Ch. 16 OB Emergencies Flashcards
is uterine asphyxia uncommon or common?
what does it cause?
- uncommon
- newborn depression
CP: neonatal encephalopathy attributable to intrapartum hypoxia in the absence of any other preconception or antepartum abnormality is approx 1.6 out of 10,000 babes
.
T/F: continuous FHR monitoring has better outcomes than intermittent FHR electronic ascultation
false
is meconium staining always significant?
why or why not?
- not always of serious importance
- bc it is not necessarily indicative of intrauterine asphyxia
are there any precise clinical or biochemical indicators that have a high positive predictive value for perinatal asphyxia?
if yes, what are they?
not any ptl
regarding blood gases:
CP: the ideal time for delivery is when abnormalities exist only in the umbilical and venous circulations and before any abnormalities are observed in the FHR tracing. this may be influenced by gestational age
.
anesthetic considerations for category II FHR patterns (6)
- supplemental O2
- left uterine displacement
- IV hydration
- correction of hypotension from neuraxial
- treating uterine overstimulation
- prep for c-section or operative vaginal delivery
optimal goals for anesthesia care in obstetrics says that “availability of anesthesia and surgical personnel to permit start of cesarian delivery within ___(how long?)___ of the decision to perform the procedure” is adequate for most c-sections?
what is the exception to this?
- 30 minutes
- VBAC is the exception - all personnel should be immediately available (time varies based off institutional protocols)
CP: the OB determines the severity of the FHR abnormality. emergency c-section performed when situation is life-threatening to mother or fetus
.
what anesthetic technique is preferred for most c-sections?
neuraxial preferred over GA
what women are at an increased risk for placenta accreta?
women with placenta previa and a prior history of c-section delivery
what is anesthetic management of an obstetric emergency dependent upon? (2)
- urgency of the situation
- maternal hemodynamics (degree and rate of hemorrhage)
why is vasa previa, if left undiagnosed, associated with a high rate of perinatal mortality?
bc rupture of fetal vessels can lead to exsanguination of the fetus and is often disastrous for fetal-well being
why is blood loss often underestimated with placental abruption?
bc of the concealed retroplacental hematoma formation
when can neuraxial anesthesia be considered for women with placental abruption? (4)
- maternal status is stable
- fetal status is reassuring
- volume status is normal
- coagulation studies are normal
AGOG recommendation for uterine atony
prophylactic uterotonic administration to stimulate uterine contraction and prevent uterine atony
why is analgesia or anesthesia often needed for a retained placenta?
bc the OB must explaire a uterus that is partially contracted
what are the two important components of managing uterine inversion?
- the immediate treatment of hemorrhagic shock
2. replacement of the uterus
early recognition of shoulder dystocia is imperative.
if an epidural is in place, what should the anesthesia provider adminster?
why?
- 10-15 mL of either 3% 2-chloroprocaine or 2% lidocaine with bicarb
- to enhance pelvic relaxation
if an emergency c-section is required because of fetal bradycardia from cord prolapse, what is the best anesthetic plan?
GA, unless there is already a neuraxial catheter in place
important principle we must always remember - never, ever treat postpartum hemorrhage without ???
- simultaneously pursuing an actual clinical diagnosis
- postpartum hemorrhage is a clinical sign of an underlying condition that is amenable to diagnosis
