Ob Notes

pre-eclampsia

BP > 140/90 with proteinuria after 20weeks gestation

severe-preeclampsia includes higher BP (DBP > 100-115) and systemic symptoms

renal dysfunction

pulmonary edema

blurred vision

AMS

hepatic dysfunction

low platelets

No diuretics or nitroprusside (lower placental blood flow) or ACEi

Mg has a mortality benefit and prevents seizures

titrate to DBP < 90

HELLP syndrome is a severe pre-eclampsia though 20% patients are without HTN

can lead to ruptured subcapsular liver hematoma and hemorrhagic shock

dexamethasone tried without benefit

urgent delivery and Mg

Acute fatty liver of pregnancy

no hemolysis

ALF

delivery/termination of pregnancy

TTP of pregnancy

sometimes overlaps with HELLP

sometimes normal liver enzymes

more mental status changes

DIC NOT present

does not resolve with delivery

plasmapheresis

eclampsia includes seizures

Peripartum cardiomyopathy incidence is in final month of pregnancy to 5mo postpartum

LVEF < 45% is definition, treatment is similar to systolic dysfxn

patients should not get pregnant again

high risk for intramural thrombus ?anticoagulation

Hemorrhage

painless - previa

painful and no overt bleeding - abruption

- associated with DIC

a pregnant woman can lose 2L of blood and still have normal vital signs and the fetus will show abnl vital signs first

Oxygenation

Umbilical vein PaO2 is high 30s but results in fetal SaO2 of 80-90%

Acidemia does not improve uterine artery blood flow because it is maximally dilated but may improve fetal oxygen transfer by right shifting maternal Hb curve

Fetal Hb is much less sensitive to maternal pH

however, permissive hypercapnia effects on fetus is unknown and recommendations are to keep pH normal (slightly alkalemic)

Maternal alkalemia reduces uterine blood flow as does catecholamines. Alkalemia also reduces oxygen delivery to fetus.

Maternal fetal circulation is via concurrent exchange, which is less efficient.

Fetal oxygenation most dependent on cardiac output, uterine blood flow, and Hg

Respiratory mechanics