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OB Exam 1 > Key Points Exam 1 > Flashcards

Key Points Exam 1 Flashcards

1
Q

what happens to CO during pregnancy and why

A

Cardiac output increases during pregnancy as a result of an increase in stroke volume and heart rate. A pregnant woman with cardiovascular disease may not be able to
meet this greater demand.

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2
Q

pregnant women have ↑ or ↓ sympathetic tone than nonpregnant women

A

greater

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3
Q

may result in compression of the inferior vena cava and aorta by the gravid uterus

A

laying in the supine position beginning at mid-pregnancy

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4
Q

The outcome of labor reflects the interaction of 3 components:

A

the powers, the passageway, and the passenger

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5
Q

what happens when the IVC and aorta are compressed

A

may result in decreases in both cardiac output and uteroplacental perfusion.

Severe hypotension and bradycardia in the supine position is called the supine hypotension syndrome.

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6
Q

Assuming that the fetus is tolerating labor satisfactorily, the most important obstetric determination is ________

A

whether the patient is in the latent or the active phase of the first stage of labor.

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7
Q

when should pregnant women not lie supine

A

after 20 weeks gestation

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8
Q

how should the uterus be displaced on the OR table

A

The uterus should be displaced to the left
by placement of a wedge underneath the right hip or by tilting the operating table, or the pregnant women should
assume the full lateral position.

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9
Q

what happens to blood volume during pregnancy and why

A

The greater blood volume of pregnancy allows the parturient to tolerate the blood loss of delivery, within limits, with
minimal hemodynamic perturbation.

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10
Q

what happens to maternal vascular capacitance at the time of delivery

A

it is reduced

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11
Q

oxygen demand and delivery are ↑ or ↓ during pregnancy and labor and delivery

A

Oxygen demand and delivery are greater during pregnancy
and further increase during labor and delivery.

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12
Q

what happens to minute ventilation and FRC during pregnancy

A

Minute ventilation increases whereas functional residual
capacity decreases during pregnancy. It is not uncommon
for the pregnant women to experience dyspnea.

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13
Q

_____ shortens labor

A

amniotomy

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14
Q

_______ is the most valuable obstetric drug, and judicious use of a higher dose regimen may increase vaginal birth and shorten labor.

A

oxytocin

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15
Q

________ is the standard choice for the very
preterm patient with premature rupture of membranes; induction of labor is generally undertaken in patients exhibiting this condition at term

A

Expectatnt management

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16
Q

pregnancy ABG

A

Pregnancy is a state of partially compensated respiratory
alkalosis.

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17
Q

Gastric volume, emptying, and pH are ____________ during
pregnancy

A

unaltered

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18
Q

LES tone during pregnancy

A

lower esophageal sphincter tone may
be reduced with increased risk for gastroesophageal
reflux

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19
Q

pregnancy coagulation state

A

hypercoagulable

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20
Q

Elective induction of labor is an appropriate choice for a
patient with _____

A

a favorable cervix

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21
Q

MAC during pregnancy

A

Minimum alveolar concentration (MAC) values for the
volatile anesthetics are decreased during pregnancy.

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22
Q

The declining numbers of operative vaginal deliveries
reflect ____

A

medicolegal concerns rather than new scientific
information.

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23
Q

pregnant women have a ____________ in PaO2 during periods of apnea

A

rapid decrease

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24
Q

pregnant women are at risk for what issues with intubation

A

failed tracheal intubation

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25
Q

maternal response to vasopressors

A

less responsive to vasopressors

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26
Q

_____ is the most commonly performed major
operation in the United States, and _______ is the most common indication

A

Cesarean delivery; previous cesarean
delivery

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27
Q

Uteroplacental blood
flow constitutes approximately ____________ of maternal cardiac
output at term.

A

12%

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28
Q

uteroplacental circulation is a ____________, ____________ vascular bed

A

The uteroplacental circulation is a dilated, low-resistance
vascular bed

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29
Q

does uteroplacental circulation autoregulate?

A

limited ability

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30
Q

A trial of labor is successful in 72% to 75% of women in
whom a _______ uterine incision was made during a previous cesarean delivery

A

low-transverse

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31
Q

The uteroplacental circulation is composed of placental
and nonplacental circulations that are anatomically and
functionally ____________ .

A

dissimilar

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32
Q

_____ is the greatest predictor for
successful vaginal birth after cesarean delivery (VBAC).

A

A previous vaginal delivery

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33
Q

Acute or chronic reductions in uteroplacental blood flow may threaten ____________ and predispose to disorders
such as ____________ and ____________

A

fetal viability; preeclampsia; fetal growth restriction

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34
Q

______ are associated with a lower likelihood of
successful VBAC.

A

A history of dystocia, the need for induction of labor, and/or maternal obesity

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35
Q

Hospitals and insurers should not mandate a trial of labor for pregnant women with ______

A

a history of previous cesarean
delivery.

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36
Q

method most commonly
used clinically to assess uteroplacental blood flow in humans

A

doppler ultrasonography

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37
Q

The ACOG has recommended that ______ should be immediately available in women attempting a trial of labor after previous cesarean delivery (TOLAC). Other groups have argued that this
guideline is too restrictive and has created barriers that prevent women from choosing TOLAC

A

resources for performing emergency cesarean delivery

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38
Q

Abnormal waveforms and indices of resistance in doppler ultrasonography
may be predictive of complications such as

A

preeclampsia, fetal growth restriction, and preterm labor.

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39
Q

what can neuraxial anesthesia do to uterine blood flow

A

Neuraxial anesthesia can increase uterine blood flow by reducing pain and stress, or it can decrease uterine blood flow by causing hypotension.

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40
Q

does phenylephrine cross placenta

A

NO

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41
Q

vasopressor of choice in OB

A

phenylephrine

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42
Q

_____ represents the best means of detecting uterine rupture

A

Continuous electronic fetal heart rate monitoring

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43
Q

does general anesthetic agents usually have direct effects on uterine blood flow

A

The doses of general anesthetic agents used clinically have
minimal direct effects on uterine blood flow.

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44
Q

Women are more likely to undergo TOLAC if _____

A

they
know that they will receive effective analgesia during
labor

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45
Q

how can general anesthesia reduce uterine blood flow

A

may reduce uterine blood flow by causing decreased
cardiac output and hypotension.

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46
Q

T/F Epidural analgesia does not delay the diagnosis of uterine rupture or decrease the likelihood of successful VBAC.

A

TRUE

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47
Q

what does the release of catecholamines do to uterine blood flow

A

decrease it

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48
Q

Labor pain exists and is severe in many women, with a
close correlation between _____ AND ____

A

cervical dilation and pain during
the first stage

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49
Q

For cardiovascular emergencies in pregnant women, the
choice of inotropic drug should depend primarily on….

A

the efficacy of the drugs to optimize the maternal condition, rather than on minor differences in uterine blood flow.

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50
Q

placenta functions

A

It brings two circulations close together for the exchange of
blood gases, nutrients, and other substances

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51
Q

during pregnancy what happens to the spiral arteries

A

substantial vasodilation

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52
Q

what does vasodilation of uterine spiral arteries cause

A

a low-resistance pathway for
the delivery of blood to the placenta

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53
Q

The _____ stage of labor involves visceral pain from the
lower uterine segment and endocervix, which results in
hypersensitivity to convergent somatic dermatomes. This pain is most likely amplified over time as a result of the sensitization of peripheral and central pain-signaling
pathways.

A

First

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54
Q

adequate uteroplacental blood flow depends on

A

the maintenance of
a normal maternal perfusion pressure

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55
Q

The _____ stage of labor results in somatic pain
from the vagina and perineum and is briefer than the first stage

A

second

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56
Q

physical factors that affect the placental transfer of drugs and other substances

A

molecular weight, lipid solubility, degree of ionization, changes in maternal and fetal blood flow, placental binding, placental metabolism, diffusion capacity, and extent of maternal and fetal plasma protein binding

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57
Q

Afferent terminals transduce a mechanical process into
electrical signals, which are probably amplified by ________

A

the release of prostaglandins, cytokines, and growth factors into the cervix as part of the normal disruption of collagen that allows the cervix to soften and dilate

58
Q

Fetal acidemia can result in the ____________ of both local anesthetics and opioids.

A

ion trapping

59
Q

do vasoactive drugs cross the placenta

A

Yes, vasoactive drugs cross the placenta, and may affect the fetal
circulation, and may have effects on fetal metabolism.

60
Q

T/F Pain transmission in the spinal cord is hardwired

A

FALSE
it is NOT hardwired

61
Q

Accurate determination of gestational age is essential for

A

the management of pregnancy complications and the
effective use of antepartum fetal testing.

62
Q

Ultrasonography can be used to estimate

A

gestational age

assess fetal growth

monitor amniotic fluid volume

detect and characterize fetal anomalies.

63
Q

Pain transmission in the spinal cord is altered by _____

A

local neuronal activity that releases µ-opioid receptor agonists and descending pathways that release α2-adrenergic and serotonergic receptor agonists

64
Q

Appropriate fetal growth is strongly correlated with ____________ and can be assessed ____________

A

fetal health; clinically or with ultrasonography.

65
Q

T/F: Fetal movement charts (“kick counts”) can be used to confirm fetal well-being in both high- and low-risk populations

A

true

66
Q

There are large individual differences in pain perception,
which likely reflect ______

A

differences at suprathalamic sites

67
Q

The activation of suprathalamic sites is the primary mechanism of action for _____

A

distraction methods of analgesia

68
Q

High-risk pregnancies may require addi-
tional fetal monitoring such as

A

the nonstress test (NST), biophysical profile (BPP), or contraction stress test (CST).

69
Q

how can a fetal karyotype be obtained

A

by chorionic villus
sampling, amniocentesis, or fetal blood sampling (cordocentesis).

70
Q

_____ alters the obstetric course and the maternal
cardiac and respiratory function in a complex manner that normally is well tolerated, can sometimes be detrimental to both mother and fetus, and is alleviated by analgesia

A

labor pain

71
Q

is doppler velocimetry’s role in confirming fetal well-being clearcut?

A

no, doppler velocimetry has advanced our understanding of maternal-fetal physiology, but its role in confirming fetal well-being is unclear

72
Q

may be used in selected cases to better
define fetal malformations

A

Additional radiologic imaging (especially magnetic
resonance imaging)

73
Q

T/F Acute postpartum pain after either vaginal or cesarean delivery deserves attention and treatment

A

TRUE

74
Q

delivery is indicated when

A

the benefits of delivery to the fetus or mother outweigh the risks associated with continuing the pregnancy

75
Q

the factors or mechanisms responsible for the development of persistent or chronic postpartum pain are _____

A

Under investigation

76
Q

T/F Systemic analgesia is commonly used in laboring women
worldwide

A

TRUE

77
Q

A normal FHR tracing accurately predicts

A

fetal well-being

78
Q

An abnormal tracing (is/ is not) specific in the prediction of fetal compromise

A

is not specific

79
Q

suggest a high likelihood of fetal hypoxia/acidemia

A

the fetus with prolonged bradycardia or the fetus with late FHR decelerations and absence of variability

80
Q

T/F All opioid analgesic drugs rapidly cross the placenta and cause a transient reduction in fetal heart rate variability

A

TRUE

81
Q

The specificity of FHR monitoring may be improved by the use of

A

fetal scalp stimulation and fetal vibroacoustic
stimulation.

82
Q

Neither fetal pulse oximetry nor fetal ST segment analysis reduce the rate of

A

cesarean delivery

83
Q

When a Category II FHR tracing occurs, fetal resuscitation ____________ may be attempted with interventions

A

in utero

84
Q

_____ is most commonly administered as an intermittent bolus. Its active metabolite may have prolonged adverse effects on the neonate

A

Meperidine

85
Q

In-utero fetal resuscitation measures

A

maternal position change, treatment of uterine tachysystole, intravenous fluid bolus, administration of supplemental oxygen, and/or saline amnioinfusion.

86
Q

T/F There is a lot of evidence that any individual opioid confers significant benefit over meperidine when administered as a bolus

A

FALSE
there is little evidence

87
Q

Neonates whose mothers received _______ are more likely to exhibit neonatal depression than
those whose mothers who received no analgesia or epidural analgesia

A

systemic opioid analgesia

88
Q

Pregnancy ____________ the effect of local anesthetic agents.

A

enhances

89
Q

T/F: administration of epidural anesthesia does not adversely affect uterine tone or uterine or umbilical blood flow

A

true, if appropriately administered

90
Q

bupivacaine vs lidocaine toxicity

A

Bupivacaine has greater cardiotoxicity than lidocaine because of its greater electrophysiologic effects, which
predispose to ventricular arrhythmias.

91
Q

have a lower potential for cardiotoxicity than racemic bupivacaine

A

Single (levorotary) isomer formulations of amide local anesthetics, such as ropivacaine and levobupivacaine

92
Q

An oxygen saturation less than
______% when breathing room air should prompt administration of supplemental oxygen

A

94

93
Q

Anesthesia provider should be notified if what occurs when patient is receiving remifentanil patient-controlled intravenous labor analgesia (PCIA)?

A

if excessive maternal sedation, a respiratory rate less than 8 breaths per minute, and/or oxygen saturation less than 94%, despite supplemental oxygen administration, occurs

94
Q

____________ should be considered at the
first sign of a serious local anesthetic systemic toxicity
event

A

Lipid emulsion therapy

95
Q

results in a greater accumulation of amide
local anesthetic in the fetus

A

fetal acidosis

96
Q

Local anesthetics, as used clinically, (are/are not) teratogenic

A

are not

97
Q

elimination half-life of amide local anesthetics in the newborn

A

The elimination half-life of amide local anesthetics is longer in the newborn than in the adult because the former has a greater volume of distribution.

98
Q

T/F: The fetus and newborn seem to be more vulnerable to the toxic effects of local anesthetics than the adult.

A

False; The fetus and newborn seem to be no more vulnerable to
the toxic effects of local anesthetics than the adult.

99
Q

Alkalinization of a local anesthetic solution

A

shortens the latency of neural blockade but increases the risk for hypotension during the administration of epidural anesthesia

100
Q

T/F The optimal remifentanil PCIA regimen has not yet been determined, but titrated regimens likely confer an advantage as labor progresses

A

TRUE

101
Q

Neuraxial opioid administration produces analgesia without loss of

A

sensation or proprioception

102
Q

The use of a background Remi infusion
warrants extreme caution because of the significant risk
for ______

A

moderate to severe respiratory depression

103
Q

The combination of a neuraxial local anesthetic and an opioid increases

A

block density

104
Q

T/F Use of inhalation analgesia is more common in the United States than in other countries

A

FALSE
less common

105
Q

Spinal bioavailability of the ____________ drugs is greater than that of ____________

A

hydrophilic drugs; hydrophobic opioids

106
Q

T/F Nitrous oxide may be used alone or with other systemic or inhaled agents

A

TRUE

107
Q

The most common side effects of neuraxial opioid administration are

A

pruritus and nausea and vomiting.

108
Q

most serious complications of neuraxial opioid administration

A

fetal bradycardia and maternal respiratory depression

109
Q

Inhalation of nitrous oxide provides ______ analgesia, but high satisfaction in motivated patients

A

Variable

110
Q

When used alone, it does not appear to be associated with adverse effects on the fetus or neonate.

A

Nitrous oxide

111
Q

_____ inhalation of volatile anesthetic agents
appears to provide good analgesia with few maternal or
neonatal side effects, but larger studies are needed to assess the maternal and neonatal safety of these agents

A

intermittent

112
Q

______ and _______ may
provide effective analgesia for the first stage of labor.

A

Paracervical block; lumbar sympathetic block

113
Q

is the most effective form of intrapartum analgesia currently available.

A

neuraxial anesthesia

114
Q

The administration of the epidural test dose should allow the anesthesia provider to recognize

A

most cases of unintentional intravascular or intrathecal placement of the epidural catheter.

115
Q

the local anesthetic most often used for
epidural analgesia during labor in the United States

A

bupivacaine

116
Q

All therapeutic doses of local anesthetic
should be administered ____________

A

incrementally

117
Q

T/F Paracervical block and lumbar sympathetic block can relive pain during the second stage

A

FALSE
neither technique relives pain during 2nd stage

118
Q

Most anesthesia providers reserve ____________ for cases that require the rapid extension of epidural anesthesia for vaginal or cesarean delivery

A

2-chloroprocaine and
lidocaine

119
Q

The addition of a lipid-soluble opioid to a neuraxial local anesthetic allows the anesthesia provider to provide excellent analgesia while reducing

A

the total dose of local anesthetic and minimizing the side effects of each
agent.

120
Q

______ is the most worrisome complication of
paracervical block

A

Fetal bradycardia

121
Q

may provide complete analgesia
during the early first stage of labor

A

intrathecal opioids

122
Q

Epidural opioids without local anesthetic do not provide

A

complete analgesia during labor.

123
Q

Paracervical block is contraindicated in patients with _______ or_______

A

uteroplacental insufficiency; preexisting fetal compromise

124
Q

is necessary to provide complete neuraxial analgesia for the late first stage and the second stage of labor

A

administration of a local anesthetic

125
Q

T/F For patients without epidural or spinal analgesia, it is
appropriate to perform pudendal nerve block when the
patient complains of pelvic floor pain

A

TRUE

126
Q

is a common side effect of neuraxial analgesia

A

hypotension

127
Q

Prophylaxis and treatment of hypotension with neuraxial anesthesia involves

A

the avoidance of aortocaval compression and the administration of a vasopressor as needed

128
Q

Pudendal nerve block may provide satisfactory anesthesia for spontaneous _________, but it provides inadequate anesthesia for __________

A

vaginal delivery and outlet-forceps delivery;

mid-forceps delivery, postpartum repair of the cervix, and manual exploration of the uterine cavity

129
Q

T/F: The administration of an intravenous
fluid “preload” significantly decreases the incidence of hypotension in euvolemic patient

A

FALSE;

The administration of an intravenous
fluid “preload” does not significantly decrease the incidence of hypotension in euvolemic patient

130
Q

Other potential side effects of neuraxial analgesia include

A

pruritus, shivering, urinary retention, delayed gastric emptying, maternal fever, and fetal heart rate change

131
Q

________ provides anesthesia only for episiotomy and repair

A

Perineal infiltration

132
Q

Complications of neuraxial analgesia include

A

inadequate analgesia, unintentional dural puncture, respiratory depression, unintentional intravenous injection, and
extensive or total spinal anesthesia.

133
Q

It is unnecessary—and perhaps dangerous—to give
________ for paracervical block, pudendal nerve block, or perineal infiltration

A

concentrated solutions of local anesthetic

134
Q

The presence of severe pain during early labor—and/or an increase in local anesthetic/opioid dose requirement— may signal a higher risk for

A

prolonged labor and operative delivery.

135
Q

T/F: Neuraxial labor analgesia results in a higher rate of cesarean delivery than systemic opioid analgesia.

A

False;

Neuraxial labor analgesia does not result in a higher rate of cesarean delivery than systemic opioid analgesia.

136
Q

Some cases of fetal injury result from direct ________ during attempted paracervical block, pudendal nerve block, or perineal infiltration

A

fetal scalp
injection of local anesthetic

137
Q

Effective neuraxial analgesia likely results in a modest prolongation of the ____________ stage of labor

A

second

138
Q

________ is most likely the safest choice of local
anesthetic for paracervical block, pudendal nerve block,
and perineal infiltration

A

2-Chloroprocaine

139
Q

Dense neuroblockade (e.g.,
presence of significant motor blockade) and complete analgesia during the second stage of labor probably increase the rate of

A

instrumental vaginal delivery

140
Q

Use of a ____________ is less likely
to adversely affect the progress of labor.

A

dilute solution of local anesthetic and opioid

141
Q
A

OB Exam 1 (13 decks)

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