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OB Final Exam > Module 7: Part 4 > Flashcards

Module 7: Part 4 Flashcards

1
Q

Normal Pregnancy vs. Pre-eclampsia changes

A
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2
Q

Hyperperfusion of the brain, especially with endothelial dysfunction causes ______ edema

A

vasogenic

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3
Q

T/F There is a Loss of cerebral vascular autoregulation with pre-eclampsia

A

TRUE

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4
Q

what are the visual disturbances a/w pre-eclampsia?

A

(scotoma, amaurosis, blurred vision)

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5
Q

CNS changes a/w pre-eclampsia

A
  • Hyperperfused brain, esp w/ endothelial dysfxn = vasogenic edema
  • Loss of cerebral vascular autoregulation
  • Severe headache, hyperexcitability, hyperreflexia, coma
  • Visual disturbances (scotoma, amaurosis, blurred vision)
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6
Q

Use of biomarkers like _______to identify cardiac dysfunction in preeclamptics

A

brain natriuretic peptide (BNP)

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7
Q

Hemoconcentration can lead to elevated ______

A

hematocrit

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8
Q

Preeclamptics without severe features may have a normal plasma volume for a pregnant woman T/F

A

TRUE

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9
Q

(increased/decreased) intravascular volume (plasma volume up to 40% (higher/lower) in severe pre-eclamptic disease

A

Decreased; Lower

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10
Q

What are the CV features of pre-eclampsia?

A

Hyperdynamic state with severe features

  • ↑ vascular tone & sensitivity to pressors & circulating catecholamines = HTN, vasospasm, end-organ ischemia
  • ↑↑↑ SVR
  • ↑ Afterload (2-3x baseline) increases BP
  • ↓: preload, low CVP, PCWP, CO
  • LV failure
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11
Q

afterload in pre-eclampsia is ___ x above baseline

A

2-3

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12
Q

What CV features decrease in pre-eclampsia?

A

preload, low CVP, PCWP and CO

pre-E is volume depleted

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13
Q

What are the pulmonary changes a/w pre-eclampsia?

A
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14
Q

S/S of DIC:

A
  • low fibrinogen & platelets
  • prolonged PT and PTT
  • probably signs of bleeding
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15
Q

Platelets release _____ and other factors that cause platelet activation

A

thromboxane

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16
Q

Preeclampsia is the most common cause of severe _______ in the second half of pregnancy

A

thrombocytopenia

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17
Q

_______ is most common hematologic disorder in women with preeclampsia

A

Thrombocytopenia

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18
Q

Platelet abnormality a/w pre-eclampsia is ____ and _____

A

quantitative; qualitative

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19
Q

Platelet count < ________/mm3 in severe or HELLP

A

100,000

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20
Q

Preeclamptics with severe features: (hypo/hyper)coagulable

A

HYPOcoaguable

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21
Q

Women with preeclampsia without severe features: (hyper/hypo)coagulable

A

HYPERcoaguable

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22
Q

When do you normally see DIC?

A

Usually in severe liver involvement
Intrauterine fetal demise
Placental abruption
Postpartum hemorrhage

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23
Q

What do you normally see with DIC?

A

Consumption of procoagulants
Increased levels of fibrin degradation products
End-organ damage due to microemboli

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24
Q

Proteinuria is a defining element of preeclampsia but not essential T/F

A

TRUE

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25
Q

Normal pregnancy: GFR increases _______%

A

40-60

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26
Q

In preeclampsia, GFR (increases/decreases), and renal function (improves/worsens)

A

decreases; worsens

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27
Q

Elevated Uric acid levels w/ pre-eclampsia T/F

A

TRUE

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28
Q

Pre-eclampsia can eventually lead to oliguria and renal insufficiency T/F

A

TRUE

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29
Q

manifests as glomerular enlargement and cell swelling

A

Glomerular capillary endotheliosis

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30
Q

_____ is a late sign of pre-eclampsia and parallels severity of disease

A

Oliguria

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31
Q

Renal Patho of Pre-eclampsia

A
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32
Q

What is the hepatic pathophysiology a/w pre-eclampsia?

A
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33
Q

_____ is the only cure for Preeclampsia

A

Delivery

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34
Q

What are the s/s of pre-eclampsia?

A
  • Severe headache
  • visual disturbances
  • altered mentation
  • CNS hyperexcitability
  • dyspnea
  • RUQ/epigastric pain
  • N/V
  • decreased urine output
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35
Q

What lab should be drawn in pre-eclampsia?

A
  • Platelets:
    <100K: consider PT, PTT, fibrinogen
    >100K: probably no addtnl labs
    Draw at least Q6 if declining
  • Liver function: ALT, AST, uric acid
  • Urine/Renal: proteinuria, Protein: creatinine
  • Frequency depends on severity
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36
Q

Preeclamptics have Intravascular volume _____

A

depletion

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37
Q

Volume expansion not recommended for pre-eclamptics T/F

A

TRUE

38
Q

You should treat oliguria with fluids T/F

A

FALSE
DO NOT

39
Q

You should fluid before:

A

Neuraxial
Delivery
Hydralazine

40
Q

Chestnut suggests ____ ml/hr or ____ ml/kg/h for fluid management

A

80; 1

41
Q

What is the goal of BP control with pre-eclamptic pts?

A

Goal is to “prevent” further issues and reduce the risk of placental abruption, cerebral hemorrhage, myocardial ischemia

42
Q

Titrate mom’s BP control to avoid abrupt changes bc it can adversely affect_____ and _____ to the fetus

A

uteroplacental perfusion and oxygen delivery to fetus

43
Q

Antihypertensives are used to treat severe hypertension (systolic of ____ or greater/diastolic of ____ mm Hg or greater)

A

160; 110

44
Q

Antihypertensive medications for urgent BP control in pregnancy

A
45
Q

Treatment of HTN Chart

A
46
Q

most common calcium channel blocker for treating hypertension of pregnancy =

A

nifedipine

47
Q

First line antiHTN agent if no IV

A

nifedipine

48
Q

Nifedipine

A
  • most common CCB for HTN of pregnancy
  • Inhibits the influx of ECF Ca into smooth muscle
  • Relaxes arteriolar & arterial smooth muscle beds
  • Caution: exaggerated hypotensive response
  • First line agent if no IV
49
Q

Neonates may have increased rates of hypoglycemia and bradycardia w/ which antiHTN med?

A

labetalol

50
Q

Decreases cerebral vasospasm and corrected intracranial hemodynamic issues associated with eclampsia

A

labetalol

51
Q

Labetalol

A
  • Combined alpha- and beta-adrenergic (1:7 alpha to beta Ratio)
  • Rapid onset and does not cause reflex tachycardia
  • Decreases cerebral vasospasm and corrected intracranial hemodynamic issues associated with eclampsia
  • Neonates may have increased rates of hypoglycemia and bradycardia
52
Q

First line in severe hypertension

A

hydralazine

53
Q

Hydralazine

A
  • Direct arteriolar vasodilator to reduce afterload (fluid expansion with use)
  • Selectively vasodilates the uterine and renal vasculature
  • Reflex tachycardia (careful in CAD patients)
  • First line in severe hypertension
54
Q

Nipride

A
  • Arteriolar dilator
  • Caution: tachyphylaxis & metabolic acidosis if prolonged
  • Cyanide toxicity (maternal and fetal –limited ability of fetal liver to metabolize cyanide)
  • .25 mcg/kg titrated up to max of 5 mcg/kg/min
55
Q

Nitroglycerin

A

Venodilator
Careful with lowering the BP to quick or too much
0.5 to 1 mcg/kg/min

56
Q

(nitro/nipride) is an arterial dilator while (nitro/nipride) is a venodilator

A

nipride; nitro

57
Q

_____ = anticonvulsant of choice

A

10% Magnesium sulfate (MgSO4)

58
Q

10% Magnesium sulfate (MgSO4) Indicated for seizure prevention in preeclamptics with ______

A

severe features

59
Q

What is the dose of 10% Magnesium sulfate (MgSO4) for seizure prophylaxis?

A

Give IV dose then start drip:
1. 4-6 grams in 100 ml over 20 mins
2. drip: 1-2 g/hr for 24 HR after delivery or last seizure

60
Q

What does Magnesium do:

A
  • (not well understood)
  • Central NMDA receptors: raises seizure threshold
  • Stabilize cerebral cortex neurons
  • Inhibits Ach release & ↓muscle membrane excitability
  • Mild vasodilator, esp cerebral
  • ↑ hepatic & renal blood flow
  • Excreted renally (renal insufficiency can increase Mag lvl)
61
Q

Mag levels and Effects Chart

A
62
Q

What is the tx for mag toxicity?

A
  • Stop infusion
  • IV Ca Gluconate 1 gm or Chloride 300 mg
  • Mask O2
  • Intubation if respiratory arrest
63
Q

Preeclamptics with ______ may show signs of toxicity sooner (decrease dose of Magnesium)

A

renal impairment

64
Q

Serum magnesium levels should be done as well as _____

A

reflex testing

65
Q

Does Mag cross the Placenta?
If so what effect does it have on the fetus?
How can it be reveresed?

A
  • Crosses the placenta
  • Mag levels rise in fetal blood within an hour & amniotic fluid w/in 2-3 hours; equilibrates with maternal and fetal serum levels w/in 2 hours
  • ↓ fetal beat to beat variability
  • Neonatal resp depression & hyporeflexia
  • reverse with calcium
66
Q

What all is included in the pre-anesthetic evaluation for patients with pre-eclampsia?

A
  • Complete H&P
  • Focus on airway evaluation (Edema)
  • Volume Status: Urine output, Fluid bolus
  • Control High BP (careful starting NA if extremely high)
  • Coagulation
  • Labs (Platelet count for neuraxial, what count?)
  • TEG
  • Hemodynamic monitoring
67
Q

Advantages of epidural for labor:

A
  • Good analgesia: ↓ hypertensive response to pain
  • ↓ circulating catecholamines & stress hormones
  • Improves intervillous blood flow
  • Use if emergency cesarean delivery
68
Q

Should you stop the mag drip during surgical procedures?

A

NO

69
Q

You should continue the mag drip for how many hours postpartum?

A

12-24

70
Q

If your patinet is receiving mag drip you should (decrease/increase) their dosage of non-depolarizing muscle relaxants

A

DECREASE

71
Q

T/F If the patient is on mAgnesium due to preterm labor vs Preeclampsia then discontinuing the infusion may be ok/necessary

A

TRUE

72
Q

Document platelet before _____ insertion

A

epidural

73
Q

A platlet cound >____K (considered safe for administration)

A

100

74
Q

A platelet count >____ (may be ok without any other risk factors)

A

80

75
Q

For a platelet count between ___-____ K (risks and benefits are weighed against general anesthesia)

A

50-80

76
Q

A platelet count <___K (precludes regional anesthesia)

preclude=prevents

A

50

77
Q

Should you start with higher or lower vasopressor doses for pregnant patinets?

A

low

78
Q

T/F pregnant patients may have an exaggerated response to vasopressors

A

TRUE

79
Q

Platelet count in women with HELLP usually reaches nadir on ___ or ____ postpartum day

nadir=lowest point

A

second or third

80
Q

Catheter stays in place until acceptable or increasing platelet count (differs among practitioners) T/F

A

TRUE

81
Q

TEG may assess patients with ______

A

thrombocytopenia

82
Q

Platelet function analysis (PFA-100) may be more sensitive in severe ______

A

preclamptics

83
Q

When is there a risk for an epidural hematoma?

A

at time of placement and removal

84
Q

What are the 3 main considerations for anesthesia for cesarean delivery?

A
  • Choice of anesthetic
  • Technique for induction of general anesthesia
  • Interaction btwn Mag & ND muscle relaxants
85
Q

What are the indications for GA?

A
  • Severe Thrombocytopenia/coagulopathy
  • Maternal hemorrhage
  • Severe fetal bradycardia with a reassuring maternal airway
  • Placental abruption, DIC…..
86
Q

GA is less desirable in what instances?

A
  • Airway edema and possible difficult airway
  • Transient/severe hypertension with intubation/extubation
87
Q

Moms with gestational HTN or preeclampsia without severe features should have what considerations for delivery?

A

routine delivery with careful observation for no severe features

88
Q

If pre-eclamptic moms have severe features when should they deliver?

A

less than 34 weeks

89
Q

You should delay delivery for pre-eclamptic moms for ____ hrs for corticosteriod to facilitate fetal lung maturity if possible

A

24-48

90
Q

What are indications for immediate delivery?

A
  • Eclampsia
  • DIC
  • pulmonary edema
  • abnormal fetal surveillance
  • previable or nonviable fetus
91
Q
A

OB Final Exam (15 decks)

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