Reproductive system II part 2 (LECOM ISP)

Laceration involves vaginal epithelium or perineal skin

First degree

Laceration involves subepithelial tissues

Second degree

Laceration involves the anal sphincter

Third degree

Laceration involves the rectal mucosa

Fourth degree

Occult bleeding (like a uterine hematoma) is manifest as what, post-delivery?

Vaginal pain

After delivery, how would hypovolemia due to bleeding manifest itself?

An increase in heart rate

Artificial rupture of the membranes

Amniotomy

Localized, edematous swelling of the baby's head caused by pressure from the cervix

Caput

What can be applied locally to promote cervical ripening?

Prostaglandin E1 (tablet)
Prostaglandin E2

Why is oxytocin given intravenously?

Easy to stop

Excessive infusion of oxytocin causes hyperstimulation, which leads to what for the baby?

Ischemia

Excessive hyperstimulation of the uterus can lead to a tetanic contraction of the uterus - causing it to what?

Rupture

Oxytocin has a similar structure to what renal hormone?

ADH

Excessive oxytocin can cause water retention, leading to what?

Water intoxication

What are the signs of water intoxication?

Convulsions
Coma

Prolonged use of oxytocin can cause uterine muscle fatigue - this increases the chances of what two conditions?

Hypotonus of the uterus
Hemorrhage

Uterine discharge color for 3 days following delivery

Red

Uterine discharge from day 3 to day 10

Pale pink or brown

Uterine discharge after day 10

White

Source of pain in the early stages of labor

Visceral pain

Opioid narcotics that can relieve pain in early labor, thanks to short neo-natal halflife

Fentanyl
Nalbuphine

Reason opioids are dangerous during labor>?

Depress fetal respiration

Most effective analgesia during labor

Neuraxial analgesia

How do you start out an epidural infusion?

With a bolus of local anesthetic and narcotic

What local anesthetic do you use in an epidural?

Any of the "caines

What narcotic do you use in an epidural?

Fentanyl
Sufentanil

Why do you try to minimize motor block in an epidural?

So mom can push

What nerves does a pudendal nerve block numb?

Somatic afferent nerves at S2-S4

What part of labor does a pudendal nerve block help with?

Episiotomy, perineal pain

What part of labor does a pudendal nerve block NOT help with?

Uterine contractions

Absolute Contraindications to regional anesthesia

Coagulopathy
Infection at needle insertion site
Hypovolemia with blood loss

Relative contraindications to regional anesthesia

Prior back surgery
Cardiac lesions
Increased intracranial pressure

All patients requiring anesthesia require what?

Airway exam

What do you always administer along with anesthesia?

An antacid

For elective or non-urgent C-section, why is regional anesthesia preferred to general anesthesia?

Because the airway is maintained

What is the leading cause of anesthetic-related maternal mortality?

Loss of airway

Faster onset: block or epidural?

Block

General anesthesia in C-section: 3 situations

-Extreme urgency
-Regional anesthesia has failed
-Regional anesthesia is contraindicated

Induction agents for general anesthesia

Propofol
Thiopental
Etomidate
Ketamine

Muscle relaxant used to intubate?

Succinylcholine

Why do you wait for the patient to be fully awake before you extubate?

Minimize risk of aspiration

Normal APGAR score at 1 minute

7 or better at 1 minute

Normal APGAR score at 5 minutes

9 or 10

5 categories assessed in an APGAR test

Heart rate
Respiratory effort
Muscle tone
Reflex irritability
Colour

Most common causes of maternal death (HEMI)

Hemorrhage
Embolism
Hypertensive disease
Infection

Potential causes of third-trimester bleeding

Placenta previa
Abruptio placenta
Preterm labor

Most accurate method to determine cause of antepartum bleeding

Ultrasound

Predisposing factors for placenta previa

Multiparity
Older age
Prior placenta previa
Previous pregnancies

Placenta completely covers os of cervix

Complete placenta previa

Placenta partially covers os of cervix

Partial placenta previa

Placenta covers margin of os

Marginal placenta previa

Patient has painless vaginal bleeding

Placenta previa

If the patient with placenta previa reaches 36 weeks, fetal lung maturity should be determined how?

Amniocentesis

How is a low-lying placenta different from a placenta previa?

Low-lying placenta is within 2 cm of the endocervical os

What is the most common predisposing factor for abruptio placenta?

Maternal hypertension

Patient presents with PAINFUL vaginal bleeding, uterine tenderness, hyperactivity, and increased tone

Abruptio placenta

What is the most common cause of DIC in pregnancy?

Placental abruption

An abrupt placenta releases what into the maternal circulation?

Thromboplastin

Severe abruption can cause what two systemic problems?

Hypovolemic shock and acute renal failure (due to hemorrhage)

Coagulation from placenta abruptia can cause what pituitary necrosing disorder?

Sheehan's syndrome

What blood loss volume is indicative of postpartum hemorrhage during vaginal delivery?

500 mL

What blood loss volume is indicative of postpartum hemorrhage in C-section?

1000 mL

What causes delayed postpartum hemorrhage?

Disruption of "scab" or retention of placental fragments that separate later

Where does most of the blood loss occur in postpartum hemorrhage?

Myometrial spiral arterioles and decidual veins

What drug, used for treatment of preeclampsia, can lead to uterine atony?

Magnesium sulfate

What causes most postpartum hemorrhages?

Uterine atony

How can you fix hemorrhage due to uterine atony?

Oxytocin

If oxytocin doesn't fix uterine atony, what else can you use? (2)

Ergonovine or
methyergonovine

What is the second most common cause of postpartum hemorrhage?

Genital tract trauma

C-section increases your chances of febrile morbidity by how much?

2x

Rising fever and increasing uterine tenderness 2 or 3 days postpartum?

Puerperal sepsis

After birth, the pH of the vagina changes - how?

Goes from acidic to alkyline

The newly alkaline environment of the vagina after birth is an ideal environment for what kind of organisms?

Aerobic

About 48 hours after birth, the endometrial and placental remnants undergo necrosis. This creates an ideal environment for what kind of organisms?

Anaerobic

Usual relative pelvic venous stasis + large amounts of pathogenic bacteria = ?

Pelvic vein thrombophlebitis (usually on the right)

Clinical definition of macrosomia?

Fetus is 4500 grams or more

Turtle sign indicates shoulder dystocia. What is it?

Retraction of fetal head.

Preterm birth occurs during what gestational timeframe?

20 weeks to 37 weeks

What usually causes preterm labor?

SPONTANEOUS DAWG

Name the 4 pre-term birth "pathways

1. Infection - Cervical pathway
2. Placental - Vascular pathway
3. Stress - Strain pathway
4. Uterine Stretch pathway

What test, which detects a basement membrane produced by fetal membranes, predicts more than half of spontaneous preterm births?

Fetal fibronectin