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40 Cards in this Set

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Mechanisms of ANTEPARTUM hemorrhage
Placenta Previa
Placental abruption
Uterine Rupture
Spont. abortion
Ectopic pregnancy
Vasaprevia
Mecanisms of POSTPARTUM hemorrhage
Uterine atony
Retained placenta
Placenta accreta
Uterine inversion
What are the eligibility criteria for VBAC?
One previous C-section
Lower uterine segment incision
Adequate Pelvis
OB & Anesthesia immediately available
Advantages of VBAC:
Decreased incidence of: postpartum transfusion, fever, and duration of hospitalization
What are the risks of VBAC?
Uterine rupture (triple risk)
Uterine wound dehiscence
(Induction with prostaglandins increases rupture risk by factor of 15)
What are signs of uterine rupture?
-Non-reassuring FHR pattern
-Uterine or abd pain
-Loss of station of presenting part
-Vaginal bleeding
-Hypovolemia
-If have working epidural & have onset of shoulder pain
How is uterine rupture treated?
Emergent delivery (GETA)
Repair of uterus vs. TAH
Volume resuscitation of mother
What is placenta previa?
An abnormal implanation of the placenta over or close to the cervical os. Can be complete, partial, or marginal
S/S of placenta previa:
Painless 2nd or 3rd trimester bleeding
Risks for placenta previa:
Multiparous, prior C-section, prior hx, myomectomy hx
Mechanisms of ANTEPARTUM hemorrhage
Placenta Previa
Placental abruption
Uterine Rupture
Spont. abortion
Ectopic pregnancy
Vasaprevia
Mecanisms of POSTPARTUM hemorrhage
Uterine atony
Retained placenta
Placenta accreta
Uterine inversion
What are the eligibility criteria for VBAC?
One previous C-section
Lower uterine segment incision
Adequate Pelvis
OB & Anesthesia immediately available
Advantages of VBAC:
Decreased incidence of: postpartum transfusion, fever, and duration of hospitalization
What are the risks of VBAC?
Uterine rupture (triple risk)
Uterine wound dehiscence
(Induction with prostaglandins increases rupture risk by factor of 15)
What are signs of uterine rupture?
-Non-reassuring FHR pattern
-Uterine or abd pain
-Loss of station of presenting part
-Vaginal bleeding
-Hypovolemia
-If have working epidural & have onset of shoulder pain
How is uterine rupture treated?
Emergent delivery (GETA)
Repair of uterus vs. TAH
Volume resuscitation of mother
What is placenta previa?
An abnormal implanation of the placenta over or close to the cervical os. Can be complete, partial, or marginal
S/S of placenta previa:
Painless 2nd or 3rd trimester bleeding
Risks for placenta previa:
Multiparous, prior C-section, prior hx, myomectomy hx
Treatment of placenta previa:
Delivery at 32 weeks via C-section;
What is placenta accreta?
Accreta-placenta adheres to myometrium
Increta-placenta invades myometrium
Percreta-penetrates the full thickness of myometrium
Placental Abruption:
-Associated with HTN, ETOH, cocaine
-Can be pre or intra partum
-Leading cause of DIC b/c activates intrinsic pathway **assess coag status before admin regional
S/S of Placental Abruption:
Vaginal bleeding with uterine tenderness--there is pain with abruption
How is the patient with abruption managed?
If stable and labs okay can do regional with vaginal delivery, if not then c-section with GETA
What is the principal concern during a C-section for abruption?
Maternal hemorrhage
Damage to which layer of the uterus is of most concern?
Myometrium (middle, muscular layer); Blood vessels & nerves are located here & involution may not be possible
Uterine inversion:
Part or all of Uterus turns inside out, after delivery the OB/GYN reports a mass in vagina & hemorrhage; Risk factors: uterine atony, inappropriate fundal pressure, umbilical cord traction, uterine anomalies, or placenta accreta
What is the treatment of uterine inversion?
Replace uterus ASAP, volatile agents may be needed to relax uterus, NTG 100-500mcg IV for relaxation
What are the anesthetic considerations for uterine inversion?
Place large bore IV, give warm fluids, admin GA with volatile agent, have blood available, O2, ETT with RSI
What drug should be administered after the uterus is replaced?
Oxytocin, use nitrous/narcotic technique (d/c volatile agent)
Name two reasons for postpartum maternal hemorrhage:
Uterine atony
Retained placenta
Uterine atony:
Most common cause of post partum bleeding; severe hemorrhage can occur; Risk factors: uterine overdistention (twins/polyhydramnios) and chorioamnionitis
How is uterine atony treated?
Fluid replacement, IV oxytocin, methylergonovine, 15-Methyl prostaglandin F2 alpha, O2, Trendelenburg, Monitor B/P, UO, CVP, uterine massage, volatile agents
What are the actions and side effects of oxytocin?
Increases the frequency & intensity of uterine smooth muscle contractions;
Side Effects: can decrease SBP, DBP, increase HR, cause arrythmias; Antidiuretic effect can lead to H2O intoxication; tetanic contractions
Oxytocin should be avoided in which patients?
-HTN
-Pre-eclamptic (but, commonly given to these pt's to induce)
-Heart Disease
What are the actions and side effects of methylergonovine?
-Causes intense & prolonged uterine contractions-alpha agonist effect in uterus
-Can cause severe HTN
-Methergine 0.2mg IM
-Methergine is given SLOWLY IV >60sec as life saving measure
What are the actions and side effects of 15-methyl prostaglandin F 2 alpha (Hemabate)
-Effective uterotonic-increases intracellular Ca+ in myometrium
-215mcg Q 15min max 2mg
-Can be given IM or into myometrium
-**Can cause bronchospasm or altered V/Q ratios
What is a retained placenta?
Placenta is retained & uterus can't contract b/c not empty & arteries of the decidua basalis will continue to bleed; If 3rd stage of labor lasts >30min the MD will try manual removal of placenta
How is anesthesia for retained placenta managed?
Regional/Local/GETA
-Uterus need explored=needs relaxed=Volatile agents >1MAC, IV sedation, NTG, redose CLE; may be hypovolemic-check H&H