Learning Objectives Recognize clinical presentation of thyrotoxicosis. Describe management of thyrotoxicosis in pregnancy. Thyroid storm and thyrotoxic heart failure are life-threatening hypermetabolic states in pregnancy. Thermoregulation, cardiovascular, nervous, and gastrointestinal systems can be affected, typically leading to multisystem failure ( Fig. 23.1 ). The key to management is to have a high index of suspicion. Thyroid Storm Simulation Materials Needed Volunteer to act as standardized patient You’re…

Learning Objectives Identify risk factors for diabetic ketoacidosis in pregnancy. Recognize presentation of diabetic ketoacidosis in pregnancy. Describe management algorithm for diabetic ketoacidosis in pregnancy. Diabetic ketoacidosis (DKA) is a relatively rare but life-threatening condition. Pregnant women are prone to develop more severe and more rapidly progressive episodes of DKA at lower glucose levels than nonpregnant women. In pregnancy, there is a particularly increased susceptibility to…

Learning Objectives Recognize warning signs of maternal sepsis. Identify initial treatment strategies for maternal sepsis. Definitions Systemic Inflammatory Response Syndromes (SIRS) Defined by two or more of the following: Temperature >38 or <36°C Heart rate >90 beats per minute Respiratory rate >20 breaths/minute or PaCO 2 <32 mmHg White blood cells >12,000 cells/mm 3 or <4000 cells/mm 3 or >10% bands You’re Reading a Preview Become a Clinical…

Learning Objectives Recognize the presentation of eclampsia. Describe management priorities for a patient with eclampsia. Eclampsia is defined as new-onset, generalized, tonic-clonic seizures or coma in a patient with preeclampsia. It is one of the several clinical manifestations of severe preeclampsia. Preeclampsia/eclampsia constitutes a common cause of maternal morbidity and mortality ( Fig. 20.1 ) . Open full size image Fig. 20.1 Organ systems affected by preeclampsia. Risk…

Learning Objectives List risk factors for uterine inversion. Recognize clinical presentation of uterine inversion. Describe management of uterine inversion. Uterine inversion occurs when the fundus of the uterus collapses after delivery and, in its most severe form, delivers through the vagina ( Fig. 19.1 A-B ) . If not quickly recognized, it has a reported maternal mortality rate as high as 15%. Open full size image…

Learning Objectives Identify the contents and indications for various blood component therapies. Recognize and manage transfusion reactions. In the event of a hemorrhage, blood transfusion can be lifesaving. The obstetric team must be well-versed in when to transfuse which products as well as how to respond to transfusion reactions ( Fig. 18.1 ). Open full size image Fig. 18.1 Symptoms of transfusion reaction. Open full size image Technical…

Learning Objectives Define postpartum hemorrhage. Discuss technique for quantification of blood loss. Manage postpartum hemorrhage. Postpartum hemorrhage (PPH) is defined as cumulative blood loss greater than or equal to 1000 mL or excessive blood loss leading to development of symptoms (i.e., lightheaded, vertigo, syncope) and signs of hypovolemia (i.e., hypotension, tachycardia, or oliguria) Classification of Postpartum Hemorrhage Postpartum hemorrhage affects 5%–15% of women giving birth. PPH…

Learning Objectives List risk factors for uterine rupture. Recognize signs of uterine rupture. Describe management of uterine rupture. Uterine rupture, also known as uterine dehiscence, refers to the total or partial disruption of the uterine layers ( Fig. 16.1 ). It is a life-threatening emergency for both the mother and fetus. Most commonly uterine rupture occurs in the context of a “scarred uterus.” A “scarred uterus” includes…

Learning objectives Define vasa previa. Describe risks of vasa previa. Describe antenatal management of vasa previa. The term vasa previa refers to fetal blood vessels present in the membranes covering or within 2 cm of the internal cervical os . These vessels are not protected by Wharton's jelly and are at risk for rupture upon spontaneous or artificial rupture of the membranes. Their presence can be…

Learning Objectives Evaluate patients with antepartum hemorrhage. List differential diagnoses for antepartum bleeding. Manage antepartum hemorrhage safely and promptly. Counsel patients on recurrence risks for antepartum hemorrhage. Antepartum hemorrhage is defined as any bleeding from the genital tract after the 20th week of pregnancy and before the onset of labor. Antepartum hemorrhage complicates 2%–5% of all pregnancies . It is associated with increased rates of perinatal…

Learning objectives List risk factors for umbilical cord prolapse. Recognize and manage umbilical cord prolapse. Participate in constructive team debriefing after cord prolapse. Umbilical cord prolapse is a condition in which the umbilical cord presents ahead of the presenting part of the fetus. The umbilical cord will typically protrude into the cervix, vagina, or outside of the body. Cord prolapse is considered an obstetric emergency because…

Learning Objectives Identify indication for breech extraction. Describe technique for breech extraction. Identify potential difficulties encountered during breech extraction Breech extraction has been performed for a long time with different results among the operators. It is usually used to describe the delivery of the second twin with vertex-breech presentations. Breech extraction is preferred over passive delivery of a breech second twin. It is reasonable to avoid…

Learning objectives Identify the types of vaginal breech deliveries. Describe the complications associated with vaginal breech delivery. Be able to safely perform vaginal breech delivery. Breech presentation occurs when the presenting part of the fetus is the buttocks or feet. There are three main types of breech presentation Fig. 11.1 . Open full size image Fig. 11.1 Types of breech presentation. (A) Frank breech is defined by flexed…

Learning objectives Identify indications and contraindications to operative vaginal delivery Identify the flexion point and apply proper technique to vacuum-assisted vaginal delivery Describe and apply proper technique to forceps-assisted vaginal delivery List potential maternal and neonatal complications of operative vaginal delivery Operative vaginal delivery is a delivery in which the operator uses forceps or a vacuum to facilitate the delivery of the fetus. When successful, operative vaginal…

Learning objectives List risk factors for shoulder dystocia. Recognize shoulder dystocia. Describe maneuvers used to relieve shoulder dystocia. Apply a team-based approach to shoulder dystocia. Identify complications of shoulder dystocia. Shoulder dystocia is an obstetric emergency. It occurs when, following delivery of the fetal head, routine gentle traction fails to deliver the fetal shoulders. Risk Factors Known risk factors for shoulder dystocia include: High birth weight…

Learning objectives Classify fetal heart rate patterns according to the three-tiered system of categorization. Assess and develop management plans for intrapartum fetal heart rate tracings. Assess and develop management plans for uterine contraction patterns. Discuss variables that can affect the maternal–fetal oxygen pathway. Interpret fetal cord gas results. Fetal heart rate monitoring is the most common obstetric procedure, and yet it remains a frustrating technology, plagued…

Learning objectives Describe tools and technique for ultrasound image optimization. Describe techniques to effectively obtain crucial obstetric information in an emergency. Image Optimization Control deck, probe type, frequency, and orientation The ultrasound control panel and keyboard share several common knobs and button even across brands. Such common controls include ultrasound modes, gain, depth, focal zone, and zoom ( Fig. 7.1 ) Most common probe used is a…

Learning objectives List potential complications of neuraxial anesthesia. Recognize and manage common anesthesia complications. The most common modes of anesthesia used in obstetrics are neuraxial and general anesthesia. Examples of neuraxial anesthesia include epidural anesthesia and spinal anesthesia. This chapter begins with potential complications of neuraxial anesthesia. Fig. 6.1 demonstrates the important anatomy for these neuraxial anesthesia techniques. At the end of this chapter, we also discuss the…

Learning objectives List common causes of respiratory distress. Describe evaluation and management of respiratory distress. Signs of Increased Work of Breathing Retractions and use of accessory muscles of respiration Inability to talk in full sentences Long pauses between sentences Orthopnea Sweating in a setting where it is not expected Restlessness, agitation, or decreased level of consciousness Warning Signs of Imminent Respiratory Arrest Decreased level of consciousness…

Learning objectives Describe principles of Basic Life Support. Describe principles of Advanced Cardiovascular Life Support as they relate to pregnancy. The goal of this chapter is to highlight pregnancy-related pearls with regards to maternal resuscitation. This section presupposes knowledge of Basic Life Support and Advanced Cardiovascular Life Support (ACLS) training. Please see your local training agency if you require formal training Fig. 4.1 shows the basic…