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40 Cards in this Set
- Front
- Back
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Mechanisms of ANTEPARTUM hemorrhage
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Placenta Previa
Placental abruption Uterine Rupture Spont. abortion Ectopic pregnancy Vasaprevia |
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Mecanisms of POSTPARTUM hemorrhage
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Uterine atony
Retained placenta Placenta accreta Uterine inversion |
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What are the eligibility criteria for VBAC?
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One previous C-section
Lower uterine segment incision Adequate Pelvis OB & Anesthesia immediately available |
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Advantages of VBAC:
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Decreased incidence of: postpartum transfusion, fever, and duration of hospitalization
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What are the risks of VBAC?
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Uterine rupture (triple risk)
Uterine wound dehiscence (Induction with prostaglandins increases rupture risk by factor of 15) |
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What are signs of uterine rupture?
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-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 |
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How is uterine rupture treated?
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Emergent delivery (GETA)
Repair of uterus vs. TAH Volume resuscitation of mother |
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What is placenta previa?
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An abnormal implanation of the placenta over or close to the cervical os. Can be complete, partial, or marginal
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S/S of placenta previa:
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Painless 2nd or 3rd trimester bleeding
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Risks for placenta previa:
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Multiparous, prior C-section, prior hx, myomectomy hx
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Mechanisms of ANTEPARTUM hemorrhage
|
Placenta Previa
Placental abruption Uterine Rupture Spont. abortion Ectopic pregnancy Vasaprevia |
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|
Mecanisms of POSTPARTUM hemorrhage
|
Uterine atony
Retained placenta Placenta accreta Uterine inversion |
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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
|
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What are the risks of VBAC?
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Uterine rupture (triple risk)
Uterine wound dehiscence (Induction with prostaglandins increases rupture risk by factor of 15) |
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What are signs of uterine rupture?
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-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 |
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How is uterine rupture treated?
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Emergent delivery (GETA)
Repair of uterus vs. TAH Volume resuscitation of mother |
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What is placenta previa?
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An abnormal implanation of the placenta over or close to the cervical os. Can be complete, partial, or marginal
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S/S of placenta previa:
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Painless 2nd or 3rd trimester bleeding
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Risks for placenta previa:
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Multiparous, prior C-section, prior hx, myomectomy hx
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Treatment of placenta previa:
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Delivery at 32 weeks via C-section;
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What is placenta accreta?
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Accreta-placenta adheres to myometrium
Increta-placenta invades myometrium Percreta-penetrates the full thickness of myometrium |
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Placental Abruption:
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-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 |
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S/S of Placental Abruption:
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Vaginal bleeding with uterine tenderness--there is pain with abruption
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How is the patient with abruption managed?
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If stable and labs okay can do regional with vaginal delivery, if not then c-section with GETA
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What is the principal concern during a C-section for abruption?
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Maternal hemorrhage
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Damage to which layer of the uterus is of most concern?
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Myometrium (middle, muscular layer); Blood vessels & nerves are located here & involution may not be possible
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Uterine inversion:
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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
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What is the treatment of uterine inversion?
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Replace uterus ASAP, volatile agents may be needed to relax uterus, NTG 100-500mcg IV for relaxation
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What are the anesthetic considerations for uterine inversion?
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Place large bore IV, give warm fluids, admin GA with volatile agent, have blood available, O2, ETT with RSI
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What drug should be administered after the uterus is replaced?
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Oxytocin, use nitrous/narcotic technique (d/c volatile agent)
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Name two reasons for postpartum maternal hemorrhage:
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Uterine atony
Retained placenta |
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Uterine atony:
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Most common cause of post partum bleeding; severe hemorrhage can occur; Risk factors: uterine overdistention (twins/polyhydramnios) and chorioamnionitis
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How is uterine atony treated?
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Fluid replacement, IV oxytocin, methylergonovine, 15-Methyl prostaglandin F2 alpha, O2, Trendelenburg, Monitor B/P, UO, CVP, uterine massage, volatile agents
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What are the actions and side effects of oxytocin?
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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 |
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Oxytocin should be avoided in which patients?
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-HTN
-Pre-eclamptic (but, commonly given to these pt's to induce) -Heart Disease |
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What are the actions and side effects of methylergonovine?
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-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 |
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What are the actions and side effects of 15-methyl prostaglandin F 2 alpha (Hemabate)
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-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 |
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What is a retained placenta?
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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
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How is anesthesia for retained placenta managed?
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Regional/Local/GETA
-Uterus need explored=needs relaxed=Volatile agents >1MAC, IV sedation, NTG, redose CLE; may be hypovolemic-check H&H |
