OB Flashcards
relaxin
relaxes chest wall-> inc ap diameter
progesterone
inc mv by 50%- inc ap diameter
what lung volumes decrease
frc, erv, rv
what lung volumes inc
mv, tv, rr, o2 compensation
progesterone and cardiac
inc nitric oxide-> dec dbp, svr
do clotting factors inc or dec
inc- hypercoag state
what happens to rbc and plasma volume
both inc but plasma volume inc more- dilutional anemia- prepares mom for hemorrhage with delivery
what happens to pt and ptt
decreases 20%
mac
dec 30-40% - inc progesterone
les tone
decreases
what happens to gfr, cr clearance, glucosuria
dec gfr
inc creatine clearance
inc glucosuria
what happens to albumin and pche
both dec- no effect on sux
what happens to gastric volume and ph
inc gastric volume
dec ph
due to inc gastrin
when does gastric emptying slow
with labor
where does pain for 1st stage of labor analgesia come from
t10-L1
c fibers hypogastric plexus
where does 2nd stage pain come from with labor analgesia
pudendal nerve s2-s4
bupivicaine epidural infusion
0.05-0.125%
rate 8-15 mL
bolus 10-15 mL dividided doses
s/e with bupivicaine
dec tachyphylaxis
dec placentall transfer- inc protein binding; inc ionization
inc cv toxicity
inc sensory and motor blcok
what can be used for walking epidural
ropiviciane- less motor block
normal fhr
110-160
fetal bradycardia
< or = 110
fetal tachycardia
> or = 160
causes of fetal bradycardia
fetal: asphyxia and acidosis
maternal: hypoxemia, drugs that decrease placental perfusion
causes of fetal tachycardia
fetal: hypoxemia, arrhythmias
maternal: fever, chorioamnionitis, atropine, ephedrine, terbutaline
s/e of terbutaline
beta agonist- inc camp -> causes fetal hypokalemia/ hypoglycemia
hypermag 2.5-5
asymptomatic
hypermag 5-7
diminished dtr, lethargy, drowsy, n/v
hypermag 7-12
loss of dtr, hypotension, ecg changes, somnolence
hypermag >12
resp depression, apnea, complete ht block, pulm edema, reduced response to ephedrine
dose and se of methergine
0.2 mg IM
causes vasoconstriction, htn, cerebral hemorrhage
dose and se of hemabate
prostaglandin f2
250 mcg IM or intrauterine
causes n/v, diarrhea, hotn, htn, bronchospasm
dose and se of oxytocin
post pit- augments labor, stimulates uterine contraction, helps with uterine hypotonia/ hemorrhage- causes h2o retention, hyponatremia, hotn, reflex tachycardia, coronary vc
do you use defasiculating dose with c section
no
should you confirm placment of ett before incision
yes
how much mac / anesthetic do you use
low concentration- 0.8% anesthetic and 50% n2o
how do you extubate c section pt
fully awake- still full stomach
when to do surgery for obstetrics
2-6 weeks post delivery or 2nd trimester
when is tertagenicity higest
oranogenesis- 13 to 60 days
avoid n2o first 2 trimesters- avoid benzos first trimester
when to start rsi
18-20 weeks - gerd prophylaxis
when to avoid nsaids
1st trimester- potentially closes ductus arteriosus
chronic htn
before 20 weeks ; does not go back to nromal after deluvery
gesttaional htn
after 20 weeks-r eturns to normal after dleiveyr
no proteinuria
preeclampsia
htn > 140/90 after 20 weeks + proteinuria
need delivery for tx
eclampsia
pree with seizures
hellp syndrome
hemolysis elevated liver enzymes low plt
hellp syndrome is highest risk for
thrombocytopenia and dic
what is placenta previa
covering cervical os
painless bleeding
apgar normal
8010
apgar impending demise
0-3
what does apgar look at
HR, RR, muscle tone, reflex irritability, color
