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OB Test 3 > High Risk OB > Flashcards

High Risk OB Flashcards

1
Q

Once uterine incision is made if fetal problems are occurring a higher incidence of low APGAR scores and acidosis are related to time it takes to get fetus out, this occurs if it takes longer than?

A

3 minutes

180 seconds

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2
Q

Where does central catecholamine release occur?

A

Periventricular and paraventricular tissue and dorsal medial medulla and throughout the brain

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3
Q

Neuraxial anesthesia for asthma patients has minor effects on which effort?

A

Inspiratory

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4
Q

Expiratory function is more affected by neuraxial because of?

A

More intense motor block affects:
ABD wall muscles
Cough strength

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5
Q

Some prefer epidural over spinal with severe asthma patients because?

A

Not as much decrease in epinephrine secretion

-helps bronchodilation

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6
Q

What can be used to help dry up secretions and bronchodilation in asthma patients?

A

Atropine

Glycopyrrolate

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7
Q

For GA with asthma patients, what is the drug of choice?

A

Ketamine

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8
Q

What is considered to be the most important factor in producing acute airway obstruction in asthma patients?

A

Constriction of airway smooth muscle

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9
Q

Definition of asthma

A

Reversible airway obstruction
Airway inflammation
Airway hyper responsiveness

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10
Q

Other mechanisms of acute airway obstruction in asthma patients

A

Neural imbalance between constricting and dilation influences
Airway inflammation
Airway epithelial destruction > changes it’s function

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11
Q

Neural components of asthma

A

PNS
SNS
Alpha adrenergic system
Non-adrenergic non-cholinergic system

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12
Q

What system is the most predominant constrictor of the airway in asthma patients?

A

Parasympathetic nervous system

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13
Q

What is the dilator in the non-adrenergic, non-catecholamine system (NANC)?

A

Nitric oxide

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14
Q

What is the leading cause of maternal mortality?

A

DVT & PTE

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15
Q

Pregnant women vs non-pregnant women have a ____ time greater risk of thrombotic event

A

5 times greater

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16
Q

When is the highest risk for a pregnant women’s thrombotic event?

A

Immediately postpartum

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17
Q

How much does a c-section increase the risk of a thrombotic event?

A

Doubles the risk

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18
Q

What are the 2 most important risk factors for thromboembolic events in pregnancy?

A

Previous history of thromboembolism

Diagnosis of thrombophilia

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19
Q

Which thrombophilia increases the risk for VTE in pregnancy the most?

A

Homozygous factor V Leiden mutation

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20
Q

What are the most modifiable risk factors for thromboembolic event

A

Antenatal
Immobilization
Obesity

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21
Q

Physical s/sx of PE

A 
SOB
Anxiety
Palpitations
CP
Cyanosis
Diaphoresis
Coughing +/- blood
Crackles
Decreased breath sounds
Tachycardia
Tachypnea
JVD
Split 2 heart sounds
Right axis shift
ST segment abnormalities 
T wave inversion
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22
Q

Most air emboli are small with no sequelae, but emboli larger than _____ may be lethal

A

200-300 mL

-or 3-5ml/kg

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23
Q

When is the most common time of air entrainment with c-section?

A

Immediately after placental separation

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24
Q

What are the manifestations of massive VAE?

A 
Hypotension
Hypoxemia
Dyspnea
Arrhythmia
Chest pain
Cardiac arrest
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25
Q

During neuraxial anesthesia how can a VAE present?

A

Hypoxemia
Dyspnea
Chest pain during uterine repair

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26
Q

During GA what suggests VAE?

A

Hypoxemia

Slight decrease in end-tidal CO2

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27
Q

What is the treatment for VAE?

A

Flood sx field with saline
Drop ABD lower than heart
Vasopressors
CPR
Deliver infant
100% O2 (turn off nitrous if in use- grows air embolus)
Avoid PEEP and valsalva maneuvers (can cause paradoxical embolism)

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28
Q

During what stage of labor does amniotic fluid embolus usually occur?

A

Second stage

-during labor or after delivery of placenta

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29
Q

S/Sx of amniotic fluid embolus

A 
Sudden onset chills
Shivering
Diaphoresis 
Tachypnea
Cyanosis
CV collapse
DIC
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30
Q

What other conditions appear just like amniotic fluid embolus (AFE)?

A

Placental abruption
Uterine Rupture
Anaphylaxis

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31
Q

What is the classic triad of AFE?

A 
Acute hypoxia (respiratory distress)
Hemodynamic collapse (CV collapse)
Coagulopathy without precipitating cause, may not manifest for several hours
32
Q

Risk factors of AFE

A 
Meconium in fluid
Older age
Abnormal presentation
Placental abruption
Eclampsia
Multiple gestation
Induction of labor
Artificial rupture of membranes
Operative delivery
33
Q

Test/diagnosis of AFE?

A

No specific one, often diagnosed after death

34
Q

What are the 2 phases of AFE?

A

Stage 1: CV collapse within 30 minutes of delivery

Stage 2: Hemorrhage and DIC

35
Q

What is often the first sign of AFE?

A

Respiratory failure due to RV failure from severe pulmonary vasoconstriction

36
Q

Treatment for AFE?

A 
Intubate - 100% O2
CPR - must deliver fetus to be effective 
Inhaled nitric oxide or prostacyclin
Cardiopulmonary bypass
Aggressive volume and press or support
Order blood, FFP, Cryo
RV assist device
ECMO
37
Q

What is the AOK protocol? What is it used to treat?

A

Atropine 1mg
Ondansetron 8mg
Ketorolac 30mg
Amniotic fluid embolus

38
Q

What does atropine do for AOK protocol?

A

Blocks vagal responses
Prevents systemic hypotension because it prevents bradycardia
Decreases vasoconstriction in pulmonary vasculature

39
Q

What does Zofran do in AOK treatment?

A

Serotonin antagonist
Help with vagotomy
Also prevents CV collapse

40
Q

What does Ketorolac do in AOK treatment?

A

Directly inhibits thromboxane > stopping coagulation cascade and prevent DIC

41
Q

AOK shows profound hemodynamic recovery with complete neurological recovery within how long?

A

2 minutes

42
Q

After cardiac arrest what has the largest impact on saving mom and fetus avoiding severe neurological injury

A

CPR

43
Q

If mother survives what should be expected?

A

Hemorrhage and DIC

+/- Emergency hysterectomy

44
Q

What is cervical insufficiency?

A

Inability of the cervix to hold a pregnancy in the uterus through the second trimester in the absence of labor

45
Q

List 4 causes of cervical insufficiency

A

Congenital disorders
Acquired
Previous D&C
Loop electrical excision procedure (LOOP)

46
Q

When is transvaginal cervical cerclage done?

A

12-18 weeks

-more successful if done before problems

47
Q

What is the anesthetic of choice for cervical cerclage?

A

SAB

48
Q

What position is used for cerclage placement and why?

A

Steep trendelenburg

-to help get membranes out of the way

49
Q

What needs to be avoided during cerclage placement?

A

Coughing and vomiting

-give meds to avoid

50
Q

Symptoms of cervical insufficiency

A 
Altered vaginal discharge
Lower abdominal or back pressure or discomfort
Vaginal fullness 
Urinary frequency
Can be asymptomatic
51
Q

When is diagnosis of cervical insufficiency definitive?

A

If delivery occurs in the second trimester before 24 weeks gestation in the absence of bleeding, infection, or labor as the initial symptom
-she says when herniated fetal membrane is seen or palpated during second trimester

52
Q

What provides proficient certainty of cervical insufficiency?

A

Cervical dilation or prolapse of membranes through the cervix in the absence of other findings or symptoms

53
Q

Why is a spinal preferred with cerclage? (She says)

A

Faster onset q

54
Q

GA may need to be performed for cerclage if what?

A

Uterine relaxation is needed

55
Q

Is dantrolene safe in pregnancy

A

Yes

56
Q

Trial of labor after c-section/vaginal birth after c-section is advised to be

A

In the hospital

57
Q

What anesthetic should be avoided in epilepsy?

A

Ketamine

58
Q

Multiple Sclerosis relapse rate is 3x higher when?

A

First 3 months postpartum

59
Q

With intrauterine fetal death what develops in the mother if the fetus stays in how long?

A

DIC

More than 1 month

60
Q

HIV/AIDS may have difficult intubation why?

A

Pharyngeal lymphatic hypertrophy

61
Q

Myasthenia Gravis prolongs what stage of labor and why?

A

Second stage

Muscle weakness

62
Q

What medications should be avoided and used cautiously in myasthenia gravis patients?

A

Avoid Magnesium

Overly sensitive to ND-NMB

63
Q

Why should Mg be avoided in myasthenia gravis patients?

A

It can precipitate a myasthenic crisis

64
Q

When is neuraxial anesthesia for c-section not the preferred choice in MG patients?

A

When myasthenia gravis patient has significant bulbar involvement or respiratory compromise

65
Q

What procedure decreases myasthenia gravis exacerbations and exerts a favorable outcome in pregnancy?

A

Thymectomy

66
Q

Why and how long should a woman delay pregnancy after initial myasthenia gravis diagnosis?

A

Exacerbations occur more frequently in the first year after diagnosis
Delay for 1-2 years

67
Q

What stage of labor does myasthenia gravis affect, why?

A

Second stage
First stage is smooth muscle in the uterus (not affected by MG)
Second stage often requires use of striated muscle

68
Q

Myasthenia gravis symptoms in neonate

A 
Poor sucking
Generalized hypotonia 
Difficulty feeding
Feeble cry
Ptosis 
Respiratory distress
69
Q

When do myasthenia gravis symptoms develop in the newborn and when do they usually abate?

A

Develop within the first 12-48 hours

Abate within 2-4 weeks as antibodies are metabolized

70
Q

Why may succinylcholine be prolonged in myasthenia gravis patients?

A

Decrease in plasma cholinesterase from their MG treatment with anticholinesterases

71
Q

What genital herpes outbreak requires a c-section for delivery to prevent transmission to baby?

A

Primary outbreak

72
Q

When is vaginal delivery and regional anesthesia acceptable with a genial herpes patient?

A

Secondary infection and if cervical cultures are negative

73
Q

What is the major concern with genital herpes and fetus?

A

Neonatal HSV is a life-threatening infection with the potential for permanent CNS sequelae
-encephalitis

74
Q

Why med/anesthetic technique increases the recurrence of oral HSV?

A

Spinal or epidural morphine

-avoid using

75
Q

Risk of maternal death is greater with what anesthetic?

A

GA vs neuraxial

OB Test 3 (3 decks)

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