PPH
describe the criteria for PPH in both a vaginal and C-section birth
vaginal birth PPH is blood loss of 500ml or more and a c-section PPH is blood loss of 1000ml or more OR any blood loss with s/sx of hypovolemia.
what is the difference between GDMA1 and GDMA 2
GDMA1 is diet controlled and GDMA2 is insulin or medication controlled.
these type of twins result from two separate eggs fertilized by two different sperms
dizygotic twins
describe shoulder dystocia
delivery of the fetal head followed by impaction of one or both shoulders against the maternal pelvis is known as
describe placenta previa and explain why a cervical exam is contraindicated
placenta previa is abnormal implantation of the placenta over or near the cervical opening. A cervical exam is contraindicated because it can disrupt the placenta and cause severe hemorrhage.
List three risk factors of PPH
- previous PPH
- polyhydramnios
- macrosomic fetus
- full bladder
- obesity
Insulin requirements will increase during pregnancy due to this hormone
human placental lactogen hormone
which category of twins has the lowest fetal risk?
dichorionic-diamniotic (separate placenta and separate amniotic sac)
name the classic physical sign seen with shoulder dystocia
turtle sign
describe placenta accreta spectrum disorders
abnormal growth of the placenta into or through the uterine muscle
what are some of the priority actions for a patient experiencing PPH
- give uterotonics
- fundal massage
- foley catheter
- fluid resuscitation and transfusion
- surgical interventions (balloon tamponade)
Explain the screening process for gestational diabetes
1hr GCT test is done at 24-28wks using 50g of glucose, if results are >135, a 3hr GTT test is done using 100g of glucose. The GTT has 4 values: fasting, 1hr, 2hr, 3hr and 2/4 failed values = GDM diagnosis
Name 3 risks of multiple gestation
- hyperemesis gravidarum
- anemia
- preterm labor
- polyhydramnios
- preeclampsia
- malpresentation/ Cesarean birth
List the priority actions taken when a shoulder dystocia happens
- call for help
- Perform McRoberts Manuever
- prepare for neonatal resuscitation
List two risk factors associated with placenta accreta spectrum
- hx of instrumentation in the uterus (D&C)
- placenta previa
- hx of cesarian birth (most common cause)
What is included in the active management of the 3rd stage of labor to prevent PPH?
- Pitocin (10 IM or 20-40 IV) immediately after birth of the infant
- Gentle cord traction until birth of the placenta
what are the target glucose ranges for a woman with GDM?
FBS =< 95, PPBG <140 at 1 hour postprandial, PPBG < 120 at 2 hours postprandial
Why are multiple gestations at an increased risk for preterm labor, preeclampsia, and anemia?
There is an increased physiological demand and uterine overdistention leading to greater maternal and fetal stress.
List 3 risk factors for shoulder dystocia
- gestational diabetes
- Hx of shoulder dystocia
- suspected fetal macrosomia
- prolonged second stage
- assisted vaginal deliveries
what is the cause of placental abruption and name two risk factors
Cause: premature separation of placenta from uterine wall that impacts fetal oxygenation
Risk factors: abdominal trauma, multiples, untreated substance use disorders, short umbilical cord
Describe the 4Ts of PPH
Tone: uterine atony
Trauma: lacerations, uterine rupture
Tissue: retained placenta
Thrombin: coagulopathies
Name three neonatal complications of GDM
- Shoulder dystocia
- Large for Gestational Age (LGA)
- Neonatal hypoglycemia
these type of twins have the highest fetal risk. (provide the name and description)
monochorionic monoamniotic twins described as twins who share one placenta and one sac
name some of the neonatal consequences associated with shoulder dystocia
- neonatal death (5mins till severe hypoxic injury)
- brachioplexus injury
- clavicular injury/fracture
- humerus fractures
describe the key clinical difference in presentation between placenta previa and placental abruption
previa presents with PAINLESS bleeding while abruption presents with PAINFUL bleeding and rigid abdomen