RH Case 12 Nothing Left to Offer

Day 1
-Braxton Hicks occur during 3rd trimester, and increase during the last week or
2 of pregnancy: irregular in intensity, infrequent, non-rhythmic, uncomfortable
rather than painful, minimal or no cervical dilation.
-1st stage of labor: Early/latent labor- cervix effaces (thins out), an ddilates
, irregular contractions. Active labor: contractions become stronger.
-2nd stage of labor: Fully dilated 10cm, and delivery of baby.
-3rd stage of labor: Delivery of baby to delivery of placenta. Takes about 15 mi
nutes for expulsion of placenta; up to 30 minutes.
-Pre-term labor is 20-37 weeks.
-Tocolytics are contraindicated at >4cm dilation. Active labor: 4-7cm dilation.
-Preeclampsia: systolic BP> 140 with proteinuria. Third spaced: fluid goes out o
f vasculature and lymphatics into interstitial space.
-Regular pregnancy will have decreased oncotic/colloid pressure which can lead t
o peripheral edema in lower limbs. The following are also decreased: Hb, hematoc
rit,
albumin, total protein. Increased GFR causes a loss in some protein.
-Severe preeclampsia is BP>160/110. Gestational hypertension= Preeclampsia-prote
inuria. Gestational hypertension develops after 20 weeks and resolves by 12 week
s
post partum.
-HELLP: increased hemolysis (elevated LDH), increased AST and ALT, and decreased
platelets.
-Late decelerations are non-reassuring. MgSO4 is an anticonvulsant, blocks neuro
muscular transmission by decreasing ACh released by nerve. Also causes vasodilat
ion.
MgSO4 is a tocolytic: blocks Ca++ influx (comptitive with Ca++). [MgSO4
is reversible with calcium gluconate].
-Labetalol: non-selective Beta and Alpha adrenergic receptor blocker. Decreases
BP.
-Preeclampsia has 2 stages:
Insufficient blood flow to the placenta as a result of defective trophob
last invasion of maternal spiral arteries.
Systemic activaiton of maternal endothelium causing hypertension, protei
nuria, and inflammation.
-DIC: decreased platelets, activation of the few platelets leading to clots (mic
rothrombi= deposition of fibrin). Exhaustion of coagulation proteins and platele
ts
lead to bleeding in other areas. Severe bleeding-->organ failure.
-HELLP syndrome can become DIC (15-38% of cases do) because of a drastic decreas
e in platelets. Lab findings in DIC: increased PT/PTT ratio, elevated D-dimer wh
ich
is a product of split fibrinogen. Treatment: fresh frozen plasma (FFP) w
hich will provide clotting factors and platelets, also give heparin.
DAY 2

-Low birth weight is <5.5lbs. Preeclampsia can lead to IUGR (asymmetrical IUGR).
Placenta separates at stratum spongiosum of uterus.
-Cytotec: prostaglandin E1 analog that inhibits gastric acid secretion and prote
cts GI mucosa. It also produces uterine contractions.
-Hemabate: Prostaglandin F2alpha analog, stimulates smooth muscle and uterine co
ntractions, leads to placental expulsion.
-Bakri balloon: provides pressure to stop post partum bleeding of uterus. B-Lync
h suture: suture of uterus to stop bleeding.
-Dopamine is Beta1 agonist at the heart and alpha1 agonist in vessels. This lead
s to stronger contractions and increased vasoconstriction, leading to increased
BP.