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OB Final Exam > Module 9: Part 1 (1-22) > Flashcards

Module 9: Part 1 (1-22) Flashcards

1
Q

t/f there are no serious adverse effects r/t the induction of general anesthesia

A

false

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2
Q

what can occur from a severe hypertensive response to intubation in women with comorbidities

A

cerebrovascular injury

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3
Q

fetal/neonatal risks of general anesthesia

A

respiratory depression (apgar < 7 @ 5 min)

in utero exposure to agents causing potential neurobehavioral impact

reduced benefits of immediate breast feeding, ↓ likelihood of exclusive breastfeeding

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4
Q

what happens to plt aggregation after the 1st trimester

A

plt aggregation ↑

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5
Q

which coag factors ↑ in pregnancy

A

I, VII, VIII, IX, X, XI

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6
Q

what happens to endogenous anticoagulant effects

A

they are decreased, (increased resistance to activated
protein C and decreased free protein S levels)

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7
Q

what happens to fibrinolytic capacity during pregnancy

A

modified (whatever that means)

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8
Q

Review changes in coagulation and fibrinolytic parameters in pregnancy (Know pages 23-25)

A
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9
Q

when is it ok to administer neuraxial if the patient took UFH SQ low dose

A

more than 4-6 hrs after last dose

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10
Q

when is it ok to proceed with neuraxial after low dose LMWH

A

12+ hours since last dose

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11
Q

when is it ok to proceed with neuraxial after high dose LMWH

A

24 or + hours

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12
Q

each 1 mg of IV protamine can neutralize ____________ U of IV heparin

A

100

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13
Q

Reversal of SQ heparin may require repeated doses of IV protamine (half-life approximately ____________ )

A

7 minutes

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14
Q

t/f you cannot repeat the dose of protamine

A

false

Reversal of SQ heparin may require repeated doses of IV
protamine

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15
Q

maternal side effects and complications of protamine include

A

hypotension from histamine
release
hypersensitivity reactions
anaphylaxis
pulmonary hypertension
noncardiogenic pulmonary edema
coagulation disturbance related to thrombocytopenia
altered platelet aggregation
fibrinogen precipitation
reduced thrombin effect.

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16
Q

trigger for the reaction in women with AFE

A

exact trigger is poorly understood

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17
Q

how is AFE diagnosed

A

by EXCLUSION

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18
Q

AFE pathophysiology

A

Fetal material in the maternal circulation has the potential to trigger a massive cascade of inflammatory
and hemostatic reactions that culminate in CV collapse and DIC

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19
Q

what is the clinical criteria for diagnosis of AFE

A

acute hypotension, cardiac arrest,
hypoxemia and/or coagulopathy with no other explanation

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20
Q

what is pathologic evidence for AFE diagnosis

A

fetal squamous or hair in the
maternal lungs postmortem

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21
Q

maternal risk factors for AFE (2)

A

Older maternal age
Race or ethnicity

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22
Q

obstetric factors for AFE (6)

A

Abnormal placentation
Placental abruption
Eclampsia
Multiple gestation
Induction of labor, AROM and SROM
Operative delivery

23
Q

AFE is traditionally diagnosed clinically by (3)

A

acute respiratory distress
CV collapse
Coagulopathy

24
Q

other symptoms of AFE include (7)

A

hypotension
FHR
abnormalities
loss of consciousness
bleeding
uterine atony
seizure like activity

25
Q

US AFE Registry Entry Criteria

A

1.Acute hypotension or cardiac arrest
2.Acute hypoxia (dyspnea, cyanosis, respiratory arrest)
3.Coagulopathy (laboratory evidence or hemorrhage
without an alternative explanation)
4.Onset of the above during labor, cesarean delivery,
dilation and evacuation, or within 30 minutes
postpartum (delivery of placenta)
5.Absence of an alternative explanation for the observed
signs/symptoms

26
Q

patho of AFE

A

could be a rare pathologic
fetal antigen or common antigen that enters the maternal circulation

27
Q

AFE is a ____________ inflammatory response in association with an inappropriate release of ____________

A

Systemic inflammatory response in association with inappropriate release of endogenous inflammatory mediators

28
Q

what maternal endogenous mediators are released that play an important part in the initial AFE reaction

A

arachidonic acid metabolites (thromboxane, prostaglandins,
leukotrienes, endothelins)

29
Q

Amniotic fluid contains…(5)

A

fetal squamous cells, vernix,
lanugo, trophoblasts, and bile-stained meconium

30
Q

AFE is often described as

A

the anaphylactoid syndrome of pregnancy

31
Q

AFE is a response to

A

the fluid and material that passes into the maternal circulation

32
Q

it is hypothesized that ____________ is a prerequisite for AFE to occur

A

exposure of the maternal circulation to amniotic or fetal antigens

33
Q

events that lead to open vessels coming into contact with amniotic fluid (3)

A

uterine trauma, cervical trauma
or trauma of the utero-placental unit

34
Q

T/F AFE cannot occur during normal labor and surgical delivery because there is no exposure of amniotic fluid to open vessels

A

FALSE

35
Q

T/F Many women may be exposed but will not show signs of AFE

A

TRUE

36
Q

2 theories surrounding AFE

A

mechanical or immune-mediated

37
Q

how is tissue factor affected by AFE

A

irreversibly aggregates platelets, causing platelet degranulation
which causes the release of thromboxane, serotonin
and other mediators

38
Q

how is serotonin affected by AFE

A

Serotonin is a potent pulmonary vasoconstrictor that produces vasodilation in the systemic vasculature and can cause right-sided heart failure

39
Q

____________ develops in the majority of women who survive initial AFE cardiovascular collapse

A

coagulopathy

40
Q

As pregnancy progresses, increasing
amounts of tissue factor accumulates
in the amniotic fluid and its entrance
into maternal circulation could initiate…

A

the coagulation cascade

41
Q

tissue factor binds to factor

A

VII

42
Q

tissue factor binding to factor VII activates

A

the extrinsic pathway

43
Q

factor VII activates the extrinsic pathway and triggers clotting by activating…

A

factor x

44
Q

another possible mechanism of AFE is that…

A

amniotic fluid has a thromboplastin-
like effect, which induces platelet
aggregation, releases platelet factor III,
and activates the clotting cascade

45
Q

when can AFE happen

A

After abdominal trauma, first trimester abortion, in
the second trimester, at the time of delivery, and in the
postpartum period

46
Q

new criteria require diagnosis of AFE be made within ____________ minutes of placental delivery

A

30 minutes

47
Q

classic triad of AFE

A

respiratory distress, CV collapse and
coagulopathy near the time of delivery

48
Q

in the US registry what 2 symptoms were most common before collapsing

A

seizure and dyspnea

49
Q

Fetal bradycardia, or abrupt onset of variable decels that progress to fetal bradycardia may indicate ____________ in
labor

A

AFE

50
Q

nonobstetric differential diagnosis of AFE

A

MI, PE, Aspiration, Sepsis,
Anaphylaxis, VAE

51
Q

obstetric differential diagnosis of AFE

A

Placental abruption, eclampsia,
uterine rupture/laceration, Obstetric hemorrhage

52
Q

anesthetic differential diagnosis of AFE

A

Total spinal, LAST, medication
error

53
Q
A

OB Final Exam (15 decks)

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