Obstetrical Hemorrhage
The QBL that constitutes hemorrhage in both vaginal and cesarean section deliveries.
What is 1000cc?
BP >140/90, Onset >20 weeks Gestation, and negative proteinuria
What is Gestational Hypertension?
True or False - Fundal pressure is necessary during a shoulder dystocia emergency.
What is False?
Your patient needs a D&C. This is the first thing you will need to do to use the machine.
What is plug it in?
The only PO medication given to treat SEVERE hypertension (>160/110) during pregnancy
What is Nifedipine IR?
Name the 4Ts (causes of obstetrical hemorrhage) and which type accounts for 80% of cases of PPH.
What is Tone (atony), Trauma (lacerations), Tissue (retained placenta), and Thrombin (coagulopathies); uterine atony?
What is included in your focused assessment of a patient with a hypertensive disorder of pregnancy
What are BP, headache, visual changes, epigastric pain, edema, weight gain, DTRs, clonus?
A significant clinical sign of an impending shoulder dystocia. Hint-we put signs of these on the doors of our at-risk patients.
What is a Turtle Sign?
"Code Malignant Hyperthermia." This will need to be brought from the OR hallway. And this will be the first thing you will need to do once it arrives.
What is the Malignant Hyperthermia Cart; Reconstitute the Ryanodex?
Reversal agent for Magnesium Sulfate
What is Calcium gluconate?
How long you need to continue QBLs in a patient who lost >1000cc blood
What is 12 hours?
The most reliable signs of impending seizure activity include a) Headache and visual changes b) Hypertension and tachycardia c) Epigastric and RUQ pain d) Peripheral edema
What is a) headache and visual changes?
The biggest area our team often misses in safety compliance for shoulder dystocias is: a) provider signature b) completely filling out the form c) notifying providers of risk
What is b) completely filling out the form?
Emergent c-section! Your patient goes under General and there is no time for a count. These two units will need to be notified ASAP.
What is the PACU (house sup) & Radiology?
IV drug given for SEVERE Hypertension (>160/110) during pregnancy, typically if the patient has a slower heart rate
What is Hydralazine?
What needs to be ordered when a patient reaches a stage 2 hemorrhage and what needs to be added when a patient reaches a stage 3 hemorrhage.
What is a DIC panel and what are blood products?
Maternal Hypertension can slow development of this vital organ that supplies O2 and blood to the fetus
What is the Placenta?
The first nursing intervention that should be the performed in response to a shoulder dystocia.
What is the McRobert’s maneuver?
Cause of absent DTRs, Decreased respiratory rate, urine output <30ml/hr.
What is Mag Toxicity?
An antifibrinolytic medication used during obstetrical hemorrhages that has been shown to reduce morbidity and mortality
What is TXA (Tranexamic Acid)?
Cause of PPH that should be considered in cases of HELLP, abruption, prolonged IUFD, sepsis, or amniotic fluid embolism.
What is coagulopathy?
Most severe complication of Eclampsia as a result of a seizure (HINT: We can determine this by using the FAST screening assessment)
What is a Stroke?
The most significant risk factor for shoulder dystocia is: a)Maternal age b) Parity c) Length of second stage d) Pregnancy weight gain
What is c) Length of second stage?
The most significant intrapartum factors associated with the development of shoulder dystocia are a) Prolonged first stage labor and early SROM b) Post-dates pregnancy and labor induction c) Prolonged second stage labor and slow descent d) Fetal macrosomia and prolonged second stage
What is d) fetal macrosomia and prolonged second stage?
The uterotonic medication that is contraindicated in hypertensive patients and what its dosage and route of administration are.
What is Methergine? What is 0.2mg IM