Ch. 16 OB Emergencies

Question 1

is uterine asphyxia uncommon or common?

what does it cause?

Answer 1

• uncommon

- newborn depression

Question 2

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

Answer 2

.

Question 3

T/F: continuous FHR monitoring has better outcomes than intermittent FHR electronic ascultation

Answer 3

false

Question 4

is meconium staining always significant?

why or why not?

Answer 4

• not always of serious importance

- bc it is not necessarily indicative of intrauterine asphyxia

Question 5

are there any precise clinical or biochemical indicators that have a high positive predictive value for perinatal asphyxia?

if yes, what are they?

Answer 5

not any ptl

Question 6

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

Answer 6

.

Question 7

anesthetic considerations for category II FHR patterns (6)

Answer 7

• supplemental O2
• left uterine displacement
• IV hydration
• correction of hypotension from neuraxial
• treating uterine overstimulation
• prep for c-section or operative vaginal delivery

Question 8

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?

Answer 8

• 30 minutes

- VBAC is the exception - all personnel should be immediately available (time varies based off institutional protocols)

Question 9

CP: the OB determines the severity of the FHR abnormality. emergency c-section performed when situation is life-threatening to mother or fetus

Answer 9

.

Question 10

what anesthetic technique is preferred for most c-sections?

Answer 10

neuraxial preferred over GA

Question 11

what women are at an increased risk for placenta accreta?

Answer 11

women with placenta previa and a prior history of c-section delivery

Question 12

what is anesthetic management of an obstetric emergency dependent upon? (2)

Answer 12

• urgency of the situation

- maternal hemodynamics (degree and rate of hemorrhage)

Question 13

why is vasa previa, if left undiagnosed, associated with a high rate of perinatal mortality?

Answer 13

bc rupture of fetal vessels can lead to exsanguination of the fetus and is often disastrous for fetal-well being

Question 14

why is blood loss often underestimated with placental abruption?

Answer 14

bc of the concealed retroplacental hematoma formation

Question 15

when can neuraxial anesthesia be considered for women with placental abruption? (4)

Answer 15

• maternal status is stable
• fetal status is reassuring
• volume status is normal
• coagulation studies are normal

Question 16

AGOG recommendation for uterine atony

Answer 16

prophylactic uterotonic administration to stimulate uterine contraction and prevent uterine atony

Question 17

why is analgesia or anesthesia often needed for a retained placenta?

Answer 17

bc the OB must explaire a uterus that is partially contracted

Question 18

what are the two important components of managing uterine inversion?

Answer 18

1. the immediate treatment of hemorrhagic shock

2. replacement of the uterus

Question 19

early recognition of shoulder dystocia is imperative.

if an epidural is in place, what should the anesthesia provider adminster?
why?

Answer 19

• 10-15 mL of either 3% 2-chloroprocaine or 2% lidocaine with bicarb
• to enhance pelvic relaxation

Question 20

if an emergency c-section is required because of fetal bradycardia from cord prolapse, what is the best anesthetic plan?

Answer 20

GA, unless there is already a neuraxial catheter in place

Question 21

important principle we must always remember - never, ever treat postpartum hemorrhage without ???

Answer 21

• simultaneously pursuing an actual clinical diagnosis

- postpartum hemorrhage is a clinical sign of an underlying condition that is amenable to diagnosis