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Principles II, Exam 1 > Labor, C-section > Flashcards

Labor, C-section Flashcards

1
Q

Beat to beat variability

A

Best indicator of fetal well being
Decreased variability with acidosis
Meds will diminish: atropine, beta blockers, narcotics

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2
Q

Early deceleration

A
  • Begin with cx
  • Rarely drop below 110
  • Vagal
  • Secondary to head compression
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3
Q

Late deceleration

A

Begin 20 sec or more after cx onset

Decrease in uterine blood flow

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4
Q

List stages of labor and pain

A

Stage 1. Cervical dilation: visceral pain, C fibers T10-L1
Stage 2. Delivery: a delta fibers, somatic S2-4 spino-thalmic tract
Stage 3. Placenta
Stage 4. 60 min after delivery: high risk hemorrhage, uterine atony, significant increase in CO

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5
Q

Rx for deceleration

A

LUD, oxygen, fluid bolus, vasoprssors
Saline amniotransfusion-restores cushion of amniotic fluid for patient with variable decels, also for thick meconium

Goal: optimize placental blood flow and maternal oxygenation

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6
Q

Prenatal assessment

A 
Anasthetic eval, maternal HTN
oxytocin use
Dysfunctional labor/induced
Bleeding
Post date: old placenta
GDM
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7
Q

Paracervical block

A

Interrupts transmission of impulses from uterus and cervix during 1st stage of labor
No Bupivicane - cardio toxicity lido 1% 5-10 cc
High incidence of fetal asphyxia and bradycardia

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8
Q

Lumbar epidural block
First stage level
Second stage level

A

1st stage: T10 - L1
2nd stage: S2 - S4

Prehydrate, platelet > 100,000, proper equipment

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9
Q

How much bolus is needed to achieve sensory level of T10-L2, epidural

A

8-10 cc to achieve sensory level of T10-L2

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10
Q

What concentration not to be used in OB pt in epidural

A

> 0.5% NEVER

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11
Q

Toxic systemic reaction with epidural happen when

A

Large volumes increase the risk
1/5000 risk
No concentration >.5% in OB pts

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12
Q

Treatment for toxic systemic reaction with epidural

A

O2, secure airway, BZDP, propofol, hypotension- vasopressors, fluids

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13
Q

What is the elimination half life for LA aside

A

2-3 hrs

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14
Q

What is the dose of meds for combined spinal epidural

S/S

A

10-25 mcq fentanyl
1.25-2.5 mg Bupivicane

S/S: pruritis, n/v, urinary retention

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15
Q

Drugs used for uterine atony

A
  1. Pitocin: after placental delivery, keep it wide open
  2. Methergine 0.2 mg IM, not for labor just bleeding
  3. Prostaglandin: F2aHemabate, 250 mcq IM/IU q 15-90 min
    - bronchospasm, tachycardia
  4. Tocolytics: B2 agonists (terbutaline) to stop labor
  5. MgSO4: replaces Ca in myometrial receptor site
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16
Q

Which med- Ergot poisoning

What are the signs of ergot poisoning

A

Methergine

S/S: HA, N/V, diarrhea

17
Q

Example Tocolytic

A

Terbutaline: beta 2 agonist

18
Q

Example of prostaglandin

A

F2aHemabate 250 mcq IM or IU

Misoprostol (Cytotec) 400-1000 mcq PR

19
Q

Prevention of spinal HoTN

What is the% and treatment

A
  1. Co loading with crystalloids
  2. Zofran 5 min b4 block
  3. Lateral position

45-100%: neo ( improved fetal acid-base status) and ephedrine

20
Q

Interrupts the transmission of nerve impulses from the uterus and cervix during the first stage of labor

A

Paracervical block

21
Q

How often do u need to assess motor mobility r/t catheter migration

A

Every 1 hr

22
Q

What can u use for forceps delivery

A

Saddle block

Top off epidural : forceps and vacuum extractor

23
Q

Potential Complications of spinal

A
  1. High or total: hoarseness, tingling fingers, diff breathing
  2. Inadequate spinal: 30-40% N2O, Ketamine .1-.2mg/kg
  3. Anxiety
  4. Hypotension: IVF, vasopressors, LUD, brady after SAB
24
Q

Prevention of aspiration

A

Bacitra 10 min b4 surgery
Reglan 15-30 min prior
Pepcid 20 mg
RSI

25
Q

Stats about deaths occurring during c/s

A

1/300
106/129 deaths occurred during c section
52% during GA and 73% airway problems

26
Q

What to document

A

Abd incision

Uterine incision time should be

27
Q

Goals for induction

A

Preserve BP and CO
Minimize fetal depression
Ensure maternal hypnosis and amnesia

28
Q

What agent to use if pt hypotensive and asthmatic

A

Ketamine

29
Q

Propofol stuff

A

Rapidly cleared
Hypotension
Currently used in OB

30
Q

Which IV agents don’t cross placenta

A

Muscle relaxants

Anticholinergics: atropine

31
Q

Etomidate

A

.3mg/kg

Maternal hypovolemia

32
Q

Which med suppresses cortisol production in neonates

A

Etomidate

33
Q

What are the doses of VA agents

A

ISO .75%
Des 4.8%
Sevo 1.7%

34
Q

Most popular inhalation agents in OB

A

N2O
No uterine relaxation
>70% and >20min will increase likelihood of fetal depression

35
Q

What can decreased PaCO2 cause

A

Fetal hypoxemia and acidosis
- reduced uterine umbilical blood flow and increased affinity of maternal Hgb for O2
Avoid hyperventilation

36
Q

Post op concerns

A

Airway obstruction
Hypo ventilation
Hypoxemia
More death during emergence than induction

Principles II, Exam 1 (8 decks)

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