Pre-eclampsia
preeclampsia definition
new hypertension after 20 weeks + proteinuria OR maternal/placental organ dysfunction
complications: maternal
magnesium sulfate
Seizure treatment and prophylaxis in eclamsia/severe preeclamsia when indicated. Monitor RR, LOC, reflexes and urine output. calcium gluconate is antidote for toxicity
definition
blood loss >1000ml or blood loss accompanied by S/S of hypovolemia within 24 hours after birth
neonatal jaundice definition
yellow discoloration caused by elevated biliruben. unconjugated hyperbiliruben is common because newborns produce relatively more biliruben and have immature hepatic conjugation/clearance.
Eclampsia definition
preeclampsia complicated by a seizure not explained by another cause.
complications fetal
Fetal growth restriction, Oligohydramnios, prematurity, fetal hypoxia/distress or still birth
oxytocin
first-line uterotonic
4 Ts
Tone-uterine atony
Trauma- lacerations, hematoma, uterine rupture/inversion
Tissue- retained placenta/products
Thrombin- Coagulopathy/DIC
Neonatal resuscitation definition
immediate stabilization of a newborn who is not breathing effectively, has adequate resp effort, low low heart rate after birth. priority is effective ventilation because most neonatal compromise is primarily resp
HELLP definition
Hemolysis, Elevated Liver enzymes, Low Platelets; severe manifestation of preeclampsia.
Eclampsia priorities
altered LOC, protect airway/safety, magnesium sulfate, control severe BP, deliver when appropriate
tranexmic acid
antifibrinolytic, stops or reduces heavy bleeding by preventing blood clots from breaking down too quickly
risk factors
previous pph, prolonged labor, induction, uterine overdistension (multips, macrosomia, polyhydramnios), Chorioamniontis, placental abnormalities or retained placenta, operative birth, genital track trauma, coagulopthy/anticouagulation, uterine fibroids, Magnesium sulfate exposure can be accositaed with uterine relaxation.
jaundice treatment
feedings, phototherapy (eye protection and diaper only), iv fluid if applicable
Risk factors
-Previous Preeclampsia, Chronic hypertension, kidney disease, diabetes, Multifetal pregnancy, autoimmune disorders, first pregnancy, maternal age >35, obesity, assisted reproductive technology/family.
HELLP: symptoms and priorities
RUQ pain, Nausea, thrombocytopenia, increase AST/ALT, hemolysis, Llabs, stabilization, blood products if indicated, delivery.
additional uturotonics
methylergonovine/ergometrine, carboprost and misoprostol
S/S
heavy/ongoing vaginal bleeding, boggy/enlarged uterus with atony, firm uterus with continued bleeding, tachycardia (early sign), hypotension (late sign), tachypnea, pallor, cool/clammy skin, dizziness, weakness, anxiety, altered LOC, oliguria
resuscitation steps
anticipate risk, call for help, provide warmth; stimulate, dry, position airway; assess breathing and HR; if apnea gasping or HR <100 provided positive pressure ventilation, typically 30-60 breaths per minute; if not effective consider other airway; if heartrate <60 after 30 seconds of good ventilation do cpr
symptoms
headache, visual changes/scotomata, RUQ or epigastric pain, BP >140/90 (or worse), hyperreflexia/clonus, edema, sudden weight gain, proteinuria, dyspnea/pulmonary edema, oliguria, nausea/vomiting with severe disease, fetal growth restrictions
Pulmonary edema/stroke: Symptoms and treatment
dyspnea/hypoxemia or severe headache/neuro chages; urgent BP control. O2/resp support as needed, escaation and delivery planning
treatment
help ASAP, quantify blood loss, 2 large bore ivs, oxygen as clinically indicated, uterine/fundal massage, empty bladder, rapid isotonic fluids and blood products prn, meds