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SNRAObPedGer > EXAM 3 Review > Flashcards

EXAM 3 Review Flashcards

1
Q

In the liver, blood flow through the

A

DUCTUS VENOSUS

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2
Q

When Ductus Venosus closes remnant is

A

LIGAMENTUM VENOSUS

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3
Q

Foramen Ovale closes and becomes the

A

FOSSA OVALIS

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4
Q

When Ductus Arteriosus closes it becomes

A

LIGAMENTUM ARTERIOSUM

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5
Q

DUCTUS venosus shunt is

A

LIVER

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6
Q

Foramen ovale shunt is

A

Right atrium to left atrium

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7
Q

Ducturs arteriosus shunt is CONNECTION between

A

Pulmonary artery to AORTA

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8
Q

Fetal blood Oxyhemoglobin dissociation curve

A

↓ 2,3 DPG, shift to the left (Left for LOVE of oxygen) increased affinity for oxygen (hold on to oxygen)

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9
Q

Womb approx hgb

A

15g/dL

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10
Q

Fetal PO2 max is

A

50-60mmhg

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11
Q

Fetal blood and CO2 relationship

A

less affinity for CO2

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12
Q

Highest possible baby SPO2 is

A

90%

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13
Q

For a PaO2 of 60 what is the SPO2 approx?

A

90%

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14
Q

For a PaO2 of 50, what is the SPO2 approx?

A

80%

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15
Q

In the fetal circulation, Hgb binding is (increased/decreased)

A

Increased

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16
Q

Parallel circuit in the fetal circulation

A

Both right and left venticles provide systemic blood flow

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17
Q

In fetal circulation, PVR is

A

High

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18
Q

In fetal Circulation, SVR is

A

Low

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19
Q

What is the ratio of R to left contribution in fetal circulation

A

2:1 Right to left ration

Right is 2x LV output because of R to L shunt

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20
Q

The ductus venosus receives blood

A

Inferior vena cava coming from lower extremities

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21
Q

Where does the first admixture occur

A

in the Ductus venous in the liver

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22
Q

The presence of which structure makes the SVR low in the fetal circulation?

A

Placenta

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23
Q

Immediately after delivery, the removal of the placenta leads to what changes?

A

ELEVATED SVR

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24
Q

Most of the oxygenated blood in fetal circulation comes from ?

A

UMBILICAL VEIN from PLACENTA

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25
Q

Where does blood/ nutrients exchange occur?

A

In the INTERVILLOUS SPACE

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26
Q

Explain blood flow in fetal circulation

Path of oxygenated blood from placenta

A
  1. OXYGENATED: From placenta, blood flow through umbilical vein which separates into 2 branches (one is portal vein, the other is DUCTUS VENOSUS, which join the IVC
  2. The blood bypasses the liver, goes through the Ductus venosus into the IVC
  3. Blood enters RA
  4. Goes from RA through FORAMEN OVALE to LA
  5. From LA to LV
  6. From LV to proximal aorta then supplied to the coronaries and Head vessels and upper torso
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27
Q

Fetal blood in the

A

Chorionic villi

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28
Q

What are the 4 shunts

A

Ductus Venosus :
Foramen Ovale : right atrium to Left atrium
Ductus Arteriosus: pulmonary artery to Aorta

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29
Q

What are the 4 shunts

A

Ductus Venosus : Joins IVC blood, blood bypasses liver
Foramen Ovale : right atrium to Left atrium
Ductus Arteriosus: pulmonary artery to Aorta
Placenta

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30
Q

Path of UNOXYGENATED blood in fetal circulation

A
  1. flow directly from Superior vena cava to tricuspid to Right ventricle
  2. From RV to Pulmonary artery
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31
Q

Path of UNOXYGENATED blood in fetal circulation( blood from body)

A
  1. flow directly from Superior vena cava to tricuspid to Right ventricle
  2. From RV to Pulmonary artery
  3. Because lungs not inflated , and PVR is high, most of the DEOXYGENATED blood return to AORTA via the DUCTUS ARTERIOSUS
  4. Then from the aorta FLOW to UMBILICAL ARTERIES
  5. FROM UMBILICAL ARTERIES back to PLACENTA
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32
Q

What maintains DA potency ?

A

Prostaglandings

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33
Q

How can hypoxemia leads to PDA?

A

Hypoxemia will release endothelial nitric oxide which will results in vasoilation, may OPEN PDA after closure

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34
Q

What medication is given to attempt to close PDA?

A

Indomethacin (blocks PGE1, prostaglandins)

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35
Q

Functional closure of shunt happens

A

Immediately after birth

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36
Q

What causes the dramatic increase in SVR in postnatal circulation ?

A

Removal of placenta

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37
Q

What causes the dramatic decrease in PVR in postnatal circulation?

A

INFLATION of the lungs with the first breath

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38
Q

What pressure must be generated to fully expand lungs

A

40-60 cm H2O

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39
Q

In maternal circulation what is the direction of the Oxyhemoglobin curve?

A

↑ 2,3 DPG, Shift to the Right ( R- for RELEASE O2) lower O2 affinity)

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40
Q

Foramen ovale in fetal circulation closes due to

A

Increase in LVEDP (Left ventricle End diatole Pressure)

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41
Q

Functional closure of shunt happens

A

immediately

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42
Q

Does mother and Baby blood ever mix?

A

No

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43
Q

90 % of placental blood flow through which structures

A

Intervillous space

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44
Q

Properties that facilitate placental transfer

A

High lipid solubility
Low molecular weight
Lipophillic

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45
Q

CO2 is present in the form of ? Give percentage

A

62% of CO2 is in the form of BICARBONATE (HCO3-)

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46
Q

Placental O2 consumption rate

A

8ml/min/kg of FETAL WEIGHT

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47
Q

Efficiency of placenta compared to lungs

A

1/5th the efficiency of adult lung

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48
Q

The Placenta is supplied by 2 arteries which are

A

UTERINE and OVARIAN arteries

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49
Q

Uterine blood flow is

A

Directly proportional to the fetal umbilical venous partial pressure of O2

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50
Q

These arteries may bleed after placental removal

A

Spiral arteries

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51
Q

What can worsen spiral arteries bleeding after removal of placenta?

A

Nitrous oxide

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52
Q

Connect placenta to uterus

A

Spiral arteries

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53
Q

Uterine blood flow formula

A

Uterine arterial- venous pressure / Uterine Vascular resistance

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54
Q

Perfusion pressure relationship with Uterine Blood flow

A

Direct relationship (as one increases, the other increases)

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55
Q

Vascular resistance and Uterine Blood flow

A

INVERSE PROPORTIONAL relationship (as VR increases, UBF decreases vice versa)

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56
Q

2 main determinants of UBF

A

Perfusion pressure and vascular resistance

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57
Q

UBF at term is

A

> 700-900 ml/min

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58
Q

Uterine blood vessels are _________to vasopressors than systemic blood vessels

A

More sensitive

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59
Q

Vasodilators that may dilate uterine vessels

A

Nitrous oxide

PGE (prostanglandins)

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60
Q

What is altered in pregnancy as vasoconstriction?

A

Hypertensive response to IV epinephrine, phenylephrine and Angiotensin II is diminished

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61
Q

This receptor altered in pregnancy

A

Altered receptor mediated G-protein coupling

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62
Q

Placental transfer requiring ATP (2)

A

Active transport

Pinocytosis

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63
Q

Placental transfer NOT REQUIRING ATP

A

Passive transport

Facilitated transport

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64
Q

Placental transfer is LIMITED To

A

FLOW

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65
Q

Placental transfer is not limited to

A

diffusion

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66
Q

Placental transfer : passive transport driven by (COMLDM)

A 
Concentration gradient
Occurs via membrane or protein 
Molecular weight
Lipid solubilty
Degree of ionization
Membrane surface area
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67
Q

Passive process requiring carrier protein

A

Facilitated transport

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68
Q

Determinants of ACUTE changes in UBF are

A

Systemic Blood pressure
Uterine venous pressure
Uterine Vascular resistance

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69
Q

The 3 Determinants of ACUTE changes in UBF are

A

Systemic Blood pressure
Uterine venous pressure
Uterine Vascular resistance

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70
Q

Best positions for UBF

A

Prone- best (i.e on all four extremities)

Left LATERAL TILT

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71
Q

Worst position for UBF

A

SUPINE

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72
Q

Why is supine position worse for the pregnant female?

A

AORTAL CAVAL Compression: Gravid uterus sitting on top of major vessels, decreases preload and venous return which decreases CO and lead to hypotension

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73
Q

HYPOTENSION in pregnant ladies associated with

A

VOMITING

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74
Q

Which medication can be given IM to prevent vomiting

A

EPHEDRINE IM 50mg

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75
Q

These 2 hormones increases vascular resistance leading to decrease perfusion

A

Vasopressin

Angiotensin II

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76
Q

Factors that decrease UTERINE arterial presure

A

Supine position
Hemorrhage/ hypotension
Drug induced hypotension
Hypotension during sympathetic Blockade

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77
Q

Factors that increase UTERINE PRESSURE

A

Venal caval compression
UTERINE CONTRACTION
Drug induced uterine hypertonus (oxytocin, cocaine)
Skeletal muscle hypertonous

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78
Q

Most common cause of UTERINE PRESSURE increase is

A

Uterine contractions

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79
Q

2 major thing in summary decreasing perfusion pressure

A

Decrease Arterial pressure

Increase uterine venous pressure

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80
Q

Causes of Decrease uterine Blood flow

A
  1. Endogenous vasoconstrictors (catecholamines, vasopressin)

2. Exogenous Vasoconstrictors ( Phenylephrine> ephedrine) high concentrations of local anesthetics

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81
Q

Uterine blood flow if often reduce clinically (P-DUE) 4 factors

A

Position
Drug induced HYPOTENSION
UTERINE CONTRACTIONS and PUSHING EFFORTS
Endogenous and Exogenous vasoconstrictors

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82
Q

PaO2 of 60 gives SPO2 of

A

90

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83
Q

Diffusion rate of O2 vs CO2

A

CO2 has a high diffusion capacity, 20x greater than O2

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84
Q

Progesterone in pregnancy direct effect

A

Dilation of airways

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85
Q

***Progesterone on CO2

A

Increased sensitivity of CENTRAL CHEMORECEPTORS to CO2

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86
Q

Progesterone in pregancy indirect effect

A

Enhances B2 agonist activity

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87
Q

**Progesterone and MAC

A

It decreases MAC requirement by 30 %

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88
Q

If progesterone decreases MAC by 30%, if the MAC is 1.4 what would be the new MAC?

A

1.4 (0.30) = 0.42 so 1.4-0.42 = 0.98

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89
Q

Hormonal changes due to 4 main hormones (PECR)

A

Progesterone
Estrogen
Cortison
Relaxin

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90
Q

Action of Cortison and Relaxin

A

Dilates airways

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91
Q

Pregnancy and Estrogen

A

High local ESTROGEN leads to a DIMINISHED in activity of KEY intracellular enzymes that mediate vasconstriction

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92
Q

Plasma volume changes secondary to hormones

A

Increases due Progesterone and Estrogen

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93
Q

Progesterone and GI

A

Esophageal peristalsis/intestinal transit are slowed

due to Progesterone

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94
Q

_____And _______ are minimally affected if at all?

A

Gastric acid content and plasma gastrin levels

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95
Q

Progesterone on Kidneys and ureters

A

Kidneys enlarge and the ureters/renal pelvis dilate

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96
Q

Kidneys enlarged due to

A

Progesterone

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97
Q

Ureter and renal pelvis dilate due to

A

Progesterone

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98
Q

Estrogen increases ____% which leads to ______

What other thing causes renin release beside Estrogen?

A

100%; renin releases from juxtaglomerular cells of nephron cleave angiotensinogen
Sympathetic input

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99
Q

Pregnancy induced ↑ forgetfulness due to

A

Progesterone

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100
Q

Alveolar anesthetic concentrations rise fastersecondary to

A
  • ↑ MV

* ↓ FRC

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101
Q

Progesterone increases by _____% which leads to _________

A

Increase aldosterone levels

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102
Q

2 Actions of aldosterone

A

Increase sodium and water reabsorption by nephron collecting duct →Increase effective blood volume to correct initial stimulus to the system

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103
Q

Vicious cycle of persistent Fetal circulation (HPIR)

A
  1. hypoxia/hypercabnia/acidosis/ cold
  2. Pulmonary vasoconstriction
  3. Increased pulmonary vasoconstriction
  4. RIGHT TO LEFT SHUNTING of BLOOD
    Back to number 1.. vicious cycle
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104
Q

What is the danger of persistent fetal circulation

A

Can pop open foramen ovale and return circulation to fetal circulation

105
Q

Estrogen and endocrine

A

Increase plasma cortisol during 1st trimester by 100%

by 200% by term

106
Q

Joint mobility and pregnancy

A

RELAXIN increase joint mobility

107
Q

Blood glucose and pregnancy

A

LACTOGEN; reduces tissue sensitivity to insulin

108
Q

Which hormone reduces tissue sensitivity to insulin during pregnancy ?

109
Q

What changes in occur in MV in pregnancy ?

A

MV increase by 50%

110
Q

The MV ventilation is because of _____not _____

A

TV increase by 45%, NOT RR

111
Q

RR with pregnancy

A

remains the same

112
Q

Pregnancy O2 consumption and Co2 production

A

O2 consumption and CO2 production increases by 60%
primary due to fetus, uterus and placenta
secondary due to cardiac/resp work

113
Q

Diaphram changes during pregnancy

A

FLATTER and Higher

114
Q

Inspiration at term is TOTALLY

A

Diaphragmatic

115
Q

Respiration at term dependent of PHRENIC NERVE which is

A

C3, C4, C5

116
Q

FRC and pregnancy

A

Decreases by 20%

117
Q

FRC is reduced TO

118
Q

Why does FRC decreases? What is the meaning of a decreased FRC?

A

because Diaphragm is higher

Less O2 reserve , less time to intubate, desaturation occurs quicker. MUST PRE-OXYGENATE

119
Q

When does FRC changes start?

A

by the 5th month

120
Q

These 2 respiratory paramaters remains the same during pregnancy

A

Vital capacity

RR

121
Q

FRC is combination of ___ and _____

% decrease of each ?

A

ERV 25%

RV 15%

122
Q

Critical FRC point any further you loose ability to ventilate

A
  • Pneumonia
  • Pulmonary edema
  • ARDS
123
Q

PaCO2 decreases due to

A

• ↑ TV/MV

124
Q

PaCO2 in pregnancy _____ by when?

A

Decrease PaCO2 to 30 mmHg by 12 weeks

125
Q

What compensate for the decrease of PaCO2 ?

A

Bicarbonate decreases to ~ 20 mEq/L to compensate for the reduced PaCO2

126
Q

pH in pregnancy

A

Slightly alkalotic

127
Q

PaO2 level during pregnancy 1st, 2nd, 3rd respectively

A

107 - 105- 103

128
Q

pH blood gas level 1st, 2nd,3rd

129
Q

Bicarb pre-pregnant levels

130
Q

Bicarb during pregnancy, 1st, 2nd,3rd respectively

131
Q

PaCO2 pre-pregnant

132
Q

PaCO2 gas level 1st, 2nd,3rd

133
Q

Which hormones may account for back pain and carpal tunnel syndrome during pregnancy ?

134
Q

Thoracic age and pregnancy

A

Increases in size

135
Q

This hormone is a respiratory stimulant

A

Progesterone

136
Q

Hormone responsible for the decreased PaCO2

A

Progesterone (stimulate respiration)

137
Q

Pregnancy and Local anesthetics changes

A

increase sensitivity to local anesthetics due to progesterone increase

138
Q

Progesterone causes

A

Capillary engorgement and nasal passageway swelling

139
Q

Recommended ETT tube size

140
Q

Avoid in pregnant patient as far as UPPER airways

A

Any nasal NG, nasal airway or oral airway due to AIRWAY SWELLING

141
Q

Highest maternal mortality associated with

A

Difficult intubations

142
Q

Mallampati scores and pregnancy

143
Q

Denitrogenation is more

A

rapid due to increase MV and decrease FRC

144
Q

In pregnancy • PaCO2 of 40mmHg leads to

A

acute respiratory acidosis

145
Q

• FRC ↑ but below normal up until

A

1-2wks postpartum

146
Q

How long does it take for TV, MV and O2 consumption remain elevated

A

up to 6 weeks

147
Q

CV: issues Murmur associated with pregnancy

A

Grade I-II systolic murmur is typically heard; usually TR or MR

148
Q

Regurgitation with pregnancy

A

Tricuspid regurgitation 94% and Mitral

149
Q

Pulmonary compliance and pregnancy

A

Pulmonary compliance DECREASES

150
Q

Thoracic compliance during pregnancy

A

Thoracic compliance INCREASES

151
Q

NO effect on this respiratory parameters

A

FEV, FEV1/FRC, Flow volume loop or CLOsing capacity

152
Q

NO effect on this respiratory parameters

A

FEV, FEV1/FRC, Flow volume loop or closing capacity

153
Q

Obese and pregnant patient will show

A

RESTRICTIVE pattern

154
Q

Supine position decrease PaO2 by

A

Reducing FRC
Closing small airways
Increase shunt
Reducing CO via Aortacaval compression

155
Q

Types of hypertrophy normal in pregnancy

156
Q

Pulmonary pressure and pregnancy

157
Q

EKG changes and pregnancy

A

Sinus tachycardia with short PR

158
Q

When is the CO the highest in pregnancy

A

Immediately after delivery 75%

159
Q

When is the SV the highest in pregnancy

A

Immediately after delivery 75%

160
Q

IS the pregnant female at risk for AORTIC DYSFUNCTION?

161
Q

CO and pregnancy and distribution of change

A

CO increases by 50%
HR increase by 25%
SV increase by 25%

162
Q

EF and pregancy

A

LVEDP increases , EF increases

163
Q

Pulse pressure and pregnancy

A

Widening pulse pressure

164
Q

ORGANS with increase perfusion are (KUE)? any other organs affected?

A

Kidneys
Uterus
Extremities

NO

165
Q

What happens during Aorto Caval Compression

A

Aorta is partially obstructed

166
Q

In supine position aorta is (IPCR)

A

Increased femoral venous pressure
Partially obstructed
Collaterals cannot maintain venous return
Right side pressure Fall

167
Q

In Lateral Decubitus Position (PCA)

A

Partial caval obstruction
Collateral MAINTAIN venous return
AORTA is unaffected

168
Q

BEST POSITION if can’t do prone

A

LATERAL DECUBITUS POSITION

169
Q

Collateral veins that maintain venous return when patient in lateral decubitus position (IPE)

A

Intraosseous vertebral vein
Paravertebral vein
Epidural venous plexus

170
Q

Aortocaval compression preload is

A

Decreases 10-20%

171
Q

Uterine blood flow and aortocaval compression

A

Decreases by 20%

172
Q

Lower extremities flow and aortocaval compression

A

falls by 50%

173
Q

SUPINE HYPOTENSIVE SYNDROME is

A

From the profound drop in VENOUS RETURN from which the CV system CANNOT COMPENSATE

174
Q

There is rising pulse pressure because

A

Diastolic pressure lower due to low resistance vascular intervillous space and homone induced vasodilation

175
Q

Supine position associated with

A

Hypotension → vomiting

Bradycardia

176
Q

SV increased in pregnancy is mostly due to

177
Q

Spinal anesthesia CSF volume and pregnancy

A

↓ spinal CSF volume

178
Q

Spinal Anesthetic Requirements and pregnancy

A

•Reduced by 25%

179
Q

High spinal and epidural catastrophic

A
  • Check hands

* C6

180
Q

Fasting gastric volume and pH are normalized by

A

18hrs postpartum

181
Q

IF patient start to have contractions

A

STOP all neuraxial anesthesia process (can cause wet tap - hit spinal –> headaches)

182
Q

Renal plasma flow, GFR, and creatinine clearance all

183
Q

Renal plasma flow, GFR, and creatinine clearance all normalize by

A

8-12 wks PP)

184
Q

Returns toward pre-pregnant sympathetic tone by

185
Q

Epidural vein and pregnancy

A

•Distension of Epidural Veins

186
Q

Regional and Pregnancy

A

LOCAL Anesthetics requirement lowered

187
Q

Do Left lateral

A

before spinal anesthesia

188
Q

Do Left lateral position

A

before spinal anesthesia

189
Q

This medication is unaffected by pregnancy

190
Q

Epidural pressure and pregnancy

A

↑ EPIDURAL PRESSURE

191
Q

Pneumatic space and ↓ spinal CSF volume and pregnancy

A

• ↓ SPINAL CSF and pneumatic space

192
Q

Preoxygenation for pregnant can lead to PaO2 500mmHg which allows

A

3 mins of apnea

193
Q

First stage of labor

A

onset of true labor until cervix is completely dilated (10 cm)

194
Q

Subdivision of first stage of labor

A

 Early labor phase: time of onset until cervix dilated
3cm
 Active labor phase: cervix dilates from 3cm to 7cm
 Transition phase: cervix dilates from 7cm to 10 cm

195
Q

Second stage of Labor

A

period after cervix dilated to 10cm until the baby is delivered.

196
Q

Third stage of Labor

A

Delivery of the placenta.

197
Q

1st stage of labor what type of pain

198
Q

1st stage Dull pain transmitters are the

Cervical dilation mediated by

A

unmyelinated C fibers

199
Q

1st stage pain comes from

A

T10-L1(L2) DERMATOMES

200
Q

Second stage

A

Cervical dilatation progresses
Fetal head descends into pelvis
Stretches and compresses pelvic structures

201
Q

In second stage pain is mediated by

A

THE SACRAL PLEXUS

T12-L1, S2-S4

202
Q

This nerve block provides sensory to perineum

A

PUDENTAL BLOCK

203
Q

Not always completely anesthetized with epidural

A

The Pudental NERVE

204
Q

Third Stage of Labor

A

Placental EXPULSION

205
Q

Which anesthetic block is better during SECOND stage of labor?

A

Pudental Block (rarely done, high risk)

206
Q

MAC return to normal when?

A

72 hours (3 days) postpartum

207
Q

Patient return had baby 3 days ago, do you need to alter MAC?

208
Q

Dull, diffuse midline define

209
Q

Sharp, pricking, throbbing,and/or burning sensation

210
Q

Increase sensitivity to

A

YOU NEED LESS
-curonium
Ester Benzoisoquilines
Despite increase clearance

211
Q

Onset of perineal pain is associated with which stage of labor?

212
Q

Appropriate analgesia for FIRST stage labor

A

Neuraxial, Paravertebral and Paracervical

213
Q

Associated with the most FETAL BRADYCARDIA

A

PARACERVICAL (especially with bupivacaine)

214
Q

Less spinal due requirement due to

A

thoracic Kyphosis apex is higher (stopping use from apnea)

215
Q

Decreased normal dose of LOCAL Anesthetics start during

A

2nd trimester

216
Q

Regional more difficult due to

A

Lombar lordosis

217
Q

When does requirement of LOCAL anesthetics return to normal ?

A

40 hours postpartum

218
Q

Obstetric History

A 
Gravity = # of conceptions
Parity = # of live births
Abortus = # of preterm dead birth
219
Q

G1 P2 means

220
Q

Any regional will decrease

221
Q

ASSESS NEURO C6 gives you the ability to do

A

put 2 fingers together with hands

Watch for signs of respiratory depression

222
Q

_____________ has a poor predictive value for abnormal outcome

A

Abnormal FHR

223
Q

Historical RISK FACTOR For abnormal outcome

SUWAN

A 
 Smoking
 Unmarried
 Weight < 50 kg
 Age <18 or >39 years
 No education beyond primary
224
Q

Past OB risk factor for Abnormal outcome

PIP

A

Hx of perinatal loss
 Hx of infant < 2500gms
 Hx of preterm birth (<28 weeks gestation)

225
Q

Past MEDICAL hx risk factor for abnormal outcome

RRP TC

A 
 Rh negative with antibodies
 Renal disease
 Previous cone biopsy
 Thyroid disease
 Cardiac disease
226
Q

During Pregnancy; RISK FACTOR FOR negative outcome

MAH 4Ps GBD

A 
 Multiple gestation
 Anemia
 HTN
 Pyelonephritis
 Proteinuria
 Placental abruption
 Placenta previa 
Gestational or Established Diabetes
 Bleeding before 28 weeks gestation
 Delivery before 37 or after 42 weeks gestation
227
Q

PROM

A

PREMATURE RUPTURE OF MEMBRANES

228
Q

PPROM

A

PROM + PREMATURITY

229
Q

• > 34 WEEKS =

A

INDUCE AND DELIVER

230
Q

• < 31 WEEKS: EXPECTANT MANAGEMENT

A

EXPECTANT MANAGEMENT with prophylatics ABTs, tocolytics, and glucocorticoids (to accelerate lung maturity)]
Can lead to Chorioamnionitis

231
Q

ACOG RECOMMENDATIONS for PROM• IN BETWEEN

A

= EVALUATE FETAL LUNG MATURITY

• ANTIBIOTIC PROPHYLAXIS

232
Q

VBAC

A

ONLY CALLED VBAC ONCE YOU DELIVER

233
Q

VBAC is TECHNICALLY TOLAC:

A

TRIAL OF LABOR AFTER CESAREAN

234
Q

VBAC precluding Factors (UNMI)

A 
FACTORS:
• UNSUCCESSFUL TOLAC
• NO PREVIOUS VAGINAL BIRTHS
• MULTIPLE CS
• INDUCED/AUGMENTED LABOR
235
Q

VBAC successful with patient with a

A

LOW transverse INCISION

236
Q

Risks with VBAC

A

Uterine Rupture less than 1% with low transverse

237
Q

RIsk VBAC compared to elective CS and Failed TOLAC

A

Risk (better to worse)

VBAC> Elective repeat CS > Failed TOLAC

238
Q

Interpreting causes of Fetal HR changes

A 
VEAL CHOP
Variable Decels  - Cord Compression
Early decels - Head Compression
Accelerations -- Ok or give Oxygen
Late decels --- Placental Insufficiency
239
Q

2 predictor of POOR fetal status

A

Sinusoidal pattern

Absent baseline variability

240
Q

Who needs preop regardless epidural or not

A

Above 24 weeks

241
Q

Variability of FHR means

A

Reassuring pattern

Normal neurologic function of fetus parasympathetic and sympathetic functions

242
Q

Best position is

A

occiput anterior (baby kissing mom)

243
Q

Loss of resistance with needle indicates

A

Epidural space

244
Q

Can cause transient neurological symptoms

245
Q

General assssment

A

maternal health history
Obstetric history
Anesthesia related to obstetric hx

246
Q

NPO and obstetric

A

All patients are considered full stomach and at risk for pulmonary aspiration

247
Q

Supine position should be avoided unless a

A

LEFT UTERINE DISPlACEMENT device (>`15deg) wedge is placed UNDER THE RIGHT HIP

248
Q

Most common cause of Neonatal depression

A

Intrauterine asphyxia

249
Q

Preferred anesthesia

A

Spinal or EPIDURAL (less hemodynamic fluctuation, gradual resolution and lower maternal mortality

250
Q

Sings of fetal compromiss

A

Absence of baseline variability and accelerations

251
Q

More prolonged and Painful labor

A

OCCIPUT POSTERIOR (manuel or forceps rotation for delivery)

252
Q

Epidural activation for first stage of labor

A

3ml test dose with local anesthetic 1:200000 epi
less toxicity in case of UNINTENTIONAL INTRAVASCULAR INJECTION
Administer between contraction
Wait 5 minutes, with patient supine and Left uterine displacement

253
Q

Dosing for initial boulus

A

10ml in 5ml increments

  1. 1% to 0.2% ropivacaine
  2. 0652% to 0.125% Bupivacaine combined with 50-100mcg fentany or 10-20mcg of sufentanyl
254
Q

DA Functional Closure –

255
Q

DA Physiologically Closed

256
Q

DA Permanent Anatomic Closure

257
Q

Sensitive to DA

A

Oxygen, pH, & prostaglandins
• ↑ PaO2
• Less acidic pH
• Loss of placental prostaglandins

258
Q

Ductus Venosus Ligamentum Venosum

A

• Shunts blood from liver to IVC - 50% or less

259
Q

• Closes within 7 day

SNRAObPedGer (25 decks)

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