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EDRA > 6.1 Obstretrics > Flashcards

6.1 Obstretrics Flashcards

1
Q

Physiological changes seen in pregnancy,

Cardiovascular system

Increase

A

Increase

Blood volume

Plasma volume

Cardiac output

Heart rate

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2
Q

Physiological changes seen in pregnancy,

Cardiovascular system

Decrease

A

Decrease

Systemic vascular resistance

Pulmonary vascular resistance

Pulmonary artery pressure

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3
Q

Physiological changes seen in pregnancy,

Cardiovascular system

Unchanged

A

Unchanged

Central venous pressure

Pulmonary capillary

wedge pressure

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4
Q

Physiological changes seen in pregnancy,

Respiratory system

Increase

A

Increase

Respiratory
system

Minute ventilation

Alveolar ventilation

Tidal volume

Inspiratory capacity

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5
Q

Physiological changes seen in pregnancy,

Respiratory system

Decrease

A

Decrease

Functional residual capacity

Minimum alveolar concentration
of volatile anaesthetics

Residual volume

Total lung capacity

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6
Q

Physiological changes seen in pregnancy,

Respiratory system

Unchanged

A

Unchanged

Respiratory rate

Forced vital capacity

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7
Q

Physiological changes seen in pregnancy

Gastric emptying time

A

Delayed gastric emptying

Consider patients as non-fasting

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8
Q

Physiological changes seen in pregnancy

Change in composition of blood

A

Higher increase in
plasma volume
than in red blood cell mass

Physiological anaemia

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9
Q

Physiological changes seen in pregnancy

Change of serum enzymes

A

Decrease in serum cholinesterase activity

Prolonged action of suxamethonium

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10
Q

Physiological changes seen in pregnancy

Albumin conc

A

Fall in albumin concentration
Higher free fraction of most
protein-bound drugs,

leading to toxicity

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11
Q

Physiological changes seen in pregnancy

Hormonal affect on LA

A

Progesterone-mediated
increased
sensitivity to
local anaesthetics

Use lower doses

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12
Q

Physiological changes seen in pregnancy

Change in MAC?

A

Decrease in minimum alveolar
concentration of
volatile anaesthetics

Use lower
minimum alveolar concentration values

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13
Q

Physiological changes seen in pregnancy

Fibronogen

A

fibrinogen levels are raised

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14
Q

Protein binding in foetus vs mother

A

protein binding in the foetus
is less than that in the mother.

This results in higher ionised
fraction of local anaesthetics
in the foetus.

This
free fraction further increases
with foetal acidosis,
resulting in ion trapping

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15
Q

Explain ion trapping.

A

The protein binding in the foetus is
less than that in the mother.

This results in higher ionised
fraction of local anaesthetics in the foetus.

This free fraction further increases
with foetal acidosis,
resulting in ion trapping.

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16
Q

Ion trapping how does this affect highly protein bound drugs like bupiv

A

Drugs like bupivacaine which are highly protein-bound may accumulate in this way

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17
Q

Does 2 Chloroprocaine accumulate in acidosis

A

2-Chloroprocaine is an

ester local anaesthetic.

It does not accumulate in foetus during acidosis,

as it undergoes
rapid hydrolysis by
pseudocholinesterease.

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18
Q

Does RA change newborn behaviour?

A

Transient neurobehavioural changes
may be seen in
newborn after regional anaesthesia

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19
Q

Pain during First stage of labour

Stage of labour Cause of pain Dermatomes

A

First stage

Cervical dilatation
Lower uterine segment distension

T10–L1
(Pain afferents via superior hypogastric plexus)

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20
Q

Pain during 2nd stage of labour

Stage of labour Cause of pain Dermatomes

A

Second stage

Vaginal vault and perineum

S2–S4 (pudendal nerves)

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21
Q

Epidural and labour

Can it Normalise a dysfxn labour?

How?

A

Epidural analgesia relieves pain.

This decreases the
catecholamine levels in
the mother and

may change dysfunctional
labour to normal labour.

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22
Q

Epidural and labour

Effect on Resp system

A

It also decreases the

maternal hyperventilation
and prevents left shift in oxygen–
haemoglobin dissociation curve.

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23
Q

Epidural and labour affects on stages

A

Epidural analgesia
may delay the second
stage of labour.

It may not affect the first stage of labour

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24
Q

pain relief during labour

Combined spinal epidural

affect on baby?

A

Due to instantaneous pain relief,

it results in fall in maternal catecholamine

and transient changes
in foetal heart rate (bradycardia)

25
Q

Combined spinal epidural

PDPH

A

The incidence of
post-dural puncture headache
is similar to epidural block

26
Q

Paracervical block:

Involves

use?

A

Paracervical block:

involves injection of
local anaesthetic at vaginal fornix.

It was mainly used to reduce
pain of first stage of labour.

27
Q

Paracervical block:

Current use?

why

A

It is not commonly used,

due to its association with
constriction of uterine artery
and foetal asphyxia.

28
Q

Paracervical block:

second stage

A

It is not effective for second stage
of labour, as it does not block
the sensory fibres arising from the
perineum.

29
Q

Paravertebral lumbar sympathetic block

Use?

Common?

A

Paravertebral lumbar sympathetic block:

can be used for pain relief
during first stage of labour.

However, it is not popular,
as it is technically difficult
and there is higher risk of intravascular injection

30
Q

Pudendal nerve block:

Where performed

Use?

A

Pudendal nerve block:

pudendal nerves are blocked
around ischial spines

(and not ischial tuberosity.)

It can be used for analgesia during
1
repair of episiotomy

2
as well as delivery of foetus with forceps

31
Q

2-Chloroprocaine,

Use?

Preparation days gone by
-issue?

Changed to?
Issue?

A

2-Chloroprocaine,

which is used intrathecally,
is a preservative-free solution.

In the past, it was formulated
with a preservative sodium
bisulphite which
was shown to be neurotoxic.

Later it was replaced
with EDTA,
which caused severe back pain.

32
Q

Is there any change to morphine that can be used for section

A 
A new morphine formulation 
(lipid-encapsulated) 
for epidural use  has been 
approved for analgesia 
after lower-segment Caesarean section.
33
Q

Aspiration of epidural catheter

CSF / Blood

A

Positive aspiration of
blood or cerebrospinal fluid
from an epidural catheter

identifies intravascular or intrathecal location.

A negative aspiration still does not rule
out a partial intravascular
or intrathecal placement.

Hence it may not be able to
identify the correct location of
the catheter

34
Q

Other tests that may be used to identify catheter location are:

A

1
test dose with lignocaine
45 mg with epinephrine 15 mcg

2
epidural hanging drop technique

3
meniscus fall sign

4
injection of air through the epidural catheter and precordial Doppler monitoring.

35
Q

Maternal mortality RA v GA

A

The maternal mortality with
general anaesthesia is 16.7 times more
than regional anaesthesia,

according to studies between
1979 and 1990
in the United States.

36
Q

Hypertensive disorders in pregnancy are classified as

A

Gestational hypertension:

Pre-eclampsia
Mild / Severe

Eclampsia

Chronic hypertension

37
Q

Gestational hypertension

A

Gestational hypertension:
a rise in blood pressure
(> 140/90 mmHg)

after 20 weeks of gestation
without proteinuria

38
Q

Pre-eclampsia

A

Pre-eclampsia:

a rise in blood pressure after
20 weeks of gestation
with proteinuria.

Oedema may or may not be present in preeclampsia.

39
Q

Eclampsia

A

Eclampsia: pre-eclampsia associated with convulsions

40
Q

Chronic hypertension

A

Chronic hypertension:
hypertension detected before 20 weeks of
gestation.

It can be primary or secondary.

41
Q

Pre eclamptic

change in IV volume?

affect on spinal?

A

In pre-eclamptic patients,

intravascular volume is depleted.

Hence spinal anaesthesia is associated with severe hypotension in such patients.

42
Q

Pre eclamptic

Epidural and BP

A

Epidural anaesthesia results
in gradual fall in blood pressure

and is easy to titrate by
small boluses of local anaesthetic.

43
Q

Vasopressors and pre eclampsia

A

Lower doses of vasopressors
are required in patients
with pre-eclampsia,

as they have increased sensitivity to them

44
Q

The nerve supply to the perineum is as follows.

A
  1. Genitofemoral nerve
  2. Ilioinguinal nerve
  3. Pudendal nerve
  4. Perineal branch of the posterior femoral nerve
45
Q

Genitofemoral nerve

A

Genitofemoral nerve (L1, L2) –
innervates the
anterior part of perineum.

46
Q

Ilioinguinal nerve

A

Ilioinguinal nerve –

innervates the anterior part of perineum

47
Q

Pudendal nerve

arises

then

A

Pudendal nerve
arises from the anterior rami of S2–S4.

These form a trunk before
leaving the pelvis via
the greater sciatic foramen.

48
Q

Pudendal nerve
passage

terminates

A

It passes immediately behind the
ischial spine and swings forward to
enter the perineum via the lesser sciatic foramen.

The nerve passes
through the ischiorectal fossa,
where it gives off its terminal branches,
which are

49
Q

Pudendal nerve branches

A

Inferior rectal nerve

Perineal nerve

Superficial branch

Dorsal nerve of the clitoris

50
Q

Inferior rectal nerve

A

branch of pudendal

– innervates the external
anal sphincter and the
perineal skin

51
Q

Perineal nerve

A

Perineal nerve –

branch of pudendal

deep branch innervates the
sphincter urethrae and
other muscles of the anterior compartment

52
Q

Superficial branch pudendal

A

Superficial branch –
and the skin of the perineum
posterior to the clitoris

branch of pudendal

53
Q

Dorsal nerve of the clitoris

A

Dorsal nerve of the clitoris –

branch of pudendal

supplies the skin surrounding this
structure

54
Q

Perineal branch of the posterior femoral nerve

innervates?

A

Perineal branch of the posterior femoral nerve

– innervates the
lateral part of perineum.

nerve supply to perineum nerve

55
Q

Analgesics in pregnancy

safe

A

paracetamol

opioids

56
Q

Analgesics in pregnancy

Unsafe

A

Unsafe

1
non-steroidal anti-inflammatory drugs
foetus: renal dysfunction and patent ductus
arteriosus
mother: haemorrhage
57
Q

Analgesics Breastfeeding

Safe

A

Breastfeeding
Safe

non-steroidal anti-inflammatory drugs and
paracetamol

opioids

antiepileptics (neuropathic pain)

tricyclic antidepressants: amitriptyline,
imipramine

selective serotonin reuptake inhibitors

58
Q

Analgesics Breastfeeding

Unsafe (caution advised)

A

ketorolac

aspirin
up to 100 mg/day

EDRA (26 decks)

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