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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
Q

What features are typical of severe preeclampsia?

A
  • BP ≥ 160/110
  • Thrombocytopenia (PLT < 100k)
  • Creatinine > 1.1 or 2x baseline
  • Pulmonary edema
  • New onset cerebral/vision disturbances
  • Impaired liver function
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26
Q

Pregnancy HTN Disorders Table

A
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27
Q

Is a fetus necessary to develop preeclampsia?

A

Technically no

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28
Q

Abnormal placental implantation and impaired remodeling of spiral arteries is indicative of what?

A

Preeclampsia

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29
Q

What are the vascular features of preeclampsia?

A
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30
Q

Preeclampsia is early onset if it occurs before ____ weeks. Is this associated with better or worse outcomes?

A

34 weeks

worse outcomes

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31
Q

What are the features of postpartum onset of preeclampsia?

A
  • Occurs within one week of delivery.
  • Proteinuria
  • Seizures
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32
Q

What is prophylaxis on preeclampsia patients?

A

Aspirin

33
Q

Why is aspirin a prophylactic for preeclampsia?

A
  • Inhibits synthesis of prostaglandins & synthesis of thromboxane α2
34
Q

When should aspirin be initiated for patients at high risk of preeclampsia?

A

16 weeks or earlier

35
Q

________ is increased relative to prostacyclin in preeclamptic patients.

A

Thromboxane

36
Q

What are predictors of poor outcome for preeclampsia?

A
  • Early onset
  • Chest pain/dyspnea
  • ↓ SpO₂
  • Thrombocytopenia
  • ↑ Ct
  • ↑ AST
37
Q

What CNS symptoms are typical of preeclampsia?

A
  • Severe headache
  • Vision changes
  • Hyperexcitability
  • Hyperreflexia

Eventual coma.

38
Q

What are some of the visual changes characteristic of preeclampsia?

A
  • Scotoma (blind spot)
  • Amaurosis (painless vision loss).
  • Blurred vision
39
Q

Loss of cerebral vascular ______ is a severe feature of preeclampsia.

A

autoregulation

40
Q

Loss of cerebral autoregulation results in what for preeclampsia patients?

A

Brain hyperperfusion → vasogenic edema

Most commonly in posterior brain circulation.

41
Q

What drug classes does a preeclampsia patient have sensitivity to?

A

Vasoconstrictors & catecholamines

May cause vasospasm & exaggerated hemodynamic response in these patients.

42
Q

< 100,000/mm3 platelet count is associated with increased disease severity and ______ syndrome.

A

HELLP

43
Q

Pregnancy is a _____-coagulable condition.

A

Hyper

44
Q

Preeclampsia is a _____-coagulable condition.

A

Hypo

45
Q

Antiypertensives are used past what point in the progression of preeclampsia?

A

≥160 sBP
≥110 dBP

46
Q

What drug is the best agent for severe preeclampsia seizure prophylaxis?

A

Mg⁺⁺

47
Q

What are the increased risks and decreased risk of preeclampsia Mg⁺⁺ sulfate administration.

A

↓ risk of preeclampsia
↓ risk of placental abruption
↑ risk of maternal resp depression
↑ risk of c-section

48
Q

What are the common side effects of Mg⁺⁺ infusion?

A
  • Warm/Flushed feeling
  • N/V
  • Headache
  • Muscle weakness
  • Hypotension
  • Dizziness/drowsiness/confusion
49
Q

What are the fetal effects of Mg⁺⁺ sulfate administration?

A
  • ↓ Fetal HR (though should remain > 100bpm)
  • ↓ FHR variability
50
Q

What is the Mg⁺⁺ dosing for preeclampsia and eclampsia?

A
  • Load 4-6 g over 30 min
  • Infusion 1-2 g/hr
51
Q

What is the dosing of Mg⁺⁺ for recurrent eclampsia?

A

2g over 5 min
1-2 g/hr

52
Q

Mg⁺⁺ will increase the potency of neuraxially administered ________.

A

Local Anesthetics

↑ risk of hypotension

53
Q

What are therapeutic blood levels of Mg⁺⁺ ?

A

5-9 mg/dL

54
Q

What is the treatment for Mg⁺⁺ toxicity?

A

Ca⁺⁺ gluconate 1g IV over 3-10 min
Ca⁺⁺Cl 10% 500mg over 5 min

55
Q

What is the leading cause of death in preeclampsia?

A

Cerebral edema

56
Q

What is the most common CNS feature of preeclampsia? Is this reversible?

A

Cerebral edema

Yes it is reversible

57
Q

What does the HELLP syndrome acryonym stand for?

A
  • Hemolysis
  • Elevated LFTs
  • Low PLTs
  • Primarily occurs antepartum (requiring preterm delivery)
58
Q

HELLP syndrome predisposes parturients to what?

A

Everything bad essentially

59
Q

What type of hemolysis is present in HELLP syndrome?

A

Microangiopathic hemolytic anemia

60
Q

What liver marker is more sensitive for HELLP syndrome?

A
  • Bilirubin > 1.2 mg/dL

These are also seen.
AST ≥ 70
LDH > 600

61
Q

What is the treatment for HELLP syndrome?

A
  • Delivery
  • Mg⁺⁺ sulfate for seizure prophylaxis
  • Antihypertensives
62
Q

At what platelet count do we completely forget about neuraxial anesthetic techniques?

A

< 50,000/ mm³

63
Q

At what platelet count are we good to go on utilizing neuraxial techniques?

A

> 80,000 mm³

64
Q

What is the defining characteristic of eclampsia vs preeclampsia?

A

Eclampsia:

  • New onset seizures
  • Unexplained coma
  • Previous s/s of preeclampsia
65
Q

When is the onset of eclampsia most common?

A

Intrapartum or 48 hours postpartum

66
Q

What are the possible complications of Eclampsia?

A
67
Q

What mechanism is lost in eclampsia?

A

Cerebral autoregulatory mechanism

68
Q

What is the resulting issue behind the loss of the cerebral autoregulatory mechanism?

A

Hyperperfusion → cerebral edema → ↓ CBF

69
Q

What is seen on a FHT strip during and ecclamptic seizure episode?

A

Fetal bradycardia

70
Q

What is the treatment for eclamptic seizures?

A
  • Mg⁺⁺
  • Consider midazolam/diazepam
71
Q

When is neuraxial anesthesia okay for eclamptic parturients?

A

Conscious w/ no recent seizures

72
Q

If an eclamptic parturient has ongoing seizures what kind of anesthetic is necessary?

A

GETA w/ propofol = ↓ CMRO₂ & CBF = ↓ ICP

73
Q

Why should hypoventilation be avoided in eclamptic patients?

A

Hypoventilation = ↓ seizure threshold

74
Q

What are the three h’s that should be avoided to minimize neurologic injury to eclamptic parturients?

A
  • Hypoxemia
  • Hyperthermia
  • Hyperglycemia
75
Q

What is the presentation of amniotic fluid embolism?

A

Classic Triad

  • Hypoxia
  • Hypotension
  • Coagulopathy
76
Q

What is the fetal presentation of amniotic fluid embolism?

A
  • O₂ shunted from uterus to mom
  • Decels/bradycardia
  • Loss of variability
77
Q

What is the anesthesia management of amniotic fluid embolism?

A

A-OK

  • Atropine: for vagolysis
  • Ondansetron for vagolysis
  • Ketorolac blocks thromboxane production
78
Q

What condition is treated utilizing misoprostol?

A

Post-partum hemorrhage

79
Q

What are the four drugs utilized for uterine atony? (in order of what should be tried first, assuming the patient has no medical hx).

A
  1. Oxytocin
  2. Methergine
  3. Carboprost
  4. Misoprostol

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

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