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Su: Sim Lab 2 > 32. Pregnancy > Flashcards

32. Pregnancy Flashcards

1
Q

gravida

A

number of times pregnant including current pregnancy

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2
Q

primigravida

A

1st pregnancy

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3
Q

multigravida

A

2nd pregnancy

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4
Q

grand multigravida

A

4+ pregnancies

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5
Q

parity

A

number of deliveries that made it past 20 weeks gestation

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6
Q

miscarriage

A

loss of fetus prior to 20 weeks

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7
Q

stillbirth

A

loss of fetus after 20 weeks

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8
Q

GTPAL

A

Gravida
Term births
Preterm births
Abortions
Living

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9
Q

Factors that decrease O2 transfer to fetus: changeable

A

Environmental Po2
Maternal Cardiopulm function

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10
Q

Factors that decreases O2 transfer to fetus: cannot change

A

O2 transport by maternal blood
placental blood flow
placental O2 transfer
umbilical blood floow
fetal circulation
O2 transport by fetal blood

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11
Q

environmental Po2

A

high altitude

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12
Q

maternal cardiopulm function

A

cyanotic heart disease

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13
Q

O2 transport by maternal blood

A

anemia
cigarrette smoking

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14
Q

placental blood flow

A

HTN
diabetes
placental abruption
uterine contractions

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15
Q

placental O2 transfer

A

placental abruption
placental infarcts

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16
Q

umbilical blood flow/fetal circulation

A

umbilical cord occlusion
maternal heart disease

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17
Q

O2 transport by fetal blood

A

anemia
hemorrhage

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18
Q

decreases in maternal blood flow can

A

reduce placental blood flow

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19
Q

uterine blood flow is_____

A

cyclical

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20
Q

as contraction occurs, blood flow

A

decreases

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21
Q

as contraction subsides, blood flow

A

increases

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22
Q

historically, vasopressor of choice in OB

A

ephedrine

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23
Q

ephedrine DOA

A

longer

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24
Q

ephedrine activity

A

alpha
beta

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25
Q

does ephedrine cross the placenta

A

yes

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26
Q

phenylephrine benefitsm in OB

A

lower risk of fetal acidosis
higher decr in IONV
preserves SBP and UBF

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27
Q

neuraxial anesthesia: increases UBF

A

pain relief
decr sympa
decr maternal hypervenilation

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28
Q

neuraxial anesthesia: decr UBF

A

hypotension
LA or Epi injection
absorbed LA

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29
Q

primary cause of decreased UBF due to neuraxial anesthesia

A

hypotension

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30
Q

what crosses the placenta

A

small
uncharged
lipophillic
unionized
albumin bound
high unbound fraction

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31
Q
A
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32
Q

what molecular weight has increased placenta transfer

A

<1000 Da

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33
Q

what protein binding has decreased placenta transfer

A

A1-acid glycoprotein (AAG)

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34
Q

what drugs do not cross the placenta

A

heparin
glyco
nondepolarizers
sux
sugammadex
phenylephrine

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35
Q
A
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36
Q

what drugs cross the placenta

A

atropine
scopolamine
BB
nipride
NTG
bezos
IA
VA
N2O
Ephedrine
LA
opioids
neostigmine

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37
Q

what do you need to use for OB reversal

A

neostigmine and atropine

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38
Q

dilation

A

cervical opening

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39
Q

effacement

A

% of cervical thinning

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40
Q

station

A

amount of fetal decent in relation to ischial spine

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41
Q

X/X/X

A

dilated/effeced/station

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42
Q

which station is higher in the pelvis

A

-3 is high

+3 is low

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43
Q

AROM

A

artificial rupture of membranes

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44
Q

BTL

A

bilaterla tubal ligation

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45
Q

IUFD

A

intrauterine fetal demise

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46
Q

PPROM

A

preterm premature rupture of membranes

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47
Q

PROM

A

premature rupture of membranes

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48
Q

TOLAC

A

trial of labor after CS

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49
Q

1st stage: latent

A

cervical dilation

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50
Q

1st stage: latent dermatome

A

T11-12

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51
Q

1st stage: latent - nervous pathway

A

uterovaginal plexus

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52
Q

1st stage: active

A

uterine compression

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53
Q

1st stage: active dermatome

A

T11-L1

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54
Q

1st stage: nervous pathway

A

hypogastric plexus

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55
Q

what stage of labor is covered by epidural

A

stage 1

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56
Q

stage 2

A

perineal pain
fetal decent

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57
Q

stage 2 pain dermatome

A

T10-S4

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58
Q

stage 3

A

placenta expulsion

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59
Q

opioid SE

A

loss of beat to beat variability in FHR
decr fetal movement

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60
Q

meperidine: sedation dose

A

10-25 mg IV
25-50 mg IM

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61
Q

fentanyl: sedation dose

A

25-100mcg/hr

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62
Q

butorphanol: sedation doese

A

1-2 mg

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63
Q

nalbuphine: sedation dose

A

10-20 mg IV or IM

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64
Q

which drug has mixed mu activity

A

butorphanol
nalbuphine

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65
Q

promethazine: sedation dose

A

25-50 mg IM

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66
Q

hydroxyzine: sedation dose

A

50-100mg IM

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67
Q

midazolam: sedation dose

A

2mg

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68
Q

ketamine: sedation dose

A

10-15 mg IV

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69
Q

larger doses of ketamine can cause

A

incr uterine contraction

70
Q

most common drug for sedation

A

nitrous

71
Q

spinal dosing

A

0.75% bupi: 1.6 mL
fentanyl (50mcg/mL): 0.4mL
morphine (0.5mg/mL): 0.3 mL

72
Q

spinal tetracaine

A

3-4 mg

73
Q

spinal bupivacaine

A

2.5-5mg

74
Q

spinal lidocaine

A

20-40mg

75
Q

which spinal drug can cause TNS

A

lidocaine

76
Q

spinal morphine

A

0.1-0.5mg

77
Q

spinal meperidine

A

10-15 mg

78
Q

spinal fentanyl

A

10-25mcg

79
Q

spinal sufentanil

A

3-10mcg

80
Q

when would you consider epidural for c section

A

adhesions (multiple cs hx)
extreme morbid obesity
increta/percreta

81
Q

do epidural incr deliver rate

A

no

82
Q

do epidurals impede labor progress

A

no

83
Q

walking epidural

A

0.0625% bupivacaine

84
Q

epidural pump mix

A

0.0625-0.125% bupivacaine with 1-5 mcg/mL fentanyl

85
Q

initial bolus

A

1 or 2 5mL-boluses of pump mix

86
Q

what should you do if respiratory depression/hypotension happens during epidural

A

stop epidural
support as necessary

87
Q

start infusion

A

5-15mL/hr
5 mL bolus
10 min lock out

total 15-25 mL /hr

88
Q

what should you do if pt describes new pain during epidrual

A

incr basal rate dose
bolus 5mL of 0.25% bupi, 100mcg fentanyl, 3 mL saline

89
Q

emergent C/S with epidural

A

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

90
Q

CSE indication

A

pt in stage 2 labor and need immediate relief
potential for prolonged labor

91
Q

what block alleviates stg 2 labor pain

A

pudendal

92
Q

regional advantages vs GA

A

decr fetus drug exposure
decr maternal aspiration
mother awake
neuraxial opio0ds

93
Q

intrauterine resuscitations during non-OB sx

A

incr LUD
incr O2 concentration
treat hypotension
decr retraction, insufflation
good EtCo2
good acid/base status
check Hb
consider uterine relaxation

94
Q

meds for uterine relaxation

A

VA
NTG

95
Q

when can you do FHT monitoring

A

> 24 weeks

96
Q

cervical cerclage

A

suture to secure incompetent cervix

97
Q

cervical cerclage: primary anesthetic

A

spinal

alts:
epidural
GETA

98
Q

what period has high stem cell differentiation

A

teratogenic period
31-71 dayswh

99
Q

what drugs are taratogenic

A

benzos
nitrous
sugammadex

100
Q

what should you avoid to mx uterine blood flow

A

avoid:
hypercapnia
hypocapnia
hypoxia

101
Q

what drugs should you avoid in pregnant pts

A

VA
NSAIDS (PDA)
benzos (cleft palate)
keppra
amiodarone

102
Q

when are pregnant pts full stomach

A

> 18 weeks

103
Q

apiration prophylaxis

A

nonparticulate antacid (sodium citrate)
H2 agonist (famotidine)
metoclopramide

104
Q

LUD should be done after

A

18 weeks

105
Q

suction D& C primary anesthetic

A

LMA

Alts:
MAC
Spinal
Epidrual
GETA

106
Q

what should you have on standby for duction D and C

A

anxiolytic
oxytocin

107
Q

most likely ectopic pregnancy olocation

A

fallopian tube

108
Q

ectopic anesthetic consideration

A

Type and screen
large bore IV
GETA

109
Q

what could happen during a pUBS

A

emergent C/S

110
Q

external cephalic version anesthetic

A

CSE w/catheter
50 mg of 1% chloroprocaine

111
Q

intrauterine procedure concerns

A

maternal hemorrhage
(type and screen at least)

112
Q

intrauterine procedure prep

A

type and screen
art line
lg guage IV
warming
fetal monitopring

113
Q

open hysterotomy MAC for uterine relaxation

A

2-3 MAC

114
Q

open hysterotomy uterine relaxation

A

VA
NTG bolus

115
Q

NTG bolus for uterine relaxation

A

50-100 mg

116
Q

open hysterotomy maternal fluid restrictions

A

<2L

117
Q

when do you start magnesium bolus and infusion during open hysterotomy

A

after fetal sx completed

118
Q

open hysterotomy mgnesiuum

A

4-6g over 20 min
1-2 g/hr

119
Q

C/S complications

A

hemorrhage
infection

120
Q

should you push abx slow or fast during c section

A

slow

fast can cause N/V

121
Q

1st line uterotonic

A

massage
pitocin

122
Q

2nd line utertonic

A

methergine
hemabate
cytotec

123
Q

pitocin dosing

A

30 units in 500 ml saline

3 units every 3 mins for 3 doses
3 unites/hr mx

124
Q

methergine dose

A

0.2mg IM

125
Q

why dont you give methergine iV

A

severe hyptension

126
Q

methergine onset

A

10 min

127
Q

methergine duraton

A

3-6 hrs

128
Q

methergine SE

A

N/V

129
Q

hemabate dosing

A

0.25mg IM

130
Q

hemabarte max dose

A

2 mg

131
Q

hemabate SE

A

bronchospasm
diarrhea
HTN
vomiting
tachycardia

132
Q

when can you repeat hemabate

A

15-90 min intervals

133
Q

cytotec dose

A

800-1000mcg rectal

134
Q

TOLAC CI

A

t shape uterine incision
previous uterine rupture
other labor complication
facility unable to provide emergent C/S

135
Q

blood saving measures

A

iron supplements
EPO
autologous donation
normovolemic hemodilution
cell salvage
balloon catheters

136
Q

do you need to have pts pump and dump?

A

no

137
Q

Preeclampsia

A

BP: > 140/90
20+ weeks gestation
proteinuria: >300 mg/day

138
Q

ecclampsia

A

seizures
HTN
proteinuria

139
Q

HELLP

A

hemolysis
elevated liver enzymes
low platelets

140
Q

magnesium potentiaties

A

NMDRs

(need to give less Roc)

141
Q

what treats mag toxicity

A

Calcium gluconate
1 g over 10 mins

142
Q

mag loading dose

A

4g

143
Q

mag infusion dose

A

1-3 g/hr

144
Q

mag optimal range

A

4-6 mEq/L

145
Q

preeclampsia definitive treatment

A

deliver placenta

146
Q

neuraxial low limit PLTs

A

50,000 w/normal TEG

147
Q

placenta previa

A

adherance of placenta over cervical os

148
Q

placenta accreta

A

implantion onto myometrium

149
Q

placenta increta

A

implantation into myometrium

150
Q

placenta percreta

A

implantation through entire myometrium into bladder/bowel

151
Q

accreta median blood loss

A

2-5L

152
Q

abruptio placentae

A

dehiscence of placenta from uterus

153
Q

what can cause uterine rupture

A

previous C/S scar
eversion
excessive utertonics

154
Q

uterin rupture suymptoms

A

abrupt abdominal pain
hypotension

155
Q

leading cause of maternal death

A

postpartum hemorrhage

156
Q

postpartum hemorrhage

A

EBL after delivery > 500mL

157
Q

hemorrhage causes

A

uterine atony
retained placenta
obstetric lacerations

158
Q

atony correction

A

0.3-1 IU oxytocin bolus
5-10 IU/hr infusion

plus:
methergine
hemabate
TXA

159
Q

which artery may need to be ligated in severe postpartum hemorrhage

A

internal iliac hypogastric artery

160
Q

heart dz with reduced SVR

A

mitral regurge
aortic regurge
CHF
left to right shunt

161
Q

heart dz with normal to incr SVR

A

aortic stenosis
congenital lesions
right to left shunt
PHTN

162
Q

heart dz with reduced SVR neuraxial

A

normal neuraxial sympathectomy is helpful

163
Q

heart dz with normal to incr SVR neuraxial

A

use neuraxial with sole opiods
pudendal nerve block
GETA

164
Q

AFE mortality

A

86%

165
Q

what causes AFE

A

placental abruption
placenta previa
uterine rupture

166
Q

AFE symptoms

A

techycardia
cyanosis
shock
general bleeding

167
Q

AFE presents similar to

A

PE
DIC
uterine atony

168
Q

AFE treatment

A

CPR
supine
left tilt
baby out ASAP

169
Q

AFE monitoring

A

central line

170
Q
A

Su: Sim Lab 2 (18 decks)

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