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APEX: Flashcards > OB > Flashcards

OB Flashcards

1
Q

Most likely cause for rapid arterial O2 desaturation during the intubation of a pregnant patient

A

decreased FRC

FRC = RV + ERV

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2
Q

OB upper airway

A
  • increased risk for difficult mask, difficult laryngoscopy, difficult intubation (failed intubation 8x higher)
  • hormones cause vascular engorgement & upper airway swelling
  • increased MP score
  • narrow glottic opening = 6.0-7.0 ETT
  • short handle laryngoscope (Datta handle)
  • tissue friable- avoid nasal airway
  • edema worse w/ preeclampsia, tocolytics, Tburg
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3
Q

Lung physiology

A
  • relaxin relaxes ribcage, more horizontal
  • uterus pushes diaphragm cephalad
  • FRC decreases (ERV + RV)
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4
Q

ABG

A
  • progesterone = resp stimulant
  • resp alkalosis
  • pH normal
  • PaCO2 decreases
  • HCO3 decreases (to normalize pH)
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5
Q

OxyHgb curve shifts

A
  • right
  • facilitates O2 transfer to fetus
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6
Q

Ve, Vt, & RR

A

all increased d/t increased O2 consumption & CO2 production

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7
Q

Lung volumes

A
  • Decrease = TLC, FRC, ERV, RV
  • No change = VC, CC
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8
Q

O2 consumption

A
  • Term = 20 % increase
  • 1st stage labor = 45 % increase
  • 2nd stable labor = 75% increase
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9
Q

CO

A
  • increases 40%
  • during labor:
    1. 1st stage = 20% increase
    2. 2nd stage = 50% increase
    3. 3rd stage = 80% increase
  • returns to pre-labor in 24-48 hours
  • HR = 15% increase
  • SV = 30% increase
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10
Q

BP

A
  • no change MAP or SBP
  • DBP decreases
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11
Q

Vascular resistance

A
  • SVR & PVR decrease
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12
Q

CVP & PAOP

A

no change

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13
Q

cardiac axis deviation

A
  • left deviation
  • uterus pushes diaphragm cephalad which pushes heart up & left
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14
Q

aortocaval compression

A
  • “supine hypotension”
  • uterus compresses aorta & vena cava
  • decreased venous return
  • place mother in LUD (2nd/3rd trimester)
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15
Q

IV volume

A
  • increases 35%
  • plasma volume increases 45%
  • erythrocyte volume increases 20%

dilutional anemia

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16
Q

hematologic changes

A
  • clotting factors 1, 7, 8, 9, 10, 12 = increase
  • anticoagulants
    1. antithrombin = decrease
    2. protein S = decrease
  • fibrin breakdown = increase
  • antifibrinolytic = decrease (11 & 13)
  • PT/PTT= decrease
  • PLT count same or decreases
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17
Q

MAC

A

30-40% decrease

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18
Q

sensitivity to LA

A

increase

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19
Q

gastric volume & gastric pH

A
  • gastric volume increases
  • gastric pH decreases
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20
Q

LES sphincter tone

A

decreases

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21
Q

Renal

A
  • increase = GFR, CrCl, glucose in urine
  • decrease = creatinine & BUN (d/t inc CrCl)
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22
Q

Uterine blood flow

A
  • increases up to 700-900 ml/min
  • 10% of CO
  • not autoregulated

UBF = (Uterine a. pressure - Uterine v. pressure) / uterine vascular resistance

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23
Q

Most important variables that increase drugs across placenta

A
  1. diffusion coefficient (drug characteristics)
  2. concentration gradient b/t mom & fetus
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24
Q

Drug characteristics that favor placental tranfer

A
  • LMW < 500 daltons
  • lipid soluble
  • non-ionized
  • non-polar
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25
Drugs that cross placenta
- LA (except chloroprocaine - IV anesthetics - VA - opioids - benzos - atropine - BB - Mg+
26
Drugs that do NOT cross placenta
H - Heparin I - Insulin G (h)- Glycopyrrolate Noon- NMBs
27
Stage 1 of labor
- regular contractions to full dilation (10 cm) - latent = 2-3 cm - active = 3-10 cm - dull/diffuse/cramping pain in lower uterine segment & cervix (T10-L1) 1. neuraxial
28
Stage 2 of labor
- full dilation to delivery of fetus - sharp/localized perineal pain begins (T10-L2 + S2-S4) 1. neuraxial 2. pudendal n. block
29
Stage 3 of labor
- delivery of placenta
30
NPO guidelines
laboring mothers may drink a moderate amount of clear liquids through labor & eat solid food up to the point a neuraxial block is placed
31
Timing of epidural placement
ACOG recommend timing of epidural placement should be individualized and patient should not have to wait until she achieves certain dilation
32
Consequences of uncontrolled pain
- increase catecholamines = HTN, decrease UBF - hyperventilation = left OxyHgb shift = decrease O2 to fetus
33
early decelerations
VEAL CHOP - Early = Head compression - occur w/ contraction
34
late decelerations
VEAL CHOP -Late = placental insufficiency - FH falls after peak of contraction - occur w/ each contraction - Causes = hypotension, hypovolemia, acidosis, preeclampsia
35
variable decelerations
VEAL CHOP - Variable = Cord compression - no pattern b/t FHR & uterine contraction
36
Prematurity
- < 37 weeks gestation - tocolytics to suppress contractions - betamethasone to hasten fetal lung maturity
37
B2 agonists
- ritodrine, terbutaline - relax uterus - SE: hyperglycemia, hypokalemia
38
Mg+ sulfate
- Ca+ antagonist - relaxes uterus - hyperpolarizes membranes in excitable tissue (SZ prophylaxis for preeclampsia)
39
Mg+ toxicity
- 1st sign = loss of deep tendon reflexes - diminish at 5-7 , loss of reflexes at 7-12 mg/dL - other side effects: skeletal muscle weakness (potentiates NMBs), pulmonary edema, reduced response to ephedrine & neo - Tx: diuretics, IV calcium gluconate 1 gram
40
Oxytocin
- uterotonic - administered after delivery of placenta - SE: water retention, hyponatremia, hypotension, reflex tachycardia, coronary vasoconstriction - CV collapse if given too quickly
41
Methergine (Ergot Alkaloid)
- uterotonic - 0.2 mg IM - IV admin cause cause HTN & cerebral hemorrhage
42
Prostaglandin F2 (hemabate, carboprost)
- uterotonic - 250 mcg IM - SE: N/V, diarrhea, hypotension, HTN, bronchospasm
43
Which trimester is best for non-OB surgery?
2nd trimester
44
When is RSI indicated in the pregnant patient?
- 18-20 weeks - immediate postpartum period
45
Safe drugs for non-OB surgery
- opioids - VA - NMBs - thiopental
46
Why are NSAIDs avoided after the 1st trimester?
potentially close ductus arteriosus
47
Chronic HTN
- before 20 weeks gestation - does not return to normal after delivery
48
Gestational HTN
- occurs after 20 weeks gestation
49
Preeclampsia
- mild = BP > 140/90 - severe = BP > 160/110 - develops after 20 weeks gestation - proteinuria usually present - Also RUQ/epigastric pain HA, FGR, thrombocytopenia, elevated serum liver enzymea
50
Preeclampsia patho
- abnormal placental implantation creates an environment characterized by elevated vascular resistance & reduction in placental blood flow. - 7:1 thromboxane : prostacyclin ratio - thromboxane = vasoconstriction, PLT aggregation
51
Preeclampsia treatment
- definitive treatment = delivery - treat BP > 160/110 - labetalol, hydralazine, nifedipine, nicardipine
52
Eclampsia
preeclamptic patient develops seizures
53
SZ prophylaxis magnesium
- loading dose = 4 grams over 10 min - then 1-2 g/hr
54
HELLP Syndrome
H -Hemolysis EL- Eelvated Liver enzymes L- Low P- Platetes - 5-10% of preeclamptic patients - RUQ/epigastric pain - assess for thrombocytopenia before placing a block - Tx: delivery
55
Maternal cocaine abuse
- cocaine = ester LA - inhibits NE reuptake in presynaptic SNS neuron - CV = tachycardia, dysrhythmias, coronary vasoconstriction, MI - CNS = CVA, SZ, ischemia - Acute intoxication = increased MAC - Chronic use = decreased MAC - OB risks = spont abortion, premature labor, placental abruption, low APGAR, thrombocytopenia - Tx: labetalol, tx hypotension w/ phenylephrine (may not response to ephedrine d/t catecholamine depletion)
56
Placenta accreta
attaches to surface of myometrium
57
Placenta increta
invades myometrium
58
Placenta percreta
extends beyond uterus
59
Placenta accreta/increta/percreta
- potential for large blood loss - GA preferred - associated w/ placenta previa & previous c/s
60
Placenta previa
- placenta attaches to lower uterine segment & partially/completely covers cervical os - **PAINLESS vaginal bleeding - risk factors: hx c/s, multiple births
61
Placental abruption
- partial or complete separation of placenta from uterine wall - risk factors: PIH, preeclampsia, HTN, cocaine use, smoking, excessive alcohol use - **PAINFUL vaginal bleeding - risk of AFE & DIC - blood products ready, prep c/s
62
Most common cause of postpartum hemorrhage
uterine atony
63
DIC is associated with:
- AFE - placental abruption - intrauterine fetal demise
64
normal APGAR
8-10
65
moderate distress APGAR
4-7
66
impending demise APGAR
0-3
67
APGAR HR
0 = absent 1 = < 100 2 = > 100
68
APGAR RR
0 = absent 1 = slow, irregular respirations 2 = normal, crying
69
Muscle tone APGAR
0 = limp 1= some flexion of extremities 2 = active motion
70
Reflex irritability APGAR
0 = absent 1 = grimace 2 = cough, sneeze, cry
71
APGAR color
0 = pale, blue 1 = body pink, extremities blue 2 = completely pink
72
neonatal resuscitation

APEX: Flashcards (13 decks)

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