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Sp: Coexisting I > 3. Pregnancy-OB > Flashcards

3. Pregnancy-OB Flashcards

1
Q

gravida

A

number of times pregnant, including current pregnancy

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2
Q

parity

A

number of deliveries that made it past 20 weeks gestation (completed pregnancies)
- not necessarily a live birth

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3
Q

primigravida

A

1st pegnancy

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4
Q

multigravida

A

2 or more pregnancies

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5
Q

grand multigravida

A

4 or more pregnancies

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6
Q

multiparous

A

delivered more than one baby

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7
Q

nulliparous

A

has not give birth previously

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8
Q

twins count as what parity

A

1

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9
Q

miscarriage/abortion

A

loss of fetus prior to 20 weeks

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10
Q

stillborn

A

loss of fetus after 20 weeks

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11
Q

GTPAL

A

gravida
term births
pre-term births (prior to 37 weeks gestation)
abortions
living

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12
Q

CV changes in pregnancy

A

decr SVR by 35%
incr BV
incr CO

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13
Q

what decreases SVR

A

incr progesterone
incr NO
incr prostacyclin
decr NE
incr relaxin

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14
Q

prostacyclin

A

prostaglandin produces by vascular smooth muscle and endothelium
- stimulates vasodilation
- inhibits platelet aggregation

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15
Q

relaxin

A

reproductive hormone produced by ovaries and placenta
- loosens everything

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16
Q

what compensates for decr SVR

A

incr HR
incr BV

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17
Q

what incr plasma volume

A

incr renin

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18
Q

Hct changes at end of first trimester

A

decreased due to dilutional anemia

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19
Q

when is cardiac output the highest

A

3rd stage of labor (80% from pre-labor levels)

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20
Q

structural changes of heart

A

ventricular hypertrophy (both LV/RV)
dilation
mild valvular insufficiency

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21
Q

preg ECG changes

A

sinus tachycardia
left axis deviation
incr arrythmias

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22
Q

supine hypotension syndrome

A

compression of IVC
- severe hypotension
- initial tachycardia then bradycardia

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23
Q

treat supine hypotension

A

LUD
(wedge under right side)

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24
Q

preg respiratory

A

decr FRC
incr TV
incr MV
incr PaO2
airway edema = incr difficult airway

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25
Q

do pregnant pts have change in desaturation rates during apnea

A

more rapid desturation
- incr BMR
- decr FRC
- right shift

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26
Q

coagulation state during pregnancy

A

hypercoagulable to prevent hemorrhage

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27
Q

what incr coagulation

A

incr factors
decr protein S
protein C resistance
decr fibrinolysis

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28
Q

LES tone in pregnancy

A

LES tone decreases

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29
Q

gastric emptying in preg

A

normal
slow in labor

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30
Q

bile secretions during preg

A

increased bile secretions
(decr GB motility)

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31
Q

fasting glucose should be ______ compared to pre-pregnancy levels

A

fasting glucose lower than pre-preg levels

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32
Q

E2 increases levels of

A

TBG
T3/T4

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33
Q

what happens to the pain threshold in pregnancy

A

elevated due to progesterone/endorphins

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34
Q

do you need a higher or lower MAC in pregnancy

A

lower MAC

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35
Q

CSF in pregnancy

A

decreased

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36
Q

renal BF in pregnancy

A

increased

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37
Q

BUN/Cr in pregnancy

A

decreased

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38
Q

LAST symptoms

A

mental status changes
anxiety
muscle twitches
seizures
bradycardia
arrythmias
hypotension
cardiac arrest

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39
Q

LAST management

A

100% Fio2
airway management
Intralipid

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40
Q

intralipid dosing

A

100mL bolus over 2-3 mins
200-250mL infusion over 15-20 min

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41
Q

intralipid max dose

A

12 mL/kg

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42
Q

common surgeries during pregnancy

A

ovarian cystectomy
appendectomy
cholecystectomy
breast-biopsy
trauma

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43
Q

cardiac sx during pregnancy mortality

A

maternal: 3-15%
fetal” 20-35%

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44
Q

pregnancy anesthesia induction changes

A

faster induction:
incr MV
decr FRC

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45
Q

local anesthetics during pregnancy

A

increased effect
higher risk of LAST at lower doses

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46
Q

critical organogenesis

A

first trimester

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47
Q

tetragenic drugs

A

high dose diazepam
nitrous oxide (extended dose)
volatile anesthetics

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48
Q

sugammadex and pregnancy

A

avoid routine sugammadex in pregnancy due to progesterone impacts

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49
Q

intrauterine asphyxia causes

A

inadequate blood flow
inadequate O2 offload

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50
Q

inadequate blood flow causes

A

maternal hypertension
uterine hypertension

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51
Q

pregnancy BP during surgery

A

SBP > 100 mmHg
MAP > 65 mmHg
> 80% of baseline

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52
Q

elective surgery

A

delay until 2-6 weeks postpartum

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53
Q

what trimester is best for surgery

A

2nd trimester

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54
Q

1st trimester has higher risk of

A

teratogenicity

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55
Q

3rd trimester has higher risk of

A

preterm labor

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56
Q

what type of anesthetic minimized fetal exposure

A

regional

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57
Q

when is LUD needed

A

2d and 3rd trimesters

58
Q

what is required for all pregnant pts before surgery

A

aspiration prophylaxis

59
Q

aspiration precautions

A

H2 blocker (pepcid)
nonparticulate antacid (sodium citrate)
metoclopramide

60
Q

when do you use an RSI on pregnant pts

A

after 12 weeks

61
Q

gestational hypertension

A

BP > 139/89 after first 19 weeks
no proteinuria

severe >159/109

62
Q

preeclampsia

A

new onset hypertension
new onset proteinuria
20+ weeks

63
Q

preeclampsia physiologi

A

abnormal implantation of placenta

64
Q

preeclampsia risk factors

A

obesity
nulliparity
advanced maternal age
chronic HTN
CKD
diabetes
multiple gestation

65
Q

preeclampsia symptoms

A

HTN
CHF
pulm edema
hypoxemia
hypovlemia
laryngeal edema
seizures

66
Q

severe preeclampsia

A

BP > 159/109 (>6hr apart)
preoteinuria >5g in 24 hrs

67
Q

preeclampsia treatment

A

delivery
mag sulfate
HTN medications (<160/110)

68
Q

preeclampsia epidural

A

recommend early placement
facilitates safe BP managmeent in labor

69
Q

preeclampsia general

A

incr risk of difficult intubation
incr risk of apsiration
incr sensitivity to NDMR
incr risk uterine atony
incr risk postpartum hemorrhage

70
Q

eclampsia

A

preeclampsia that progresses to seizures or coma

71
Q

what percentage of seizures occur at term

A

75%

72
Q

does the magnitude of HTN correlate with risk of eclampsia

A

No

73
Q

is eclampsia an indication for c section

A

no

74
Q

seizure control

A

magnesium (2g every 15 mins)
max 6g

75
Q

HELLP

A

hemolysis
elevated liver enzymes
low platelets

76
Q

HELLP common symptoms

A

RUQ
proteinuria
malaise

77
Q

HELLP labs

A

hemolysis
- incr bilitubin
- incr lactate dehydrogenase
elevated liver enzymes
low platelets

78
Q

HELLP treatment

A

delivery
seizure prophylaxis (mag sulfate)
platelets

79
Q

neuraxial anesthesia and HELLP

A

CI with thrombocytopenia

80
Q

PPROM treatment

A

CCB
magnesium
beta agonists

81
Q

placenta previa

A

placenta attached to lower area of uterus and cover maternal cervix

82
Q

placenta previa symptoms

A

painless vaginal bleeding
32 weeks

83
Q

placenta previa types

A

complete
partial
marginal

84
Q

placenta previa treatment

A

deliver after fetal lung maturity (37 weeks)
deliver via c section

85
Q

placenta previa prognosis

A

maternal mortality: rare
infant mortalioty: 12 in 1000

86
Q

placenta previa anesthetic management

A

type and cross
regional preferred
large bore IV

87
Q

placenta previa GETA induction

A

ketamine

88
Q

vasa previa

A

fetal vessels near to inner cervical os at risk of rupture

89
Q

vasa previa risk factors

A

low lying placenta
IVF
twins

90
Q

vasa previa c section

A

elective c section at 35 weeks
maternal bedrest 30-32 weeks

91
Q

placenta accreta

A

placenta abnormally adheres to myometrium

92
Q

placenta accreta risk

A

massive hemorrhage

93
Q

accreta

A

adherant placenta that has not invaded myometrium

94
Q

increta

A

placenta that has invaded the myometrium

95
Q

percreta

A

placenta that has invaded through the serosa/bladder

96
Q

placenta accreta symptoms

A

no symptoms

97
Q

when is placenta accreta diagnosed

A

at time of delivery

98
Q

placenta accreta treatment

A

elective c section at 34 weeks
typically w/hysterectomy

99
Q

placent accreta anesthetic management

A

hemorrhage expected
2 large bore IVs
consider art line
consider central line
4 units PRBC/FFP

100
Q

most common anesthetic for placent accreta

A

GA

possibly continuous epidural

avoid spinal

101
Q

placenta abruption

A

placenta partially or completely separates from uterine wall before birth

102
Q

placental abruption fetal symptoms

A

fetal distress
decreased perfusion due to maternal hypotension

103
Q

placental abruption symptoms

A

abdominal pain
vaginal bleeding
severe blood loss

104
Q

placental abruption diagnosis

A

ultrasound

105
Q

placental abruption prognosis

A

DIC (10%)

106
Q

placental abruption anesthesia management

A

epidural if no fetal/maternal issues
emergency C section with GETA if hemorrhage

107
Q

obstetrics hemorrhage

A

leading cause of all pregnancy-related deaths
3-5% of all vaginal deliveries

108
Q

hemorrhage resuscitation

A

1:1:1
pRBC: FFP: Plts
TXA
Factor VII

109
Q

uterine rupture

A

division of all 3 layers of uterus

110
Q

uterine rupture risk factors

A

myometrial scar
connective tissue disorder
trauma

111
Q

uterine ruprure symtpoms

A

severe abdominal pain w/shoulder referral
maternal hypotension
no fetal heart tones

112
Q

uterine rupture treatment

A

immediate laparotomy

113
Q
A
113
Q

uterine rupture prognosis

A

maternal mortality: rare
fetal mortality: 35%

114
Q

uterine dehiscence

A

incomplete division of uterus that does not penetrate all layers

115
Q

DIC

A

overactive clotting followed by uncontrollable bleeding

116
Q

triad of death

A

hypothermia
acidosis
coagulopathy

117
Q

amniotic fluid embolism

A

disruption of barrier between the amniotic fluid and maternal circulation that results in CV collapse

118
Q

AFE diagnosis

A

requires 4 features:
acute hypotension/cardiac arrest
acute hypoxia
coagulopathy/severe hemorrhage
within labor or 30 mins postpartum

119
Q

AFE treatment

A

intubate/mechanical ventilation
100% FiO2
inotropic support
fluids
coagulopathy correction
ECMO

120
Q

what presents similar to AFE

A

LAST
pulm embolism
high spinal
venous air embolism

121
Q

peripartum cardiomyopathy

A

aquired cardiomyopathy during pregnancy
LV systolic
EF < 45%

122
Q

peripartum cardiomyopathy treatment

A

optimize preload
decr afterload
incr contractility
possible anticoags

123
Q

peripartum cardiomyopathy anesthetic management

A

art line
central line with PAC

124
Q

should you place a spinal or epidural in peripartum cardiomyopathy

A

epidural early
not spinal (not tolerated)
not GA

125
Q

multiple gestation

A

typically c section
- diamniotic w/breech
- monoamniotic

126
Q

multiple gestation anesthetic

A

epidural
large bore IV

127
Q

kidney disease

A

poor fetal outcomes
worse anemia
high risk preeclampsia

128
Q

liver disease

A

cholestatis
HELLP

129
Q

gestational diabetes

A

2% of pregnant women
insulin resistance

130
Q

glycemic control range

A

60-120 mg/dL

131
Q

maternal diabetes risk to neonate

A

late trimester stillbirth
resp distress
hyperglycemia

132
Q

diabetes pregnancy anesthetic management

A

epidural encouraged
more prone to hypotension

133
Q

what pts have a higher risk of epidural failure

A

obese patients

134
Q

hyperemesis gravida

A

intractable vomiting during pregnancy
- weight loss
- dehydration
- ketonuira

135
Q

chorioamnionitis

A

infection of placenta and amniotic fluid

136
Q

hyperemesis gravidarum treatment

A

antihistamines
IV fluids
NG
metoclopramide
ondansetron

137
Q

chorio symptoms

A

fever
maternal/fetal tachycardia
abdominal pain

138
Q

chorio management

A

abx
urgent/emergent C section

139
Q
A

Sp: Coexisting I (11 decks)

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