Pregnancy And Delivery Discussion Questions

Pregnancy And Delivery Discussion Questions
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Pregnancy And Delivery Discussion Questions
1. A 34-year-old G2P1 female with no prior cesarean sections is transferred to the intensive care
unit following an urgent cesarean section for failure to progress despite augmentation with
oxytocin. The case was complicated by uterine atony causing postpartum hemorrhage (PPH).
The estimated blood loss was 2.5 L. The OB massive transfusion protocol was activated, and
blood loss was replaced with 4 units of packed red blood cells, 2 units of fresh frozen plasma,
1-six pack of platelets, and tranexamic acid (TXA). On arrival, the patient is hemodynamically
unstable on a phenylephrine infusion. Which of the following laboratory values should be
immediately corrected?
A. PTT of 46 s
B. INR of 1.6
C. Platelet count of 103 × 10
9
/L
D. Fibrinogen level of 163 mg/dL
E. All of the above
2. A 27-year-old G1P0 healthy female delivers a healthy newborn under labor epidural anesthesia.
Shortly after delivery of the placenta, the patient complains of shortness of breath and dizziness,
followed by convulsions and cardiovascular collapse. The patient is intubated, resuscitated
with fluids and pressors, and brought to the intensive care unit. The obstetrical team suspects
amniotic fluid embolism. What initial findings are expected on bedside transesophageal
echocardiographic examination (TEE)?
A. Normal left and right ventricular function
B. Severe left ventricular hypokinesis
C. Large thrombus burden at the bifurcation of the right and left pulmonary artery
D. Acute right ventricular dilation and severe dysfunction
E. Right ventricular systolic pressure of 75 mm Hg
3. A 35-year-old G5P4 African American female at 40 weeks of gestation undergoes an urgent
cesarean section for poor fetal heart rate tracings after being admitted for labor induction.
Postoperatively, the patient becomes progressively short of breath, tachycardic, and
hypotensive. A rapid response team is called in the recovery area for hypoxia, and the patient is
placed on a non-rebreather to maintain SpO2 >92%. A bedside transthoracic echocardiography
is performed and the left ventricle appears to be severely hypokinetic and dilated. The patient
is admitted to the intensive care unit for further management. Which of the following statements
is true regarding peripartum cardiomyopathy (PPCM)?
A. Approximately 50% of patients with PPCM regain normal left ventricular function by 6 months
C. Beta blockers, diuretics, and ACE inhibitors are contraindicated in the postpartum period
D. The risk of PPCM in subsequent pregnancies is very low
E. The majority of patients do not recover normal LV function and require heart transplantation
4. A 27-year-old female with a past medical history of severe pulmonary hypertension secondary
to a ventricular septal defect becomes pregnant despite warnings from expert obstetricians. At
27 weeks, the patient presents to the emergency room with shortness of breath and is admitted
to an intensive care unit for hemodynamic monitoring. Several hours after admission, she
becomes comatose, apneic, and pulseless. Which of the following is NOT true regarding the
treatment of cardiac arrest in pregnancy?
A. If possible, IV access should be obtained in the upper extremity
B. Uterine displacement must be achieved by placing the patient 15 to 30° left lateral decubital
position
C. After 10 minutes of unsuccessful resuscitation efforts, a cesarean section should be performed
in the operating room
D. Chest compressions should be performed 1 to 2 cm higher on the sternum in pregnant patients
E. Defibrillation energy doses should remain the same as in nonpregnant patients
Pregnancy And Delivery Discussion Questions
5. A 30-year-old G4P3 female presents at 35 weeks’ gestation with changes in vision and
headaches. At triage, her blood pressure is elevated at 149/91 mm Hg and her urine analysis is
positive for protein. Initial blood work is within normal limits. Decision is made to treat with
steroids to improve fetal lung maturity. Two days later, the patient complains of severe right
upper quadrant pain with nausea and vomiting. A repeat metabolic panel reveals elevated
aspartate aminotransferase, alanine aminotransferase, and lactate dehydrogenase. Platelet count
and hemoglobin are downtrending. One day after an uneventful cesarean section, the patient
again complains of severe right upper quadrant pain and becomes hypotensive and lethargic.
The critical care team responds to a code, and STAT labs show a hemoglobin level of 5.2 g/dL,
with a bedside ultrasound showing free fluid in the abdominal cavity. Which of the following is
the most likely diagnosis?
A. Uterine hemorrhage
B. Splenic rupture
C. GI bleeding
D. Ruptured liver hematoma
E. Intravascular hemolysis
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