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

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