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11 Cards in this Set

  • Front
  • Back
How dangerous are embolic phenomena in pregnancy
Second only to hemorrhage
Risk factors venous thromboembolism:
>35yrs age, hig parity, obesity, immobility, pelvic trauma, sugery during pregnancy, family hx, hereditary thrombophilia, pre-eclampsia, multiple gestation
Why are pregnant women at high risk for VTE?
Venous stasis (caval compression), hypercoagulability, damage to vessel wall; resolves 2 weeks post-partum
Treatment of thromboemoli:
Unfractionated heparin is administered to prolong aPTT 1.5-2x control;
Fractionated (low molecular wt. Heparin)
*Don't use coumadin b/c passes placenta
Can a patient receiving anticoagulants get a CLE for labor pain?
Yes, if interval passes before admin
Wait 2 hours after removing CLE before resuming LMWH
Switch a patient to unfractionated Heparin at 38weeks b/c it is reversible & monitorable
Summary of recommendations for regional anesthesia & anticoagulants:
1) if blood seen with puncture-wait 24hrs for dose of LMWH
2) Neuraxial aneshtesia shouldn't occur at least 10-12hrs after last dose of LMWH (longer if on higher doses)
3) First dose of LMWH given no sooner than 24hrs after neuraxial aneshtesia & indwelling catheters removed before LMWH initiation, first dose can be given 2 hrs after catheter removed
4) If pt. on LMWH & catheter in place do not remove for at least 10-12hr after last dose of LMWH
5)Safest neuraxial may be single-shot spinal
After getting the epidural the B/P drops in a patient with mitral valve stenosis, what med should be given?
Phenylephrine should be given b/c tachycardia NOT tolerated in MV dx; in aortic stenosis fluids should be given with drug (in valve dx there is a fixed SV, so to increase B/P best to increase SVR)
If the mitral stenosis patient goes into Afib, what should you do?
cardioversion if hypotension is serious, beta blocker with rapid onset (propanolol)
Postpartum backache:
d/t: softening of maternal ligaments & mechanical stresses of delivery;
2-Chloroprocaine associated with increased backache d/t preservatives but not on market anymore
Maternal Neurologic injury d/t:
-Compression of the lumbosacral trunk by the fetal head;
-Kinking or compression of the femoral, lateral femoral cutaneous, or peroneal nerves during lithotomy position
Which nerve is the most commonly injured during vaginal delivery?
Lumbosacral nerve