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Advanced Principles B (Summer '24) > Complicated OB Pt. 2 (Exam I) > Flashcards

Complicated OB Pt. 2 (Exam I) Flashcards

1
Q

What is the most prominent symptom associated with umbilical cord compression from cord prolapse?

A
  • Fetal bradycardia (from FHT)
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2
Q

What are the possible causes of umbilical cord prolapse?

A
  • Multiple gestation
  • Abnormal presentation (breech, shoulder, etc.)
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3
Q

What is the initial primary management of cord prolapse?

A

Manual elevation of the presenting part to offload the umbilical cord.

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4
Q

Other than manual displacement of the fetus, what other option is available to manage cord prolapse?

A

Retrograde bladder filling w/ 500 - 600 mls.

If this doesnt work, then c-section.

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5
Q

What are the two different types of twins?

A
  • Monozygomatic twins (identical)
  • Dizygotic twins (fraternal)
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6
Q

In what type of situation is it more likely to have one twin transfuse the other in the womb?

A

Monochorionic

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7
Q

What are the two body systems we typically worry about with mom when she is multiparous?

A

CV & pulmonary issues

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8
Q

How much does CO increase for a multiple gestation mom?

A

20% greater than a typical parturient

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9
Q

Multiparous parturients are at increased risk of hypoxemia. Why?

A

↓ TLC & FRC near gestation due to increased uterine size

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10
Q

What system’s do not change in a multiparous parturient vs a woman having only one baby?

A
  • Renal
  • Hepatic
  • CNS

All the same whether you have one baby or multiple.

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11
Q

What are the consequences of the stomach being displaced cephalad in a multiparturient?

A

↓ LES competence = ↑ aspiration risk

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12
Q

What is the maternal blood volume of a multiparturient patient?

A

105 mL/kg

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13
Q

Multiparturient delivery EBL is typically _____ greater than a single baby delivery.

A

500 mL

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14
Q

How much more plasma volume does a multigestational patient have than a monogestational patient?

A

750 mL

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15
Q

Regarding twin-to-twin transfusion syndrome, what would be likely to be seen from the donor twin?

A
  • Small size
  • ↑ risk of IUGR
  • ↑ risk of anemia
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16
Q

Regarding twin-to-twin transfusion syndrome, what would be likely to be seen from the recipient twin?

A
  • Larger size
  • ↑ risk of volume overload
  • ↑ risk of cardiac failure
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17
Q

Multiple gestation patients tend to be at risk for _____ delivery.

A

early

50% delivery before 37 weeks.

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18
Q

Planned delivery for twins typically occurs at ____ weeks.
Planned delivery for triplets typically occurs at ____ weeks.

A

38 weeks

35 weeks

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19
Q

Increased uterine distention from multiple gestation increases the risk of ______ and ______.

A

uterine atony & PPH

Have methergine & hemabate ready.

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20
Q

How are PIH (pregnancy induced hypertension) and preeclampsia differentiated?

A

Proteinuria = Preeclampsia

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21
Q

What makes a definitive diagnosis of PIH?

A

Delivery of baby and return to normotension (by at least 12 weeks post-partum)

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22
Q

A new onset HTN & proteinuria after 20 weeks would be suspect for _______.

A

Preeclampsia

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23
Q

What alternate s/s can develop with preeclampsia (besides HTN & proteinuria)?

A
  • Persistent epigastric pain
  • Persistent cerebral s/s (syncope, blurry vision)
  • IUGR
  • Thrombocytopenia
  • ↑ LFT’s
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24
Q

What are the characteristics of preeclampsia without severe features?

A
  • BP ≥ 140/90 after 20 weeks
  • Renal Insufficiency
    – Proteinuria ≥ 300mg/24hrs
    – Creatinine ≥ 0.3
    —1+ on urine dipstick
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25
What features are typical of severe preeclampsia?
- BP ≥ 160/110 - Thrombocytopenia (PLT < 100k) - Creatinine > 1.1 or 2x baseline - Pulmonary edema - New onset cerebral/vision disturbances - Impaired liver function
26
Pregnancy HTN Disorders Table
27
Is a fetus necessary to develop preeclampsia?
Technically no
28
Abnormal placental implantation and impaired remodeling of spiral arteries is indicative of what?
Preeclampsia
29
What are the vascular features of preeclampsia?
30
Preeclampsia is early onset if it occurs before ____ weeks. Is this associated with better or worse outcomes?
34 weeks worse outcomes
31
What are the features of postpartum onset of preeclampsia?
- Occurs within one week of delivery. - Proteinuria - Seizures
32
What is prophylaxis on preeclampsia patients?
Aspirin
33
Why is aspirin a prophylactic for preeclampsia?
- Inhibits synthesis of prostaglandins & synthesis of thromboxane α2
34
When should aspirin be initiated for patients at high risk of preeclampsia?
16 weeks or earlier
35
________ is increased relative to prostacyclin in preeclamptic patients.
Thromboxane
36
What are predictors of poor outcome for preeclampsia?
- Early onset - Chest pain/dyspnea - ↓ SpO₂ - Thrombocytopenia - ↑ Ct - ↑ AST
37
What CNS symptoms are typical of preeclampsia?
- Severe headache - Vision changes - Hyperexcitability - Hyperreflexia *Eventual coma*.
38
What are some of the visual changes characteristic of preeclampsia?
- Scotoma (blind spot) - Amaurosis (painless vision loss). - Blurred vision
39
Loss of cerebral vascular ______ is a severe feature of preeclampsia.
autoregulation
40
Loss of cerebral autoregulation results in what for preeclampsia patients?
Brain hyperperfusion → vasogenic edema *Most commonly in posterior brain circulation*.
41
What drug classes does a preeclampsia patient have sensitivity to?
Vasoconstrictors & catecholamines *May cause vasospasm & exaggerated hemodynamic response in these patients.*
42
< 100,000/mm3 platelet count is associated with increased disease severity and ______ syndrome.
HELLP
43
Pregnancy is a _____-coagulable condition.
Hyper
44
Preeclampsia is a _____-coagulable condition.
Hypo
45
Antiypertensives are used past what point in the progression of preeclampsia?
≥160 sBP ≥110 dBP
46
What drug is the best agent for severe preeclampsia seizure prophylaxis?
Mg⁺⁺
47
What are the increased risks and decreased risk of preeclampsia Mg⁺⁺ sulfate administration.
↓ risk of preeclampsia ↓ risk of placental abruption ↑ risk of maternal resp depression ↑ risk of c-section
48
What are the common side effects of Mg⁺⁺ infusion?
- Warm/Flushed feeling - N/V - Headache - Muscle weakness - Hypotension - Dizziness/drowsiness/confusion
49
What are the fetal effects of Mg⁺⁺ sulfate administration?
- ↓ Fetal HR (though should remain > 100bpm) - ↓ FHR variability
50
What is the Mg⁺⁺ dosing for preeclampsia and eclampsia?
- Load 4-6 g over 30 min - Infusion 1-2 g/hr
51
What is the dosing of Mg⁺⁺ for recurrent eclampsia?
2g over 5 min 1-2 g/hr
52
Mg⁺⁺ will increase the potency of neuraxially administered ________.
Local Anesthetics ↑ risk of hypotension
53
What are therapeutic blood levels of Mg⁺⁺ ?
5-9 mg/dL
54
What is the treatment for Mg⁺⁺ toxicity?
Ca⁺⁺ gluconate 1g IV over 3-10 min Ca⁺⁺Cl 10% 500mg over 5 min
55
What is the leading cause of death in preeclampsia?
Cerebral edema
56
What is the most common CNS feature of preeclampsia? Is this reversible?
Cerebral edema Yes it is reversible
57
What does the HELLP syndrome acryonym stand for?
- **H**emolysis - **E**levated LFTs - **L**ow PLTs - **P**rimarily occurs antepartum (requiring preterm delivery)
58
HELLP syndrome predisposes parturients to what?
Everything bad essentially
59
What type of hemolysis is present in HELLP syndrome?
Microangiopathic hemolytic anemia
60
What liver marker is more sensitive for HELLP syndrome?
- **Bilirubin > 1.2 mg/dL** *These are also seen*. AST ≥ 70 LDH > 600
61
What is the treatment for HELLP syndrome?
- **Delivery** - Mg⁺⁺ sulfate for seizure prophylaxis - Antihypertensives
62
At what platelet count do we completely forget about neuraxial anesthetic techniques?
< 50,000/ mm³
63
At what platelet count are we good to go on utilizing neuraxial techniques?
> 80,000 mm³
64
What is the defining characteristic of eclampsia vs preeclampsia?
Eclampsia: - **New onset seizures** - Unexplained coma - Previous s/s of preeclampsia
65
When is the onset of eclampsia most common?
Intrapartum or 48 hours postpartum
66
What are the possible complications of Eclampsia?
67
What mechanism is lost in eclampsia?
Cerebral autoregulatory mechanism
68
What is the resulting issue behind the loss of the cerebral autoregulatory mechanism?
Hyperperfusion → cerebral edema → ↓ CBF
69
What is seen on a FHT strip during and ecclamptic seizure episode?
Fetal bradycardia
70
What is the treatment for eclamptic seizures?
- **Mg⁺⁺** - Consider midazolam/diazepam
71
When is neuraxial anesthesia okay for eclamptic parturients?
Conscious w/ no recent seizures
72
If an eclamptic parturient has ongoing seizures what kind of anesthetic is necessary?
GETA w/ propofol = ↓ CMRO₂ & CBF = ↓ ICP
73
Why should hypoventilation be avoided in eclamptic patients?
Hypoventilation = ↓ seizure threshold
74
What are the three h's that should be avoided to minimize neurologic injury to eclamptic parturients?
- Hypoxemia - Hyperthermia - Hyperglycemia
75
What is the presentation of amniotic fluid embolism?
*Classic Triad* - Hypoxia - Hypotension - Coagulopathy
76
What is the fetal presentation of amniotic fluid embolism?
- O₂ shunted from uterus to mom - Decels/bradycardia - Loss of variability
77
What is the anesthesia management of amniotic fluid embolism?
**A-OK** - **A**tropine: for vagolysis - **O**ndansetron for vagolysis - **K**etorolac blocks thromboxane production
78
What condition is treated utilizing misoprostol?
Post-partum hemorrhage
79
What are the four drugs utilized for uterine atony? (in order of what should be tried first, assuming the patient has no medical hx).
1. Oxytocin 2. Methergine 3. Carboprost 4. Misoprostol

Advanced Principles B (Summer '24) (8 decks)

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