32. Pregnancy Flashcards
gravida
number of times pregnant including current pregnancy
primigravida
1st pregnancy
multigravida
2nd pregnancy
grand multigravida
4+ pregnancies
parity
number of deliveries that made it past 20 weeks gestation
miscarriage
loss of fetus prior to 20 weeks
stillbirth
loss of fetus after 20 weeks
GTPAL
Gravida
Term births
Preterm births
Abortions
Living
Factors that decrease O2 transfer to fetus: changeable
Environmental Po2
Maternal Cardiopulm function
Factors that decreases O2 transfer to fetus: cannot change
O2 transport by maternal blood
placental blood flow
placental O2 transfer
umbilical blood floow
fetal circulation
O2 transport by fetal blood
environmental Po2
high altitude
maternal cardiopulm function
cyanotic heart disease
O2 transport by maternal blood
anemia
cigarrette smoking
placental blood flow
HTN
diabetes
placental abruption
uterine contractions
placental O2 transfer
placental abruption
placental infarcts
umbilical blood flow/fetal circulation
umbilical cord occlusion
maternal heart disease
O2 transport by fetal blood
anemia
hemorrhage
decreases in maternal blood flow can
reduce placental blood flow
uterine blood flow is_____
cyclical
as contraction occurs, blood flow
decreases
as contraction subsides, blood flow
increases
historically, vasopressor of choice in OB
ephedrine
ephedrine DOA
longer
ephedrine activity
alpha
beta
does ephedrine cross the placenta
yes
phenylephrine benefitsm in OB
lower risk of fetal acidosis
higher decr in IONV
preserves SBP and UBF
neuraxial anesthesia: increases UBF
pain relief
decr sympa
decr maternal hypervenilation
neuraxial anesthesia: decr UBF
hypotension
LA or Epi injection
absorbed LA
primary cause of decreased UBF due to neuraxial anesthesia
hypotension
what crosses the placenta
small
uncharged
lipophillic
unionized
albumin bound
high unbound fraction
what molecular weight has increased placenta transfer
<1000 Da
what protein binding has decreased placenta transfer
A1-acid glycoprotein (AAG)
what drugs do not cross the placenta
heparin
glyco
nondepolarizers
sux
sugammadex
phenylephrine
what drugs cross the placenta
atropine
scopolamine
BB
nipride
NTG
bezos
IA
VA
N2O
Ephedrine
LA
opioids
neostigmine
what do you need to use for OB reversal
neostigmine and atropine
dilation
cervical opening
effacement
% of cervical thinning
station
amount of fetal decent in relation to ischial spine
X/X/X
dilated/effeced/station
which station is higher in the pelvis
-3 is high
+3 is low
AROM
artificial rupture of membranes
BTL
bilaterla tubal ligation
IUFD
intrauterine fetal demise
PPROM
preterm premature rupture of membranes
PROM
premature rupture of membranes
TOLAC
trial of labor after CS
1st stage: latent
cervical dilation
1st stage: latent dermatome
T11-12
1st stage: latent - nervous pathway
uterovaginal plexus
1st stage: active
uterine compression
1st stage: active dermatome
T11-L1
1st stage: nervous pathway
hypogastric plexus
what stage of labor is covered by epidural
stage 1
stage 2
perineal pain
fetal decent
stage 2 pain dermatome
T10-S4
stage 3
placenta expulsion
opioid SE
loss of beat to beat variability in FHR
decr fetal movement
meperidine: sedation dose
10-25 mg IV
25-50 mg IM
fentanyl: sedation dose
25-100mcg/hr
butorphanol: sedation doese
1-2 mg
nalbuphine: sedation dose
10-20 mg IV or IM
which drug has mixed mu activity
butorphanol
nalbuphine
promethazine: sedation dose
25-50 mg IM
hydroxyzine: sedation dose
50-100mg IM
midazolam: sedation dose
2mg
ketamine: sedation dose
10-15 mg IV
larger doses of ketamine can cause
incr uterine contraction
most common drug for sedation
nitrous
spinal dosing
0.75% bupi: 1.6 mL
fentanyl (50mcg/mL): 0.4mL
morphine (0.5mg/mL): 0.3 mL
spinal tetracaine
3-4 mg
spinal bupivacaine
2.5-5mg
spinal lidocaine
20-40mg
which spinal drug can cause TNS
lidocaine
spinal morphine
0.1-0.5mg
spinal meperidine
10-15 mg
spinal fentanyl
10-25mcg
spinal sufentanil
3-10mcg
when would you consider epidural for c section
adhesions (multiple cs hx)
extreme morbid obesity
increta/percreta
do epidural incr deliver rate
no
do epidurals impede labor progress
no
walking epidural
0.0625% bupivacaine
epidural pump mix
0.0625-0.125% bupivacaine with 1-5 mcg/mL fentanyl
initial bolus
1 or 2 5mL-boluses of pump mix
what should you do if respiratory depression/hypotension happens during epidural
stop epidural
support as necessary
start infusion
5-15mL/hr
5 mL bolus
10 min lock out
total 15-25 mL /hr
what should you do if pt describes new pain during epidrual
incr basal rate dose
bolus 5mL of 0.25% bupi, 100mcg fentanyl, 3 mL saline
emergent C/S with epidural
give 20 mL 2% lido w/ 1:200,000 epi
4 ML bicarb
2 mL fentanyl
after delivery:
1.5-2mg morphine diluted to 10Ml with saline
CSE indication
pt in stage 2 labor and need immediate relief
potential for prolonged labor
what block alleviates stg 2 labor pain
pudendal
regional advantages vs GA
decr fetus drug exposure
decr maternal aspiration
mother awake
neuraxial opio0ds
intrauterine resuscitations during non-OB sx
incr LUD
incr O2 concentration
treat hypotension
decr retraction, insufflation
good EtCo2
good acid/base status
check Hb
consider uterine relaxation
meds for uterine relaxation
VA
NTG
when can you do FHT monitoring
> 24 weeks
cervical cerclage
suture to secure incompetent cervix
cervical cerclage: primary anesthetic
spinal
alts:
epidural
GETA
what period has high stem cell differentiation
teratogenic period
31-71 dayswh
what drugs are taratogenic
benzos
nitrous
sugammadex
what should you avoid to mx uterine blood flow
avoid:
hypercapnia
hypocapnia
hypoxia
what drugs should you avoid in pregnant pts
VA
NSAIDS (PDA)
benzos (cleft palate)
keppra
amiodarone
when are pregnant pts full stomach
> 18 weeks
apiration prophylaxis
nonparticulate antacid (sodium citrate)
H2 agonist (famotidine)
metoclopramide
LUD should be done after
18 weeks
suction D& C primary anesthetic
LMA
Alts:
MAC
Spinal
Epidrual
GETA
what should you have on standby for duction D and C
anxiolytic
oxytocin
most likely ectopic pregnancy olocation
fallopian tube
ectopic anesthetic consideration
Type and screen
large bore IV
GETA
what could happen during a pUBS
emergent C/S
external cephalic version anesthetic
CSE w/catheter
50 mg of 1% chloroprocaine
intrauterine procedure concerns
maternal hemorrhage
(type and screen at least)
intrauterine procedure prep
type and screen
art line
lg guage IV
warming
fetal monitopring
open hysterotomy MAC for uterine relaxation
2-3 MAC
open hysterotomy uterine relaxation
VA
NTG bolus
NTG bolus for uterine relaxation
50-100 mg
open hysterotomy maternal fluid restrictions
<2L
when do you start magnesium bolus and infusion during open hysterotomy
after fetal sx completed
open hysterotomy mgnesiuum
4-6g over 20 min
1-2 g/hr
C/S complications
hemorrhage
infection
should you push abx slow or fast during c section
slow
fast can cause N/V
1st line uterotonic
massage
pitocin
2nd line utertonic
methergine
hemabate
cytotec
pitocin dosing
30 units in 500 ml saline
3 units every 3 mins for 3 doses
3 unites/hr mx
methergine dose
0.2mg IM
why dont you give methergine iV
severe hyptension
methergine onset
10 min
methergine duraton
3-6 hrs
methergine SE
N/V
hemabate dosing
0.25mg IM
hemabarte max dose
2 mg
hemabate SE
bronchospasm
diarrhea
HTN
vomiting
tachycardia
when can you repeat hemabate
15-90 min intervals
cytotec dose
800-1000mcg rectal
TOLAC CI
t shape uterine incision
previous uterine rupture
other labor complication
facility unable to provide emergent C/S
blood saving measures
iron supplements
EPO
autologous donation
normovolemic hemodilution
cell salvage
balloon catheters
do you need to have pts pump and dump?
no
Preeclampsia
BP: > 140/90
20+ weeks gestation
proteinuria: >300 mg/day
ecclampsia
seizures
HTN
proteinuria
HELLP
hemolysis
elevated liver enzymes
low platelets
magnesium potentiaties
NMDRs
(need to give less Roc)
what treats mag toxicity
Calcium gluconate
1 g over 10 mins
mag loading dose
4g
mag infusion dose
1-3 g/hr
mag optimal range
4-6 mEq/L
preeclampsia definitive treatment
deliver placenta
neuraxial low limit PLTs
50,000 w/normal TEG
placenta previa
adherance of placenta over cervical os
placenta accreta
implantion onto myometrium
placenta increta
implantation into myometrium
placenta percreta
implantation through entire myometrium into bladder/bowel
accreta median blood loss
2-5L
abruptio placentae
dehiscence of placenta from uterus
what can cause uterine rupture
previous C/S scar
eversion
excessive utertonics
uterin rupture suymptoms
abrupt abdominal pain
hypotension
leading cause of maternal death
postpartum hemorrhage
postpartum hemorrhage
EBL after delivery > 500mL
hemorrhage causes
uterine atony
retained placenta
obstetric lacerations
atony correction
0.3-1 IU oxytocin bolus
5-10 IU/hr infusion
plus:
methergine
hemabate
TXA
which artery may need to be ligated in severe postpartum hemorrhage
internal iliac hypogastric artery
heart dz with reduced SVR
mitral regurge
aortic regurge
CHF
left to right shunt
heart dz with normal to incr SVR
aortic stenosis
congenital lesions
right to left shunt
PHTN
heart dz with reduced SVR neuraxial
normal neuraxial sympathectomy is helpful
heart dz with normal to incr SVR neuraxial
use neuraxial with sole opiods
pudendal nerve block
GETA
AFE mortality
86%
what causes AFE
placental abruption
placenta previa
uterine rupture
AFE symptoms
techycardia
cyanosis
shock
general bleeding
AFE presents similar to
PE
DIC
uterine atony
AFE treatment
CPR
supine
left tilt
baby out ASAP
AFE monitoring
central line
