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What are the signs and symptoms of magnesium toxicity
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9: Complications of Pregnancy
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Magnesium is renally excreted and blood levels may quickly become toxic if the patient become oliguric, <05 cc/kg/h Calcium gluconate IV, hydration, respiratory and cardiac support
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ABNORMAL PLACENTATION
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What is a velamentous insertion of the cord or a velamentous umbilical cord Umbilical vessels that are surrounded only by fetal membranes, with no Wharton jelly For this reason they extend to the maternal membranes, beyond the normal placental margin Yes, it occurs in 10% of twins and 1% of singleton gestations The edge of the placenta is in close proximity to or overlies the internal os of the cervix 4 per 1000 pregnancies and 1 in 200 births Complete previa placenta covers the internal os of the cervix; accounts for approximately 30% of all previas Marginal previa <2 cm from the cervical os Low-lying placenta >2 cm, has no significance Vasa previa velamentous fetal vessels cross the internal os (see Fig 9-4) Can placenta previa diagnosed early in pregnancy resolve during the course of the pregnancy Rupture of membranes (ROM) or vaginal manipulation in vasa previa is associated with what risk What are risk factors for placenta previa Yes, as the lower uterine segment enlarges and the placenta grows; 90% will resolve by term Fetal exsanguinations, with a concomitant finding of nonreassuring fetal heart rate (FHR) and a sinusoidal pattern Endometrial scarring caused by increasing parity, increasing maternal age, prior cxs, prior curettages, increased maternal age
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Is a velementous cord more common in twins What is placenta previa
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What is the incidence of placenta previa What are the various types of placenta previa
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Section III: Topics in Obstetrics
: Normal placenta : Complete placenta previa : Partial placenta previa
Cervix opening 10 cm
10 cm Cervix opening Placenta
Placenta
A Partial
B Complete
Figure 9-4 Types of placenta previa
Increased uteroplacental transport demand, which may be caused by maternal smoking, cocaine abuse, higher altitudes, or multiple gestations It is more common with male infants What are some of the complications of placenta previa Hemorrhage, placenta accrete (10%), malpresentation, and preterm premature rupture of the membranes (PPROM) Yes, the recurrence rate is 4 8%
Are women with a history of placenta previa at risk for previa in subsequent pregnancies What type of delivery is indicated in previa
Cesarean delivery, amniocentesis is performed at 36 weeks to assess
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9: Complications of Pregnancy
pulmonary maturity If immature, it is repeated weekly until maturity is confirmed with subsequent delivery What are the other forms of abnormal placentation Bipartite placenta: composed of two equal portions separated by membranes and exposed large vessels Battledore placenta: involves a marginal insertion of the cord Fenestrated placenta: involves a central defect Placenta diffusa (membranous): all fetal surfaces are covered by villi Succenturiate placenta: has a marginal accessory lobe(s) or cotyledon Circumvallata placenta: is small and limited by an amniotic ring What abnormal placentation may cause retained products of conception and subsequent postpartum hemorrhage What abnormal placentation may cause increased risk of preterm delivery Succenturiate placenta, examination of the delivered placenta will exhibit vessels that do not taper; instead they extend past the edge Circumvallata placenta, which is more common in older, multiparous patients
THIRD TRIMESTER BLEEDING
What is the most common cause of bleeding in the second and third trimester Antepartum hemorrhage refers to what type of bleeding Bloody show associated with cervical insufficiency or labor (term and preterm) Vaginal bleeding after 20 weeks EGA that is caused by some process other than labor and delivery By definition this excludes preterm labor (PTL) and preterm delivery (PTD) Abruptio placentae 30% Placenta previa 20% Uterine rupture Vasa previa Other causes, such as, infections, trauma, polyps or neoplasia, and bloody show are associated with cervical changes because of insufficiency
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What are the major causes of antepartum bleeding
Section III: Topics in Obstetrics
How often is antepartum hemorrhage observed in the third trimester What is the initial management of painless blood per vagina in the third trimester
In 4% of pregnancies Transabdominal ultrasonography is used for initial placental localization and evaluation for abnormalities A manual examination should not be performed until previa is ruled out Ogita, Londersloot, Apt, or Kleihauer Bentke tests identify fetal cells in maternal circulation EGA, or when the event occurs during pregnancy The former is used to describe noncatastrophic placental hemorrhage before 20 weeks EGA The latter refers to any placental separation after 20 weeks (see Fig 9-5)
Laboratory tests that identify the etiology of the vaginal bleeding (fetal vs maternal) include: What is the difference between a small marginal placental separation and placental abruption
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