Apex quiz questions - OB Flashcards
Maternal pH from baseline?
No change
Maternal PaO2 from baseline?
Increased
Maternal PaCO2 from baseline?
Decreased
Maternal HCO3 from baseline?
Decreased
Maternal oxyHgb curve shift baseline?
Increased or to the right
Maternal MV baseline? How much?
Increased by 50%
Maternal TV baseline? How much?
Increased 40%
Maternal RR baseline? How much?
Increased 10%
Maternal Total lung capacity? What does this include?
Decreased 5%
All values
Maternal VC? What does this include?
No change
Everything except CC
What happens to Mallampati score during pregnancy ?
It increases (becomes harder to view)
What happens to FRC in pregnancy ? What does this include?
It decreases
ERV
CC
What happens to CC during pregnancy ?
No change
O2 consumption ?
Increases with each stage of labor
Which hormones contribute to vascular engorgement?
Relaxin
Progesterone
Estrogen
Should nasal intubation be considered ?
No avoid at all costs
HR during pregnancy ?
Increased - Due to increased demand
SV during pregnancy ?
Increased - Due to increased volume
SVR during pregnancy ?
Decreased - Due to increased nitric oxide from progesterone
Pulmonary artery occlusion pressure during pregnancy?
Unchanged
O2 consumption?
Increased
MAP?
SBP?
DBP?
MAP - no change
SBP - no change
DBP - Decreased
PVR during pregnancy ?
Decreased
CVP and PAOP?
No change
Cardiac axis during pregnancy ?
Up and to the lef
Which three clotting factors decrease?
11, 13, protein S
Fibrin breakdown during pregnancy ?
Increases
PTT and antithrombin during pregnancy ?
Decreases
Plt count during pregnancy ?
Unchanged
Does pregnancy cause a hyper or hypercoagulable state? Risk for?
Hyper
6 times greater risk for DVTs
GFR and Creatinine Clearance in pregnancy ?
Increased due Higher cardiac output and higher intravascular volume
Gastric pH????
Decreases - the PH DECREASES (more acidic)
LES tone?
Decreases
Glucose in urine ?
Increases
Gastric emptying during pregnancy ?
No change until labor begins, then, decreases
Sensitivity to local anesthetics?
Increased sensitivity
Creatinine and BUN?
Decreases
Serum albumin and pseudocholinesterase ?
Decreases
Does heparin cross the placenta?
No
Does ketamine cross the placenta?
Yes
Do non depolarizing NMB cross the placenta?
No
Does metoprolol cross the placenta?
Yes
Does sevo and iso cross the placenta?
Yes
Does lidocaine cross the placenta?
Yes
Does fentanyl cross the placenta?
Yes
Does succ cross the placenta?
No
Does atropine cross the placenta?
Yes
Does versed cross the placenta?
Yes
Does glyco cross the placenta?
No
Does propofol cross the placenta?
Yes
Does insulin cross the placenta?
No
Does mag cross the placenta?
Yes
What is uterine blood flow at term?
700ml/min or 10% CO
What molecular weight is able to cross the placenta?
Low, <500 Daltons
which stage of labor has perineal pain
Stage 2
When does the first stage of labor begin and end?
Begins with regular contractions and ends at 10cm fully dilated
When does the latent stage of labor end? What stage is this apart of?
Apart of stage 1
Ends at 3 cm dilated
When does active labor begin? What stage is this apart of?
Apart of stage 1
Begins at 3 cm dilated
Do epidurals affect labor or increase the chance of C sections?
No
What should NPO guidelines be for mom during labor?
ALWAYS considered a full stomach after 20 weeks
Encourage liquids throughout
Stop solid foods when neuraxial block is done
Which block is specific to the second stage of labor?
Pudendal
Which nerve innervates the perineum? What level?
Pudendal nerve from S2-S4
What is the total coverage for labor?
T10 - S4
Is nitrous safe in pregnancy? Does it affect uterine contractility ?
Yes
No it does not affect it
What happens when mom hyperventilates?
Causes a left shift in the oxyhgb curve, thus keeping O2 from baby
What is the epidural volume technique?
Saline is injected right after the local to help spread the local higher
Which local reduces the efficacy of epidural morphine?
Chloroprocaine because it antagonizes the mu and kappa receptors
What are three ways a patient can develop a total spinal?
Epidural dose injected into the subdural space
Epidural dose injected into the subarachnoid space
Single shot spinal after failed epidural
How does a total spinal present?
-Rapid progression of sensory and motor block
-Dyspnea, difficulty talking
-Hypotension
-LOC
What position should a patient be put in for a total spinal?
Left uterine displacement
mnemonic for FHR?
VEAL CHOP
Variable - cord compression
Early - Head compression
Accelerations - okay
Late - Placental insufficiency
What are late decelerations? Risk for fetal hypoxemia?
Placental insufficiency - BAD
FHR falls after peak of contraction instead of recovering
YES
What causes late decels?
-Maternal hypotension
-Acidosis
-Hypovolemia
-Preeclampsia
What are early decelerations? Risk for fetal hypoxemia?
Head compression -
No risk for fetal hypoxemia
What are variable decelerations? Risk for fetal hypoxemia?
Cord compression
RISK FOR fetal hypoxemia
When giving a beta 2 agent, how does the uterus respond? Where does potassium shift?
-Uterus relaxes through increased cAMP
-K shifts into the cell thus resulting in hypokalemia
How does blood sugar respond from a beta 2 agent?
Hyperglycemia occurs from glycogenolysis from the liver
When a beta-2 agent is given to mom, what is the baby at risk for after delivery ?
Hypoglycemia because the mother’s glucose supply is gone but baby’s insulin is still in circulation
How does magnesium effect calcium ?
It is an antagonist - blocks it
How does magnesium effect the RMP?
It hyperpolarizes the cell
What is a normal magnesium level ?
1.8-2.5
What are responses to hypomagnesaemia
Tetany
Seizures
Dysrhythmias
(body is in an excited response)
Symptoms of a magnesium level of 2.5-5?
No symptoms
Symptoms of a magnesium level of 5-7?
Lethargy
Diminished reflexes
Flushing
N/V
Symptoms of a magnesium level of 7-12?
Loss of deep tendon reflexes
Hypotension
EKG changes
Symptoms of a magnesium level of >12?
Apnea
Heart block
Cardiac arrest
Treatment for hypermagnesemia?
Calcium gluconate (1g over 10 minutes
Diuretics
Fluids
What are 4 tocolysis drugs? What are they used for?
Stop contractions and relax the uterus
Beta-2
Mag
CCB
NO donors
How do CCB effect the uterus? Which CCB is used?
Block calcium from entering the uterus
PO nifedipine
How does NO effect the uterus? How?
Relaxes by increasing cGMP
What increases the chances of prematurity?
Multiple gestations and premature rupture of membranes
What are 6 complications of premature delivery
RINHHH
Respiratory distress
Intraventricular hemorrhage
NEC
Hypoglycemia
Hypocalcemia
Hyperbilirubinemia
Co-administering what drug with nifedipine increases the likelihood of skeletal muscle weakness in the pregnant patient?
Magnesium
How does magnesium effect NMBs?
Potentiates them by creating muscle weakness
If magnesium is low, what are likely the levels of potassium and calcium
All low
Hypokalemia
Hypocalcemia
Hypomagnesemia
Where is oxytocin stored and released?
Posterior pituitary with vasopressin
What can rapid infusion of oxytocin cause?
Cardiovascular collapse
Side effects of oxytocin?
Water retention, hypotension, hyponatremia
What routes can oxytocin be given?
IV or injected into uterus
What is the second line uterotonic drug? Dosage?
Methergine
0.2mg only IM
Side effects of methergine ?
Significant vasoconstriction and hemorrhage
Third line uterotonic drug? Dose?
Hemabate - same drug as Carboprost
(prostaglandin F2)
250mcg IV or intrauterus
What is the major side effect and contraindication of Hemabate?
Bronchoconstriction (ASTHMA)
When should oxytocin be given ?
After delivery of the placenta
What is the most common cause of maternal death during delivery? What is the mortality rate of general anesthesia?
Failure to manage the airway
17x higher
Position and tub size for intubation?
HEELP
6.0-7.0
RSI
When is mom considered a full stomach?
20 weeks
Timeframe for the baby to get out after uterine incision? What is increased after the missed time?
3 minutes, otherwise baby becomes acidotic
What is the triple prophylaxis for aspiration?
Sodium citrate (neutralizes acid)
H2 - Ranitidine (blocks secretion)
Gastrokinetic - Reglan (hastens emptying and increases LES tone)
Three benefits of GA?
Speed of onset
Secure airway
Greater hemodynamic stability
When is GA warranted?
Maternal hemorrhage
Fetal distress
Coagulopathy
Refusal to regional
Contraindications to regional
When should nitrous be avoided?
First and second trimester
What drugs have long track records of safety?
Opioids
Inhalation
All muscle relaxants
Thiopental
How long should elective surgery be delayed?
2-6 weeks
What is the best trimester for surgery ?
Second
When is the highest risk of teratogenicity ?
Organogenesis (day 13-60)
What signs are consistent with preeclampsia?
Proteinuria
HTN
Increased thromboxane
Decreased prostacyclin
Platelet aggregation
What is the definitive treatment for preeclampsia and eclampsia? What happens even after delivery ?
Delivery
Mom still at risk for HTN, stroke for 4 weeks after
Treatment for eclampsia?
Magnesium 4g over 10 minutes
1g an hour after
Which beta blocker is okay to use in cocaine overdose with mom?
Labetalol
Best drug of choice for hypotension with a mom using cocaine?
Phenyl because cocaine depletes natural catecholamines
How can cocaine effect platelets ?
Decreases them
Antidote for mag toxicity?
10mL of calcium gluconate
What is the most significant concern regarding abnormal placental implantation?
Impaired uterine contractility and massive blood loss
What are 3 causes of DIC during labor?
Amniotic fluid embolism
Placenta abruption
Intrauterine fetal demise
Fluid dosage for a neonate? Epi dose?
10ml/kg
.01mg or 10mcg /kg
What type of heat protects newborns from hypothermia?
Radiant
Normal HR and RR of a neonate?
120-160 bpm
30-60 breaths per minute
What is a normal SpO2 of the neonate immediately after delivery ?
60%