Anesthesia in the OB unit Flashcards
before birth
antepartum
dystocia
difficult labor
intrapartum
during the act of birth
multiple gestations
twins, triplets, etc.
multiparous
has had multiple gestations
normal labor term
38-40 weeks
nulliparous
never completed a pregnancy beyond 20 weeks
parturient
pregnant patient
postpartum
after birth
preterm labor gestation
<37 weeks
primapara
first pregnancy
age of viability
~ 24 weeks
At what week gestation should we consider immediate intubation after birth?
<28 weeks, unless child is pink and active
_____ includes the total number of pregnancies, regardless of how they ended
Gravida (G)
_____ includes the number of live births at any gestation, OR the number of completed pregnancies ( both births and stillbirths) that lasted more than 20 weeks
Parity (P)
Twin deliveries count as how many pregnancies?
one
Parity is the number of completed pregnancies beyond 20 weeks gestation (whether viable or nonviable). The number of fetuses delivered does not determine the parity
A woman is pregnant for the first time, and is 12 weeks along. What is her GP status?
G1P0
A woman is currently pregnant and 25 weeks along. She has had 6 miscarriages and only 1 live birth. What is her GP status?
G8P1
A woman is pregnant for the second time and delivered twin stillbirths in her first pregnancy at 19 weeks. What is her GP status?
G2P0
Oxytocic (uterotonic) drugs promote uterine ( contraction/ relaxation)?
contraction
uterotonic drugs
- ( increase/ decrease) uterine bleeding after delivery
- ( induce/ delay) labor in pregnant patients
- decrease
2. induce
Pitocin stimulates uterine (contraction/ relaxation)
contraction
Pitocin is also used to (delay/ induce) labor
induce
What is the most common side effect of Pitocin?
hypotension
other side effects include:
N/V, chest pain, ECG changes/arrhythmias, shortness of breath, myocardial ischemia, pulmonary edema, death
Because of these side effects, Pitocin should by dosed SLOWLY
Pitocin is dosed (IV/IM). Pitocin dosing is:
- _____ units in the IV bag after delivery of the baby and placenta
- ____ units in each subsequent liter of IV fluid
Pitocin is dosed IV
- 20-40 units
- 20
What is the ED 90 of Pitocin for c-sections:
- ____ units for non-laboring patients
- ___ units for laboring patients
- 0.35
2. 3
What is the Pitocin rule of 3s:
- Give 3 units (the ED90 dose) over 30 seconds
- -If this doesn’t work, the dose may be repeated twice, with 3 minutes in between each dose - If there is no response to the Pitocin after 3 doses of 3 units (over 9 minutes), move to another uterotonic
- -The thinking is that higher doses of Pitocin would just cause more side effects but not more uterine tone - Give 3 units/hr for maintenance
Hemabate is a (uterotonic/ tocolytic)
uterotonic - promotes uterine contraction
What is the dose of hemabate and how is it given?
1 mL (250 mcg) IM
What is hemabate contraindicated in?
asthmatics
Methergine is a (uterotonic/ tocolytic)?
utertonic- promotes uterine contraction
What is the dose of methergine and how is it given?
1 mL (200 mcg) IM
What is methergine contraindicated in?
hypertension (preeclampsia)
What is the drug of choice if there is consistent uterine bleeding despite administration of Pitocin, methergine, and hemabate?
cytotec (misoprostol)
how is cytotec administered?
rectally
tocolytic drugs promote uterine (contraction/relaxation)
relaxation
5 tocolytic drugs
- Magnesium
- Beta 2 agonists (terbutaline)
- Calcium channel blockers (nicardipine, nifedipine)
- volatile agents
- nitroglycerin
_____ is NORMALLY given to treat hypertension or to relieve angina in patients with coronary artery disease (CAD)
Nitroglycerin
In these situations, even smaller doses of Nitroglycerin (<50mcg) can cause significant drops in blood pressure
in pregnant patients, what are two reasons nitroglycerin has less of an effect on blood pressure?
- OB patients have increased circulating blood volume
2. the vessels are already dilated in hydrated patients
What is the dose of nitroglycerin for uterine relaxation?
up to 250-500mcg, even up to 1000mcg, with minimal hypotension (if patients are well hydrated)
the heart rate between contractions
base line fetal heart rate
normal fetal heart rate
120-160 bpm
bradycardic fetal HR
<120 bpm
tachycardic fetal HR
> 160 bpm
In healthy fetuses, the heart rate constantly fluctuates. This is referred to as ______
“fetal heart rate variability”. This is NORMAL
short term and long term variability are both present
Absence of variability is considered ______
a sign of fetal distress
variability that occurs every heart beat
short term variability
variability over a long period anywhere from 6-25 bpm
long term variability
A fetal heart rate deceleration (“decel”) refers to _______
a drop in fetal heart rate