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OB Exam 1 > Module 3: Part 3 > Flashcards

Module 3: Part 3 Flashcards

1
Q

Alternate techniques for pain relief (4)

A

Acupuncture
Acupressure
Hypnosis
Aromatherapy

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2
Q

Effect of Pain and Labor on the Mother (7)

A

↑SNS (release of catecholamines)
↑Epi
↑catecholamines = ↑ in mom’s CO, PVR and ↓uteroplacental perfusion
Intermittent hyperventilation-hypoventilation syndrome
stress= ↑gastrin release, ↑gastrin motility, ↑gastric acidity and volume
Psychological Effects
Chronic Pain

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3
Q

how does initiation of analgesia on laboring mom affect plasma epinephrine

A

Reduction in plasma epinephrine concentration

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4
Q

What is Ferguson’s reflex and how does it affect uterine activity?

A

Stretching of the cervix augments uterine activity by augmenting oxytocin release.

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5
Q

involves neural input from ascending
spinal tracts (especially from sacral sensory input) to the
midbrain, thereby leading to enhanced oxytocin release

A

Ferguson’s reflex

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6
Q

What might be questioned if neuraxial analgesia inhibits Ferguson’s reflex?

A

Prolonged labor

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7
Q

What is often observed after combined spinal-epidural anesthesia during labor?

A

Transient period of hyperstimulation or transient fetal bradycardia.

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8
Q

T/F
On initiation of labor analgesia, there’s an acute increase of beta-adrenergic tocolysis

A

False
There’s an acute decrease of beta-adrenergic tocolysis

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9
Q

T/F
When a laboring mom is in pain, Elevated catecholamines, decreases maternal CO and PVR, and decreases uteroplacental perfusion

A

False
elevated catecholamines increases maternal CO and PVR, and decreases uteroplacental perfusion

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10
Q

Relax uterus and decrease contractions

A

tocolytics

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11
Q

tocolytics used to stop contractions (4)

A

Indomethacin (NSAID)
Nifedipine
Mag sulfate
Terbutaline

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12
Q

Cause the uterus to contract

A

uterotonics

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13
Q

What’s the difference between tocolytics and uterotonics

A

uterotonics induce or augment uterine contraction

tocolytics reduce or stop uterine contractions

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14
Q

How do elevated catecholamines affect uteroplacental perfusion?

A

They increase CO and PVR, leading to reduced uteroplacental perfusion.

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15
Q

What causes uterine artery vasoconstriction during maternal pain?

A

Release of epinephrine and norepinephrine.

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16
Q

What leads to maternal oxyhemoglobin desaturation during labor?

A

Hyperventilation-hypoventilation syndrome.

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17
Q

consequences of maternal pain on maternal and fetal oxygen levels

A

Maternal and fetal hypoxemia

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18
Q

Pain management Options for Vaginal Delivery (5)

A

Simple Analgesic Techniques
Alternative Techniques
Non-Pharmacologic Analgesic Techniques
Pharmacologic Analgesia
Regional Anesthesia and Blocks

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19
Q

Simple Analgesic Techniques

A

Support
Breathing/Relaxation;
Lamaze Classes
Touch/Massage
Music
Hydrotherapy

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20
Q

Alternate Techniques for pain management

A

Acupuncture
Acupressure
Hypnosis
Aromatherapy

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21
Q

Non-Pharmacologic Analgesia

A

TENS

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22
Q

TENS electrode placement

A

Electrodes placed paravertebrally at T10 – L1 and S2-S4

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23
Q

How does the TENS device decrease pain

A

Buzzing or prickling sensation can decrease awareness of pain

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24
Q

Reasons for not giving systemic analgesia (4)

A

Regional not available
Women do not want neuraxial
Contraindications to neuraxial (coagulopathy)
Technical Challenges (scoliosis or spinal hardware)

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25
Q

Advantages of systemic opioids (3)

A

ease of administration, low cost and patient acceptability

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26
Q

Disadvantages of systemic opioids (6)

A
  • seizures with meperidine
  • N/V
  • neonatal depression
  • decrease beat-to-beat variability
  • delayed gastric emptying
  • hypoventilation
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27
Q

T/f
Not all opioid analgesic drugs rapidly cross the placenta and cause transient reduction in fetal heart rate variability

A

False
All opioids rapidly cross placenta

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28
Q
A
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29
Q

Neonatal respiratory depression with opioids depends on ..(2)

A

dose and timing of opioid administration

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30
Q

Volatile Halogenated Agents indications (4)

A

Fetal Distress
Uterine inversion
Breech or manual removal of placenta
Tetanic contractions

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31
Q

Volatile Inhalational: relaxation of uterine smooth muscle with (increased/decreased) bleeding

A

Increased

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32
Q

Does nitrous oxide interfere with uterine activity?

A

No

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33
Q

Nitrous oxide:
(low/high) solubility
(rapid/slow) onset/offset
(yes/no) metabolites formed

A

Low solubility, rapid onset/offset, no real metabolites

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34
Q

T/F
Nitrous oxide can irritate mom’s airway

A

False
Nitrous oxide is nonirritating to airways

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35
Q

Nitrous oxide crosses the placenta but no real effect on…. (3)

A

FHR, Apgar’s or umbilical cord gas

36
Q

T/F
Neonatal respiratory depression can occur with nitrous oxide

A

False
neonates DO NOT experience resp depression with N2O
They rapidly eliminate it

37
Q

Side effects for mom of N2O (3)

A

N/V, drowsiness, dizziness

38
Q

Regional Anesthesia techniques (8)

A

Paracervical Block
Paravertebral Lumbar Sympathetic Block
Pudendal Nerve Block
Perineal Infiltration
Caudal Anesthesia
Epidural Anesthesia
Spinal
Combined Spinal Epidural Block

39
Q

Sometimes used in 1st stage of labor (dilation of the cervix and distention of the lower uterine segment and upper vagina)

A

Paracervical Block

40
Q

In paracervical block, the goal is to block the transmission through the

A

paracervical ganglion (Frankenhauser’s ganglion)

41
Q

Doesn’t affect labor progress, provides analgesia without sensory or motor block

A

Paracervical Block

42
Q

Paracervical Block landmarks

A

broad ligaments deep to the lateral fornices of the vagina, lateral to the cervix

43
Q

How much local anesthetic is injected into each side during a paracervical block? With or w/out epi?

A

5-10 cc at 10, 8, 4, and 2 o’clock positions.

without epinephrine

44
Q

Procedure for the following Landmarks: palpate coccyx for midline, sacral cornu and sacrococcygeal ligament

A

Caudal Anesthesia

45
Q

T/F
Caudal Anesthesia has the same indications, contraindications and risk as with Epidural

A

True

46
Q

In Caudal Anesthesia, how much local do you inject to achieve a T10 level?

A

15-20 cc

47
Q

T/F
caudal anesthesia is used often

A

False
rarely used technique

48
Q

caudal anesthesia can be used if ____ epidural is technically difficult (spinal hardware)

A

lumbar

49
Q

Advantages of caudal anesthesia

A

Continuous analgesia

Avoids need to access neuraxial canal through
lumbar interspace in patients with previous
lumbar spine surgery

50
Q

what stage of labor is this:
Distention of the vagina and perineum

A

Second stage of labor

51
Q

what stage of labor is this:
Transmitted via the pudendal nerve at S2-S4

A

Second stage of labor

52
Q

what stage of labor is this:
Somatic

A

Second stage of labor

53
Q

what stage of labor is this:
Pain most a result from distention of the lower uterine segment and cervix

A

first stage

54
Q

what stage of labor is this:
Pain impulses transmitted by visceral afferent nerve fibers which accompany sympathetic fibers

A

first stage

55
Q

what stage of labor is this:
Enters the spinal cord at T 10-12 and L1

A

first stage

56
Q

This alone, is enough to justify the indication for an epidural

A

Maternal request : ACOG states that maternal request alone is sufficient indication for analgesia

57
Q

all indications of epidural (3)

A

Maternal request
Operative delivery
Obstetric disease

58
Q

What syndrome does epidural anesthesia blunt?

A

Hyperventilation-hypoventilation syndrome

59
Q

What types of deliveries does epidural anesthesia help facilitate? (3)

A

Twins, breech, and preterm infants.

60
Q

In which patients does epidural anesthesia enable effective control of blood pressure?

A

Preeclamptic patients

61
Q

How does epidural anesthesia affect the hemodynamic effects of uterine contractions?

A

It blunts them

62
Q

What type of patients benefit from the blunting hemodynamics blunting effects with epidurals?

A

Patients with certain medical issues, to improve uteroplacental perfusion.

63
Q

What type of analgesia does epidural anesthesia offer?

A

Excellent analgesia without causing sedation or motor block.

64
Q

epidural’s allows for easy conversion from vaginal delivery to

A

cesarean delivery

65
Q

Disadvantages of Epidural Anesthesia (7)

A

Hypotension (Supine Hypotensive syndrome)
Systemic toxicity
High Blocks
Post dural puncture headache
Possible Prolongation of labor stages
Possible Increase in Cesarean deliveries
Motor block

66
Q

Contraindications of epidural’s (8)

A

Uncooperative or Psychiatric disease
Patient refusal
Uncorrected, severe coagulopathy
Uncontrolled hemorrhage and uncorrected hypovolemia
Epidural site infection
Unskilled or inexperienced anesthesia provider
Increased ICP
Sepsis

67
Q

Neuraxial Technique

A

Continuous Epidural
Combined spinal-epidural
Continuous spinal
Continuous caudal
Single-shot spinal

68
Q

advantages of continuous epidural (3)

A

Continuous analgesia
No dural puncture required
Ability to extend analgesia to anesthesia for cesarean delivery

69
Q

disadvantages of continuous epidural (4)

A

Slow onset of analgesia
Larger drug doses required when compared with spinal techniques
Greater risk for maternal local anesthetic systemic toxicity
Greater fetal drug exposure

70
Q

advantages of combined-spinal anesthesia (7)

A

Continuous analgesia
Low doses of local anesthetic and opioid
Rapid onset of analgesia
Rapid onset of sacral analgesia
Ability to extend analgesia to anesthesia for cesarean delivery
Complete analgesia with opioid alone
Decreased incidence of failed epidural analgesia

71
Q

disadvantages of combined-spinal anesthesia

A

Increased incidence of pruritus
Possible higher risk for fetal bradycardia

72
Q

advantages of continuous spinal (4)

A

Continuous analgesia
Low doses of local anesthetic and opioid
Rapid onset of analgesia
Ability to extend analgesia to anesthesia for cesarean delivery

73
Q

disadvantages of continuous spinal (2)

A

Large dural puncture increases risk for post–dural puncture headache
Possibility of OD and total spinal anesthesia if the spinal catheter is mistaken for epidural catheter

74
Q

advantages of continuous caudal (2)

A

Continuous analgesia

Avoids need to access neuraxial canal through lumbar interspace in pt’s w/previous
lumbar spine surgery

75
Q

disadvantages of continuous caudal (4)

A

Requires large volumes/doses of drugs
May be technically more difficult than other neuraxial techniques
Possible higher risk for infection than with other neuraxial techniques
Risk for inadvertent fetal injection

76
Q

advantages of single-shot spinal (4)

A

Technically simple
Rapid onset of analgesia
Immediate sacral analgesia
Low drug doses

77
Q

disadvantages of single-shot spinal (1)

A

Limited duration of analgesia

78
Q

what is involved in the evaluation and consent for an epidural (4)

A

Complete history and physical (OB history)
Labs (platelets Vs. TEG)
AIRWAY ASSESSMENT
Does patient have a birth plan?

79
Q

Is an airway assessment part of the evaluation and consent portion of preparing for an epidural

A

YES

80
Q

After consent is signed, what are the steps involved for preparation of epidural? (5)

A

Explanation of procedure with risks/benefits
IV access and Monitors/Time out
Positioning/Monitoring/Hydration
Resuscitation Equipment/Intralipids
Epidural Kit/Drugs/Sterile Gloves/Hat/Mask

81
Q

T/F
Lack of informed consent is the least cause of actions in medical malpractice

A

False

Lack of informed consent IS a common cause of action in medical malpractice claims

82
Q

During this process, you would discuss the procedure and associated risks and identify pt’s concerns

A

Informed consent

83
Q

are not useful for most laboring women because of
their limited duration of action

A

single-shot anesthesia

84
Q

Because the available catheters require dural puncture with a large-gauge needle,
the technique may be associated with an unacceptably high PDPH

A

continuous spinal anesthesia

85
Q

technically more difficult than other neuraxial techniques

A

continuous caudal

86
Q

Hyperventilation-Hypoventilation Syndrome
what is it?

A

Excessive hyperventilation during contractions
+
No ventilation during excessive sustained pushing with maximal effort

OB Exam 1 (13 decks)

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