Uterus

55
Q

What are signs and symptoms of Uterine Rupture?

A

Sudden Severe Fetal Distress

Severe Abd. Pain even w/ Epidural

Bleeding

56
Q

What should be done once a Uterine Rupture has been identified?

A

Restore Volume

&

Emergent Lapartomy under GA

57
Q

How much blood loss would be considered Postpartum Hemorrhage?

A

> 500 cc

58
Q

What causes Postpartum Hemorrhage?

A

Uterine Atony

Uterine Overdistension d/t Twins or Polyhydramnios

Uterine Inversion

Perineal Laceration

Retained Placenta

59
Q

How is Uterine Atony treated?

A
  • Oxytocin IV
  • Methylergonovine (Methergine) IM - can cause HTN IV
  • Hemabate - prostaglandin IM - can cause Bronchospasm
60
Q

Which condition is sometimes referred to as an Anaphylactoid Syndrome of Pregnancy?

A

Amniotic Fluid Embolism that can happen b/t labor & postpartum where amniotic fluid gets into mom’s circulation

85% Mortality

61
Q

What are signs & symptoms of an Amniotic Fluid Embolism?

A

Sudden Tachypnea

Cyanosis

Shock

Generalized Bleeding (DIC)

Uterine Atony

62
Q

What is the normal Fetal Heart Rate?

A

120 - 160 bpm

< 120 = Asphyxia

63
Q

What is Short Term Variability for Fetal Heart Rates?

A

3 - 6 bpm

Reduced by CNS Depressants

64
Q

What is Long Term Variability in Fetal Heart Rates?

A

15 - 40 Accelerations per hour w/ fetal movement

Decreases w/ Fetal Sleep

65
Q

What kind of Fetal Heart Decelerations are NOT associated w/ Fetal Distress?

A

Early Decelerations from Vagal Response d/t head compression

66
Q

What kind of Fetal Heart Decelerations signify Uteroplacental Insuffiency & Decreased O2 Supply?

A

Late Decelerations - Fetal Distress

67
Q

_____ decelerations are related to cord compression

A

Variable Decelerations

>70 bpm & > 60 secs = Fetal Asphyxia

68
Q

What is the Normal ABG for a Neonate?

A

pH: 7.25 - 7.35

pCO2: 40 - 50 mmHg

pO2: 20 - 30 mmHg

Base: < 10

69
Q

How is a baby’s Apgar Scored?

A

Respirations

Crying

Reflex

Irritability

Skin Color

Muscle Tone

@1 Minute & @5 Minutes

70
Q

What should be done if the Apgar is < 7 @ 5 Minutes?

A

Repeat Apgar q5 min for 20 min or until two successive Apgars of 7 or more

71
Q

When resuscitating the neonate, what should be done?

A
  • Suction Muconium
  • BMV w/ 40 peep initially, the keep pressure < 30 cm H20 after
  • RR should be 30 - 60 /min
  • HR should be > 100 bpm
  • Start CPR & Intubate if HR at 60-80 and not rising
72
Q

What is the Normal Neonate BP?

A

For 1-2 kg
50/25

>3 kg
70/40

If Low BP, give fluids @ 10cc/kg

73
Q

What can cause Hypotension in the Neonate?

A

Hypoglycemia

Hypermagnesemia

Hypocalcemia

74
Q

True/False: Dosing is the same when giving meds through an ETT for both Pediatric & Neonatal Resuscitation?

A

FALSE

Pediatric Resuscitation needs higher dose thru ETT

Higher doses thru ETT NOT recommended for Neonatal Resuscitation

Summer 2020 - APA Foundations 2 - OB (4 decks)

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