OB exam three
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Classic triad of AFE
Amniotic fluid embolism
- 1. Hypoxia
- 2. hemdynamic collapse
- 3. coagulopathy without obvious precipitated cause
What is the primary factor that determines the diagnosis of AFE?
Speed of onset of symptoms
Right heart failure is the principle hemodynamic alteration
Hallmark sign of Venous Air Embolism
Mill-wheel murmur over the precordium
Chest pain, dyspnea, decreased EtCO2, elevated CVP
What are non-reassuring fetal heart rates?
< 60 or > 160
Placenta previa definition
- Painless vaginal bleeding with the
- placenta covering all or part of the cervix
Three types of placenta previa
- Marginal (partial)
Marginal and complete must have C-Section.
- (2) 16 or 18 g PIVs
- Blood pump IV set primed
- 2 units blood in the room
- skilled assistant
- sterile prep and drape
IF the patient is bleeding and needs a C-section, what anesthetic drugs should you choose?
- Induce with ketamine (1mg/kg) and succ. (1.5mg/kg)
- Use cricoid pressure
- awake extubation
- 50% N2O and O2
Placenta Accreta definition
placental implantations directly onto or into the myometrium giving rise to one of three conditions
Incidence increases with uterine incisions
Placenta accrete vera
placenta implantation just onto the myometrium
placental implantation into the myometrium
Placental implantation penetrating the myometrium thru the full thickness of the myometrium and possibly onto other abdominal contents
Methotrexate after delivery may facilitate placental involution
separation of normally implanted placenta after 20 weeks and before birth
Painful vaginal bleeding!!!
How much blood can be sequestered in the uterus?
Name the classifications of abruptio placenta
What is the major fetal risk with abruptio placneta?
What is the definitive management of abruptio placenta?
Empty the uterus
Uterine rupture most reliable sign
Fetal distress- non-reassuring heart tones with variable decels
- other S&S:
- vaginal bleeding, severe uterine or lower abd. pain, shoulder pain, severe maternal hypotesion/shock, loss of fetal heart tones
shows fetal head compression with descent into canal
Fetal heart rates changes with contractions
fetal heart rate decreases after the contraction is over
- Fetal heart rate decreases not correlated with contractions
- Umbilical cord compression usual culprit
- Usually not bad unless FHT <60 or >160
Left or right uterine displacement then Oxygen then fluids then ephedrine
Defined as blood loss greater than 500ml after delivery, or as a 10% decrease in HCT from admission to the postpartum period or need to administer PRBC
Primary postpartum hemorrhage
- occurs during first 24 hours after delivery
- more likely to result in maternal morbidity or mortality
secondary postpartum hemorrhage
occurs between 24 hours and 6 weeks postpartum
What can you give to relax the uterus if exploration is necessary?
- inhalational anesthetics
- 50-100 mcg NTG
What is the main goal with uterine inversion?
Get it back inside before the cervix begins to contract
Transfusion related acute lung injury
- Non-cardiogenic pulmonary edema from leukocyte antibodies a few hours after transfusion
- Reactions most commonly caused by ABO incompatible blood
Fever, chills, nausea, flushing, chest and flank pain
What can you give to get potassium back into the cells?
What can you give to combat the citrate in the PRBCs?
Placenta previa has abnormal placental _________
Placenta accreta has abnormal placental ________
Abruptio placenta has _________ of the placenta with the uterus
5 ratings of apgar scale
- A-appearance (skin color)
- P- pulse
- G- grimace
- A- activity
Ratings at birth and 5 minutes
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