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OB > Complications of Labor > Flashcards

Complications of Labor Flashcards

1
Q

Complications include:

A

-prematurity/ preterm labor
-multiple gestation
-uterine rupture
-abnormal presentation
-postmaturity
-intrauterine fetal death

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2
Q

Mean duration of pregnancy is ________ wks from first day of LMP

A

40 weeks

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3
Q

How many weeks is considered a “term pregnancy”?

A

37- 42 wks.

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4
Q

What is considered preterm labor?

A

Regular uterine contractions occurring at least 10 mins apart resulting in cervical change any time before 37 weeks.

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5
Q

What is considered low birth weight (LBW)?

A

< 2500 g at birth

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6
Q

What is considered very low birth weight (VLBW)?

A

< 1500 g

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7
Q

At how many weeks are >90% of fetus’ <1500 g

A

29 weeks

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8
Q

Mortality is 90% of infants born before _____weeks

A

24 weeks

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9
Q

Survival exceeds 90% for babies born more than _____ weeks

A

30 weeks

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10
Q

Survival is more than 98% for babies born by ____ weeks

A

34 weeks

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11
Q

Survival can increase by ______% each DAY between ____ and ____ weeks

A

5% between 25-26 weeks

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12
Q

What is respiratory distress syndrome exacerbated by?

A

Intrapartum hypoxia and maternal stress
- Almost all infants <27 weeks

almost none have respiratory distress by 36 weeks.

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13
Q

What are some prematurity comorbidities?

A

-Respiratory distress syndrome
-Sepsis
-Necrotizing enterocolitis
-Intracranial hemorrhage (uncontrolled delivery/trauma, neonatal HTN)
- ischemic cerebral damage
-immature metabolism (prolonged drug effects)
-HYPOGLYCEMIA
-HYPOTHERMIA
-Hyperbilirubinemia

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14
Q

What might cause preterm labor?

A

Preterm labor :with genital tract colonization w/: –
-Group B strep
-Neisseria gonorrhoeae
-Bacterial vaginosis

(some success at preventing preterm labor w antibiotic tx, no current recommendations for routine screening for asymptomatic infections

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15
Q

What does tocolytic therapy do?

A

Attempt to stop or slow contractions to avoid Preterm Labor.

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16
Q

When would tocolytics be used?

A

-gestational age: 20-34 wks.
-EFW < 2500g
-Absence of fetal stress

-Used for short term (<48 hrs) to permit corticosteroid treatment to aid fetal lung maturation, or allow transfer to facility w appropriate NICU facilites

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17
Q

Ethanol: no longer used d/t side effects

A

-Inhibits release of antidiuretic hormone and oxytocin.
-Possible direct effect on myometrium or interference with prostaglandins.
-IV bolus and maintenance infusion over total of 12 hr.
-Significant risk of intoxication, loss of consciousness and aspiration.
-No longer used d/t side effects and superior drug availability.

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18
Q

Methylxantheines

A
  • Aminophylline

-Phosphodiesterase= increase intracellular cAMP= uterine muscle relaxation

  • Narrow therapeutic margin and frequent toxic side effects limit clinical use
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19
Q

Calcium channel blockers

A

-Nifedipine

  • Myometrium contractility related to free calcium concentration
  • decreased ca2+ = decreased contractility
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20
Q

Maternal side effects of calcium channel blockers

A

-HoTN
-Tachycardia, dizziness, palpitations
-facial flushing
-vasodilation
-peripheral edema
-myocardial depression
-conduction defects
-hepatic dysfunction
-postpartum hemorrhage- d/t uterine atony refractory to oxytocin and prostaglandin F alpha2
-fetal side effects
-decreased UBF= fetal hypoxemia and fetal acidosis

  • Pt may be more prone to cardiac depressant effects of volatile agents
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20
Q

Prostaglandin Synthetase inhibitors : Indomethacin, Sulindac

A

MOA: decrease cyclooygenase= decrease prostaglandin

Maternal side effects:
- Nausea
- Heatburn
-transient decrease in platlete aggregation = bleeding
- primary pulm HTN

Fetal side effects:
-crosses placenta
-premature closure of ductus arteriousus
-persistant fetal circulation
-renal impairment, transient oliguira

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21
Q

Magnesium

A
  • May compete w calcium for uterine smooth muscle surface binding= decreased contractility

-prevents an increase in intracellular calcium
-Activates adenylcyclase= increased cAMP

Pts more sensitive to depolarizing and non-depolarizing muscle blockers

  • MAC IS DECREASED
  • renal elimination
    -dose: 4-7mg/100mL
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22
Q

What happens with a serum mag values of 8-10

A

loss of deep tendon reflexes

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23
Q

What happens with a serum mag value of 10-15?

A

respiratory depression

cardiac conduction defect (Wide QRS, increased PR interval)

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24
Q

What happens w a serum mag value of 20+

A

CARDIAC ARREST

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25
Q

What is the treatment for magnesium toxicity?

A

Calcium gluconate or CaCl

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26
Q

What drugs are beta-adrenergic agonists?

A

Terbutaline, Ritodrine

MOA: direct stimulation of B-adrenergic receptors in uterine smooth muscle = increased cAMP= uterine relaxation

Side effects:
-N/V
- anxiety
-restlessness
-Hyperglycemia
-hyperinsulinemia
-HYPOkalemia
-acidosis
-tachycardia, arrhythmias, peripheral vascular resistance, dilutional anemia
-decreased colloid oncotic pressure
-pulmonary edema

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27
Q

What are the risk factors for beta-agonist pulmonary edema

A

Increased IVF administration
multiple gestations
tocolysis greater than 24 hrs.
concomitant mag therapy
infection (Increase pulm cap permeability)
hypokalemia
undiagnosed heart disease

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27
Q

Why is the mortality of the second twin greater than the first?

A

-placental abruption
-cord prolapse
-malpresentation

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28
Q

Maternal consequences of multiple gestation

A

Cardiovascular:
-Increased cardiac output earlier in gestation
Hematologic:
-Increased incidence of anemia
Respiratory:
-Dec. TLC, dec. FRC, inc. closing capacity
Metabolic:
-Inc. oxygen consumption, inc. metabolic rate
Reproductive:
-Larger uterus – aortocaval compression, greater aspiration risk

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29
Q

What complications increase with multiple gestation?

A

Increased risk of pregnancy induced hypertension
placental abruption
placenta previa
malpresentation

increased risk of hemorrhage

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30
Q

What is the preferred local used for neuraxial block for multiples?

A

2-chloroprocaine 3% preferred for rapid onset

1.5% lido w 1:200,000 EPI

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31
Q

What can you give for uterine relaxation for internal manipulation?

A

NTG 100mcg initially and repeat to max of 500mcg

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32
Q

Signs and symptoms of uterine rupture

A

-Sudden abdominal pain despite functioning epidural
-vaginal bleeding
-HoTN
-cessation of labor
-fetal distress (most reliable sign)

-increased risk of postpartum hemorrhage
-DX: manual exploration/laparotomy

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33
Q

What are the risk factors for uterine rupture?

A

-Previous uterine surgery
-trauma
-multiparity
-uterine anomaly
-oxytocin
-placenta percreta
-tumors
-macrosomia
-malposition

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34
Q

What is the most common abnormal presentation?

A

longitudinal-vertex or breech

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35
Q

What abnormal presentations have the greatest chance of uncomplicated spontaneous vaginal delivery?

A

Vertex
flexed c-spine (chin to chest)
occiput anterior (face down)

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36
Q

What are the different Breech positions?

A

-complete
-frank
-incomplete (footling)
over 90% of breech infants are delivered via c-section

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37
Q

What are the risks of abnormal fetal presentation?

A

-increased risk of fetal death
-asphyxia
-birth trauma
-cord prolapse
-maternal infection (d/t internal manipulation)

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38
Q

What fetal position is an absolute indication for c-section

A

transverse lie

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39
Q

How many weeks is considered postmaturity?

A

-Gestation beyond 42 weeks

risks evident at 40-41 wks.

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40
Q

What are the complications of postmaturity?

A

-decreased uteroplacental blood flow= fetal distress
-umbilical cord compression d/t oligohyramnios
-Meconium staining of amniotic fluid
-increased incidence of macrosomia and shoulder dystocia

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41
Q

Anesthetic considerations for postmaturity

A

Labor and delivery – epidural analgesia, preparations for c-section due to cephalopelvic disproportion

C-section – as usual – epidural/spinal as needed with usual risks and precautions

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42
Q

What are some causes of Intrauterine fetal demise (IUFD)?

A

-chromosomal abnormalities
-congenital malformations
-multiple gestations
-infection
-cord accidents
-placental factors
-maternal immunological / thyroid disease
-isoimmunization
-maternal trauma

consider epidural for L&D - can develop DIC w prolonged retention of fetus

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43
Q

How long do you typically have during a prolapsed umbilical cord before fetal compromise?

A

10 mins!

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44
Q

At what cord length is there a risk of compression, constriction and rupture?

A

< 30 cm

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45
Q

At what cord length is there a risk of cord entanglement?

A

> 72 cm

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46
Q

What is the most common cause of postpartum maternal palsy?

A

cephalopelvic disproportion

results in lumbosacral trunk compression as it crosses the pelvic brim by the fetal head

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47
Q

What are the reasons for new onset backache during pregnancy?

A

-increased lumbar lordosis
-increased laxity of sacrococcygeal, sacroiliac, and pubic joints

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48
Q

What are complications that can happen with neuraxial blocks?

A

-Nerve injury
-epidural hematoma
-chemical nerve injury
-needle trauma
-positioning injury
-postdural puncture headache (PDPH)
-high or total spinal anesthesia

48
Q

Under what circumstances does an epidural hematoma usually occur?

A

Usually, in pts w hemostatic abnormality or coagulopathy

-can occur with block placement or catheter removal

49
Q

What do you want to make sure platelets are in the pt before placing a neuraxial block?

A

at least 100K

50
Q

What could a rapidly falling platelet count indicate?

A

HELLP syndrome

51
Q

How long should you wait to block someone if they are therapeutically anticoagulated?

A

24 hrs

52
Q

How long should you wait to block someone if they are prophylactically anticoagulated?

A

12 hrs

53
Q

How long should you wait to remove the catheter after the pts last dose of LMWH?

A

at least 12 hrs after last dose

54
Q

How long should you wait to administer LMWH after block is placed or after catheter is removed?

A

at least 2-4 hrs

55
Q

What other drugs should you avoid w a block and LMWH?

A

NSAIDs and anticoagulants

56
Q

What are the signs and symptoms of an epidural hematoma?

A

-Bilateral leg weakness
-incontinence
-absent rectal sphincter tone
-back pain

-If hematoma suspected pt must get stat CT or MRI

57
Q

In what timeframe should surgical decompression occur in for full neurological recovery to occur after an epidural hematoma?

A

Within 6 hrs

58
Q

What can cause an epidural abscess?

A

Bottles 10% iodine can become colonized after a single use.

59
Q

How long will it take for symptoms of an infection to appear with an epidural abscess?

A

4-10 days
-usually pain and loss of function

60
Q

What is the treatment for an epidural abscess?

A

Antibiotics and laminectomy
-6-12 hrs window before permanent damage

61
Q

What are the signs and symptoms of an epidural abscess?

A

-Severe backpain (worse w flexion, sometimes radiation of pain)

-Extreme local tenderness

-Fever, malaise

-meningitis-like headache w neck stiffness

-Lab changes: Increased WBC, Increased ESR, positive blood cluture

-progression over hours-days to neuro deficit or osteomyelitis

62
Q

What are the characteristics of the epidural space that make it resistant to toxicity?

A

-very vascular
-intact membrane btwn it and the subarachnoid space

63
Q

What are some of the drugs given via epidural?

A

-Thiopental
-ephedrine
-oxytocin
-atropine
-zantac
-KCl

64
Q

What is the most common cause of Transient neurological symptoms (TNS)?

A

Lidocaine spinals
-more associated w lithotomy position and high doses of concentrated lidocaine (5%)

65
Q

What are some of the signs and symptoms of TNS?

A

Pain and dysesthesia in buttocks, legs, and calves

  • usually resolves within 72 hrs
65
Q

When will needle trauma occur?

A

Hitting cord with a small needle causes significant pain but if needle immediately withdrawn usually no permanent sequelae if you inject into the cord is a different story

-clonus at T12-L3
-DO NOT do a regional block on sleeping pts

66
Q

What nerve can become injured w lithotomy stirrups?

A

common peroneal nerve

67
Q

What nerve can become injured with the lithotomy position?

A

Femoral and obturator nerves

Femoral or Obturator neuropathy
25% bilateral lithotomy of fetal head compression
Femoral- difficulty climbing stairs
Obturator- dec. sensation over upper inner thigh, weak hip adduction

68
Q

What are the ranges in severity of nerve injuries?

A

Transient ischemic injury–> axonal crush
Recovery 2-6 days if mild –> 2-3 years if severe

69
Q

What can cause postpartum foot drop?

A

Damage of the common peroneal nerve from stirrups or brow compression of lumbosacral trunk

70
Q

What is the typical onset time for a post-dural puncture headache?

A

12-48hrs after dura puncture

71
Q

How long does a PDPH last?

A

few days to weeks

-typically self-limiting w spinal needle but not w epidural (can become chronic)

72
Q

What are the principal determinants of a PDPH?

A

size of dural hole and type of needle used

  • Large gauge and cutting edge needles increase PDPH incidence
73
Q

What is the normal CSF volume?

A

150 ml

74
Q

How much CSF is made per day?

A

450 ml

75
Q

how much CSF has to be lost before a PDPH will occur?

A

Acute loss of as little as 20ccs

-caused by sagging of intracranial contents and stretching of the pain sensitive tissues when the pt assumes the upright position

-cerebral vasodilation may also play a role

76
Q

What are the risk factors for a PDPH?

A

-younger age
-large needle gauge
-cutting-edge Quincke spinal needle
-cephalad or caudal orientation of Quincke needle
-Hx of PDPH or migraines

77
Q

What are the risk factors for dural puncture w epidural needle?

A

Experience
-Inc. risk in training

LOR technique
-Dec. risk with saline vs. air

Fatigue and haste
-Inc. risk overnight

Accuracy of audit
-Cases lost to follow-up

78
Q

What kind of needle is better to use to decrease PDPD risk?

A

Pencil point needles are significantly better than cutting tip needles because dura fibers are not cut but just pushed apart.

79
Q

What is the Hallmark sign of a PDPH?

A

Continuous head pain when the patient sitting or standing that is completely or almost completely relieved by recumbence.

Patients may have some neck stiffness, tinnitus, photophobia, or diplopia (rarely)
If headache is not postural look for another cause!

80
Q

What is the Arnold-Chiari malformation?

A

Condition where lower brainstem portions are displaced caudally

Some cases will show symptoms of brainstem compression other cases are subclinical

In these patients leakage of CSF even through a small dural puncture (caused by 25 ga needle) can cause the brainstem to shift downwards causing headaches and focal neurological signs. In rare cases traction can tear blood vessels and cause subdural hematoma.

81
Q

What can happen if PDPH is not treated?

A

-chronic headache
-permanent impairment
-convulsions d/t cerebral vasospasm
-“coning” and brainstem death

82
Q

What are the noninvasive treatments of PDPH?

A

Bed rest:
-Most headaches resolve by w/in 1 week

Intravenous hydration:
-Typically ineffective

Abdominal compression/binders:
-Impractical/ineffective

PO, IV, epidural analgesics:
-NSAIDs, acetaminophen, opioids

Cerebral vasoconstrictors:
-PO, IV caffeine, theophylline, sumatriptan

ACTH:
-Unproven, may reduce need for EBP by 50%

83
Q

Best treatment for PDPH

A

Epidural blood patch - 15-20ccs of pts own blood injected

Start slow and stop either when patient says headache is gone or they have a pressure sensation in the ears.

84
Q

Risks of Epidural blood patch

A

same as w regular epidural
Higher incidence of backache
Risk of infection very rare

85
Q

How do EBPs work?

A

-Clotting factors help seal hole in the dura
-the mass effect of the blood compresses the CSF, giving nearly instant relief
-Try to inject at the same level as the initial dural puncture. Blood will spread a few levels, however.

86
Q

Causes of total spinal:

A

-Migrated epidural catheter
-Unrecognized dural puncture
-SAB after failed epidural

87
Q

What does a total spinal involve?

A

Hypotension
Dyspnea
Aphonia
Rarely, cerebral hypoperfusion from sympathectomy causes loss of consciousness.

88
Q

How would you manage a total spinal?

A

-Place patient in Left Uterine Displacement and Trendelenberg
-Early resuscitation, ventilation, and circulatory support.
-Epinephrine may be needed
-Naloxone for intraspinal opioid.
-Intensive maternal monitoring.
-Intensive fetal monitoring.
-Maintain maternal sedation.
-Anesthesia or sedation is usually required for 1-3 hrs.

89
Q

What conditions would make you suspect aspiration?

A

-Hypoxia
-Pulm edema
-Bronchospasm

90
Q

What can you do to prevent aspiration in the pregnant pt?

A
  • cricoid pressure
    -elective c-section pts should fast at least 6 hrs
91
Q

What can be administered to increase the pregnant pt’s gastric pH?

A

-Sodium citrate
-H2 blockers (famotidine, ranitidine- takes at least 30min to work)
-metoclopramide (Reglan): dopamine antagonist which acts on intestinal tract via release of acetylcholine, this increases gut motility and facilitates gastric emptying, requires 40-60 min.

92
Q

How would you manage aspiration?

A

Intubation and positive pressure ventilation w/ PEEP. Use only enough O2 to maintain O2 saturation in the 90s (high FiO2 may exacerbate lung injury)

Suction as much as possible from airway.

Rigid bronchoscopy only used when large food debris needs to be removed.

Prophylactic antibiotics are controversial, may be detrimental.

Prophylactic steroids have no role.

Lavage is not routinely recommended.

Patients may become hypovolemic through fluid shifts

93
Q

Match each serum magnesium concentration with its expected clinical effect:

a.) 1mg/dL
b.) 5mg/dL
c.) 8mg/dL
d.) 15 mg/dL

1.) seizures
2.) drowsiness
3.) loss of patellar tendon reflex
4.) respiratory depression

A

1mg/dL= seizures

5mg/dL= drowsiness

8mg/dL= loss of patellar tendon reflex

15mg/dL= respiratory depression

94
Q

The incidence of prematurity rises with:

A

Multiple gestations and premature rupture of membranes

94
Q

Co-administering nifedipine with what drug increases the likelihood of skeletal muscle weakness in the pregnant pt?

A

Magnesium

95
Q

How does magnesium interact with neuromuscular blockers?

A

it potentiates NMBs, which increases the risk of residual weakness

96
Q

Magnesium sulfate (MgSO4) is used as an anticonvulsant in patients with preeclampsia as well as a tocolytic to prevent preterm delivery. MgSO4 may produce any of the following effects EXCEPT

A. Sedation

B. Respiratory paralysis

C. Inhibition of acetylcholine release at the myoneural
junction

D. Hypertension when used with nifedipine

A

D. Hypertension when used with nifedipine

97
Q

Which of the following is the LEAST likely cause of pregnancy-related deaths in the United States (1998-2005)?

A. General anesthesia (failed intubation or aspiration)

B. Hemorrhage

C. Thrombotic pulmonary embolism

D. Hypertensive disorders of pregnancy

A

A. General anesthesia (failed intubation or aspiration)

98
Q

Side effects of terbutaline include all of the following EXCEPT

A. Hypertension

B. Hyperglycemia

C. Pulmonary edema

D. Hypokalemia

A

A. Hypertension

99
Q

When is the fetus most susceptible to the effects of teratogenic agents?

A. 1 to 2 weeks of gestation

B. 3 to 8 weeks of gestation

C. 9 to 14 weeks of gestation

D. 15 to 20 weeks of gestation

A

B. 3 to 8 weeks of gestation

100
Q

Which of the following drugs should NOT be used during transvaginal oocyte retrieval (TVOR) for assisted reproductive technology (ART)?

A. Propofol
B. Ketamine
C. Midazolam
D. All are safe and can be used

A

D. All are safe and can be used

101
Q

What is the BEST way to prevent autonomic hyper- reflexia in a quadriplegic woman who is to undergo induction of labor? The complete spinal cord lesion occurred 2 years ago.

A. Only IV drugs should be used; spinal and epidural anesthesia are contraindicated

B. Spinal or epidural lumbar local anesthetics such as bupivacaine alone are effective

C. Spinal or epidural narcotics such as fentanyl alone are effective

D. Autonomic hyperreflexia appears only when the complete spinal cord lesion is below T6, so there is no need to worry

A

B. Spinal or epidural lumbar local anesthetics such as bupivacaine alone are effective

102
Q

A 24-year-old gravida 2, para 1 parturient is anesthe-tized for emergency cesarean section. On emergence from general anesthesia, the endotracheal tube is removed and the patient becomes cyanotic. Oxygen is administered by positive-pressure bag and mask ven tilation. High airway pressures are necessary to venti-late the patient, and wheezing is noted over both lung fields. The patient’s blood pressure falls from 120/80 to 60/30 mm Hg, and heart rate increases from 105 to 180 beats/min. The MOST likely cause of these manifestations is

A. Amniotic fluid embolism

B. Mucous plug in trachea

C. Pneumothorax

D. Aspiration

A

D. Aspiration

103
Q

The MOST common injury recorded in the American Society of Anesthesiologists’ (ASA’s) Closed Claim Project regarding obstetric anesthetic claims is

A. Pain during anesthesia

B. Maternal nerve damage

C. Headache

D. Aspiration pneumonitis

A

B. Maternal nerve damage

104
Q

A 38-year-old primiparous patient with placenta previa and active vaginal bleeding arrives in the operating room with a systolic blood pressure of 85 mm Hg. A cesarean section is planned. The patient is lightheaded and scared. Which of the following anesthetic induc tion plans would be most appropriate for this patient?

A. Spinal anesthetic with 12 to 15 mg bupivacaine

B. General anesthetic induction with 2 to 2.8 mg/kg propofol and paralysis with 1 to 1.5 mg/kg succinylcholine

C. General anesthesia induction with 0.75 to 1 mg/kg ketamine and paralysis with 1 to 1.5 mg/kg succinylcholine

D. Replace lost blood volume first, then use any anesthetic the patient wishes

A

C. General anesthesia induction with 0.75 to 1 mg/kg ketamine and paralysis with 1 to 1.5 mg/kg succinylcholine

105
Q

Which of the following properties of epidurally administered local anesthetics determines the extent to which epinephrine will prolong the duration of blockade?

A. Molecular weight
B. Lipid solubility
C. pKa
D. Concentration

A

B. Lipid solubility

106
Q

Which intrathecal narcotic can be used as a sole agent for cesarean section (i.e., without an ester or amide local anesthetic)?

A. Morphine

B. Fentanyl

C. Meperidine

D. None of the above; a local anesthetic is needed

A

C. Meperidine

107
Q

Cesarean delivery is associated with a blood loss of about

A. 250 mL
B. 500 mL
C. 750 mL
D. 1000 mL

A

D. 1000 mL

108
Q

Which of the following statements regarding MgSO4 therapy for preeclampsia is TRUE?

A. The therapeutic range for serum magnesium is
10 to 15 mEq/L

B. High serum magnesium levels can be estimated
by changes in deep tendon patellar reflexes in a patient with an epidural anesthetic loaded for a cesarean section

C. Excessive serum magnesium levels cause widening of the QRS complex

D. As soon as delivery occurs, the chance for eclampsia no longer exists and the magnesium should be reversed so that postpartum bleeding is less likely to occur

A

C. Excessive serum magnesium levels cause widening of the QRS complex

109
Q

While moving a parturient from the birthing room to the operating room for an emergency cesarean section for a prolapsed umbilical cord, the patient develops cough, wheezing, and stridor and becomes cyanotic. The trachea is intubated, and food is noted in the pharynx. Appropriate treatment in this patient should consist of

A. Intravenous lidocaine to suppress the cough

B. Glucocorticoids

C. 100% oxygen and positive end-expiratory pressure
(PEEP)

D. Saline lavage

A

C. 100% oxygen and positive end-expiratory pressure
(PEEP)

110
Q

Which agent is the MOST useful for raising the gastric pH just before induction of general anesthesia for emergency cesarean section?

A. Ranitidine

B. Sodium citrate

C. Metoclopramide

D. Magnesium hydroxide and aluminum hydroxide

A

B. Sodium citrate

111
Q

In addition to the postural component of a postdural puncture headache (PDPH), signs and symptoms may include any of the following EXCEPT

A. Double vision
B. Hearing changes
C. Neck stiffness
D. Fever

A

D. Fever

112
Q

After a vaginal delivery under epidural anesthesia, a healthy 8-lb baby is born. The 23-year-old now gravida 1, para 1 woman is noted to have a temperature of 38.2° C. A leukocyte count is obtained and is 15,000/ mm3. The most appropriate course of action would be to

A. Get a blood culture
B. Start antibiotics
C. Administer a sedative
D. Observe

A

D. Observe

113
Q

Transient neurologic syndrome (TNS) is MOST commonly seen after the spinal anesthetic injection of which local anesthetic?

A. Lidocaine
B. Bupivacaine
C. Prilocaine
D. Tetracaine

A

A. Lidocaine

114
Q

Factors associated with advanced molar pregnancy (i.e., >14- to 16-week size uterus) include all of the following EXCEPT

A. Hypertensive disorders of pregnancy

B. Hypothyroidism

C. Acute cardiopulmonary distress

D. Hyperemesis gravidarum

A

B. Hypothyroidism

115
Q

A 38-year-old obese patient is receiving subcutaneous low-molecular-weight heparin (LMWH) for thromboprophylaxis. She received her epidural 14 hours after the heparin was stopped and developed Horner syndrome on the left side 30 minutes after placement of an epidural for an elective cesarean section. On physical examination, a T4 anesthetic level is noted, but aside from the Horner syndrome no other findings are revealed. The most appropriate course of action at this time would be to

A. Remove the epidural

B. Consult a neurosurgeon

C. Obtain a computed tomographic scan

D. None of the above

A

D. None of the above

116
Q

You are preparing to perform a neuraxial anesthetic on a full-term parturient. Which of the following is NOT a contraindication to regional anesthesia?

A. Platelet count of 150,000

B. Acute hypovolemia

C. Infection at the needle insertion site

D. Presence of coagulopathies

A

A. Platelet count of 150,000

117
Q

Continuous spinal anesthetics are not considered a first-line technique for neuraxial anesthesia due to the increased risk for

A. hypotension

B. reflex bradycardia

C. postdural puncture headache

D. allergic reaction

A

C. postdural puncture headache

118
Q

The term very low-birth-weight is defined as any infant who weighs less than _____ grams at birth.

A. 500 grams
B. 1000 grams
C. 1500 grams
D. 2500 grams

A

C. 1500 grams

OB (8 decks)

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