Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Anesthesia MM/TL > OB > Flashcards

OB Flashcards

1
Q

What anticholinergic should you use in pregnant ladies to prevent fetal bradycardia from neostigmine?

A

Atropine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What is the therapeutic range for magnesium in treating eclampsia?

A

5-9 mg/dl

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What do high levels of magnesium cause?

A

They prevent presynaptic release of acetylcholine thereby decreasing the amount of acetylcholine in the NMJ

Inhibits calcium influx

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

At what levels of magnesium are deep tendon reflexes reduced?

A

5 mg/dl

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

At what levels of magnesium is muscle weakness and respiratory depression produced?

A

7 mg/dl

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

When does hypotension occur in hypermagnesemia?

A

7-12 mg/dl

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

When are DTRs lost and cardiac conduction abnormalities seen in hypermagnesemia

A

12 mg/dl

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

When does asystole occur in hypermagnesemia?

A

25 mg/dl

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What is the best immediate treatment for hypermagnesemia

A

Calcium Gluconeogenesis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What is transient neurological syndrome?

A

Pain or sensory abnormalities in the low back, butt, and LE within 24 hours of postoperatively period that disappear in 4-5 days caused by intrathecal lidocaine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

In what position does TNS most commonly occur?

A

In the lithotomy position

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What other local anesthetic has a similar risk of causing TNS to lidocaine?

A

Mepivacaine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What is the most desired sensory level block for a c-section?

A

T4 because of manipulation and traction on the abdominal organs and peritoneum

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What is the new definition for preeclampsia?

A 
Past 20 weeks: Hypertension (severe = 160/110)
\+ Severe symptoms:
Headache
TCP < 100K
Elevated Liver Enzymes
Persistent RUQ pain
Persistent headache/cerebral symptoms
Renal insufficiency (serum Cr twice normal)
Pulmonary edema
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What is chronic hypertension in pregnancy?

A

BP > 140/90 before 20 weeks

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What is gestational hypertension?

A

High BP after 20 weeks with no other associated symptoms

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

What are the first line treatments for severe HTN (160/105) in preeclampsia?

A

Hydralazine and Labetalol

2nd line: oral nifedipine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

What are you trying to prevent by treating severe HTN?

A

Maternal stroke and CHF

Fetal growtch retardation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

What are the treatments for refractory BP?

A

Esmolol
NIcardipine drip
Nitroprusside drip

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

What can esmolol cause in the fetus?

A

Bradycardia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Which antihypertensives cross the placenta?

A

All of them

There are only trials on animals

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

What should you do if a neonate’s heart rate drops below 100?

A

Start positive pressure ventilation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

What should you do if a neonate’s heart rate drops below 60 for > 30 seconds?

A

Start chest compressions at 3:1 ratio with ventilation.

Giving a rate of 120 per minute (90 compressions + 30 breaths per minute)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

What is the most common cause of fetal bradycardia?

A

Hypoxia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

Why should FiO2 be lowered ASAP when resuscitating a neonate?

A

Due to free radicals and hypoxic-reoxygenation effects: pulmonary toxicity, retinopathy of premature

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

What should you do if the fetal heart rate remains below 60 despite chest compression for more than 30 seconds?

A

10-30 mcg/kg of epinephrine q 3-5 minutes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

How much volume resuscitation should be given to a neonate?

A

10 ml/kg of crystalloid

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

What is the definition of postpartum hemorrhage?

A

Greater than 500 ml blood loss in vaginal delivery

Greater than 1L blood loss in ceserean

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

What is the most common cause of postpartum hemorrhage?

A

Uterine atony due to bleeding intrauterine vessels which are normally constricted with uterine contraction

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

What are the risk factors for uterine atony?

A 
Multiparity
Polyhydramnios
Oxytocin-induced labor
Chorioamnionitis
Prolonged labor
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

What is the first line treatment for uterine atony?

A

Uterine massage

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

What is the first line medical treatment for uterine atony?

A

Oxytocin - stimulates uterine myosin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

What are the side effects of oxytocin?

A 
Hypotension with bolus
Headache
Nausea
Arrythmias
Diuresis
Hypertonic uterine contractions
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

What is methylergonovine?

A

An ergot alkaloid that causes uterine contraction by increasing intracellular calcium.

Note: also causes vasoconstriction elsewhere - increase pulmonary vascular resistance, systemic vascular resistance

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

What are the side effects of methylergononvine?

A

Coronary vasospasm
Bradycardia
Cardiogenic Pulmonary edema
Severe hypertension

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
36
Q

In what conditions is the use of methergine contraindicated?

A

Pregnancy induced hypertension
Preeclampsia
Chronic HTN
CAD

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
37
Q

What is carboprost tromethamine?

A

prostaglandin F2a which causes uterine contraction

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
38
Q

What are the side effects of carboprost tromethamine?

A

Bronchospasm
Nausea
Diarrhea
Labile BP

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
39
Q

What conditions is carboprost contraindicated in?

A

Reactive airway disease

HTN

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
40
Q

When would you use vasopressin for uterine contraction?

A

As a rescue measure because it is very short acting and has to inject directly into the uterus

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
41
Q

What is the first line treatment for uterine relaxation in the setting of uterine inversion?

A

Nitroglycerin - IV or sublingual

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
42
Q

What is uterine inversion?

A

A surgical emergency - must get uterus reversed before the cervix closes on the fundus

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
43
Q

What is misoprostol?

A

Synthetic prostaglandin E1 used for uterine contraction or ripening the cervix.
Given po or pr

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
44
Q

What is hPL?

A

Human placental lactogen - it is an insulin antagonist which increases lipolysis and glycosis for glucose for baby

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
45
Q

What happens to renal blood flow in pregnancy?

A

It increases by 20-25%, which increases GFR and therefore decreases BUN/Cr ratio

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
46
Q

What happens to renal bicarb excretion in pregnancy?

A

It is increased due to compensation for respiratory alkalosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
47
Q

Why are pregnant patients more prone to UTIs?

A

Because progesterone causes dilation and therefore stasis of the ureters

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
48
Q

What are the CV effects of pregnancy?

A

Increased blood volume –> increased HR, SV, CO
Increase in venous capacitance (so normal CVP)
Decrease in peripheral vascular resistance
BP decreases by 10% until 34 weeks and then returns to normal prepregnancy values
***There is an increase in myocardial O2 demand)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
49
Q

What are the pulmonary effects of pregnancy?

A

Decreased FRC (from decreased ERV and RV)
Increase in minute ventilation –>respiratory alkalosis - due to dec. alveolar ventilation ( inc. PaCO2 compensation)
Increased TV by 40%
Vital capacity = unchanged
Total oxygen consumption increases by 20%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
50
Q

What CV parameter does not change in pregnancy?

A

CVP due to increased venous capacitance

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
51
Q

What pulmonary parameter does not change in pregnancy?

A

Vital capacity

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
52
Q

Why is there increased minute ventilation in pregnancy?

A

Decreased FRC

Progesterone increases RR

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
53
Q

What happens to hematocrit in pregnancy?

A

Decreased slightly due to increased plasma volume in relation to overall increase in BV

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
54
Q

How much does Hgb change in pregnancy?

A

<11 g/dl in 1st and 3rd trimester

< 10.5 g/dl in 2nd trimester

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
55
Q

What happens to fibrinogen in pregnancy?

A

It increases –> hypercoagulability due to induction of liver enzymes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
56
Q

What causes hypercoagulability in pregnancy?

A

Increased Factor II, VII, VIII, X, fibrinogen due to induction of liver enzymes
Resistance to protein C and S
Venous stasis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
57
Q

What can be used in pregnancy to treat DVT?

A 
Lovenox
Dalteparin (Thrombin inhibitor)
Heparin drip
Heparin
Continue lovenox for 6 weeks after delivery!
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
58
Q

What happens to gastric emptying time in pregnancy?

A

It increases, more gastric motility, more salivation, relaxation of sphincters (higher parasympathetic tone)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
59
Q

What happens to cortisol levels in pregnancy?

A

They increase

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
60
Q

What happens to thyroid-binding globulin and total T4?

A

It increases due to liver induction

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
61
Q

What happens to TSH?

A

It decreases due negative feedback

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
62
Q

What happens to free T3/T4 in pregnancy?

A

It remains normal

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
63
Q

What is the latent first stage of labor?

A

Onset of labor to 3-4 cm dilation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
64
Q

What is the active first stage of labor?

A

4 cm to complete cervical dilation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
65
Q

What is the second stage of labor?

A

Complete cervical dilation to delivery of the baby

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
66
Q

What is the third stage of labor?

A

Delivery of baby to delivery of placenta

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
67
Q

What is a normal fetal heart rate?

A

110-160 bpm

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
68
Q

What are the causes of fetal bradycardia?

A
  1. Hypoxia - due to uterine hyperstimulation, rapid fetal descent, cord prolapse
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
69
Q

What are the causes of fetal tachycardia?

A

Hypoxia, maternal fever, fetal anemia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
70
Q

What is normal variability in the FHR?

A

6-25 bpm

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
71
Q

What is marked variability and what does it indicate?

A

> 25 bpm, hypoxia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
72
Q

What does sinusoidal variability mean?

A

Severe fetal anemia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
73
Q

What drug causes pseudovariability?

A

Meperidine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
74
Q

What are FHR accelerations and what do they indicate?

A

Increase in HR by 15 bpm in less than 30 seconds

Indicate appropriate response to environment

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
75
Q

What is minimal variability and what does it indicate?

A

HR less than 6 bpm indicative of fetal hypoxia, opioid use, magnesium or sleep cycle

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
76
Q

What are variable decelerations and what do they indicate?

A

They are decels with nadir < 30 seconds, > 15 seconds but less than 2 minutes that can happen at any time

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
77
Q

What are the causes of variable decels?

A

Oligohydramnios
Nuchal cord
Cord prolapse

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
78
Q

What will you see if the umbilical vein gets compressed first?

A

Reflex tachycardia due to decreased venous return and therefore decreased CO

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
79
Q

What will you see if the umbilical artery gets compressed first?

A

Reflex brady due to increased SVR and BP

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
80
Q

What are late decels?

A

Gradual onset of decrease in FHR after uterine contraction indicative of uteroplacental insufficiency and fetal hypoxia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
81
Q

What are early decels?

A

Gradual onset mirroring uterine contraction indicative of head compression

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
82
Q

What nerves are being stimulates with uterine contraction and cervical dilation?

A

T10-L1 (visceral)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
83
Q

What nerves are being stimulated during fetal descent and delivery?

A

S2-S4 (somatic)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
84
Q

What are the absolute contraindications to regional anesthesia?

A 
Refractory maternal hypotension
Maternal coagulopathy
Maternal use of lovenox
Untreated maternal bacteremia
Skin infection of site
Increased ICP
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
85
Q

What is placenta previa?

A

Abnormal placental implantation covering cervical os

  • need c-section because baby will compress vessels and compromise blood supply
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
86
Q

What are the symptoms of placenta previa?

A

Painless bright red bleeding

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
87
Q

What are the complications of placenta previa?

A

Increased risk of placenta accreta
Vasa previa –> fetal exsanguination
Premature delivery, PROM, IUGR
Recurrence risk = 4-8%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
88
Q

What are the complications of placental abruption?

A

Hemorrhagic shock
DIC
Fetal hypoxa/death
Recurrence rate = 5-16%, 2nd offense > 25%

89
Q

What are the risk factors of placental abruption?

A

HTN, cocaine, trauma, smoking, excessive stimulation, prior!!!

90
Q

What are the risk factors of placenta previa?

A 
Prior C sections
Grand multiparity
Advnaced maternal age
Multiple gestation
Prior
Smoking, cocaine
Fibroids
91
Q

What is placenta accreta?

A

Placental implantation in myometrium –> massive blood loss –> hysterectomy

92
Q

What are the normal rates of progression in stage 1 of labor?

A

> 1.2 cm/hr nulliparous

>1.5 cm/hr multiparous

93
Q

What is prolonged second stage of labor?

A

Arrest of fetal descent

94
Q

What is PROM?

A

Ruptures of membranes >1 Hour before the onset of labor

95
Q

What is PPROM?

A

Premature (<37 weeks)

***associated with oligohydramnios

96
Q

What is prolonged ROM?

A

ROM occurring > 18 hours prior to delivery

97
Q

When should betamethasone and tocolytics be given?

A

Premature labor < 34 weeks.

98
Q

What is the first line tocolytic for less than 32 weeks?

A

Indomethacin

99
Q

Which tocolytics are contraindicated in diabetics?

A

B2 agonism (ritodrine and terbutaline) due to hyperglycemia

100
Q

What are the indications for a c-section?

A 
Transverse position
Fibroids
Maternal death
Hysterectomy to be performed afterward
Cervical cancer
Active herpes
HIV
Abruption
Cord compression/prolapse
Erythroblastosis fetalis
101
Q

What artery does the uterine artery come from?

A

Internal iliac

102
Q

What is Sheehan’s syndrome?

A

Pituitary ischemia and necrosis that leads to anterior pituitary insufficiency
***Associated with postpartum hemorrhage.

103
Q

What is the presenting symptom of Sheehan’s?

A

Inability to lactate due to decrease prolactin levels

104
Q

What are the symptoms of Sheehan’s?

A

Cold insensitivity, Weakness, lethargy (dec. TSH/ACTH)
Genital atrophy (dec. FSH/LH, estrogen, testosterone)
Menstrual disorder

105
Q

What is a risk of IUFD?

A

DIC due to tissue factor released from placenta

106
Q

What is an early sign of DIC after IUFD?

A

Low fibrinogen levels (<100) because these should be higher in pregnancy

107
Q

What causes shivering in epidural anesthesia?

A

Peripheral vasodilation thereby decreased core temperature and vasoconstriction above the level of the block

108
Q

What causes shivering in labor and delivery?

A

Progesterone increases body temperature
There is more norepinephrine release which can augment core temperature
Immunologic reaction from maternofetal transfusion

109
Q

What are the components of Apgar scoring?

A
  1. Skin color
  2. Heart rate
  3. Muscle tone
  4. Reflex irritability
  5. Respiratory effort

Highest score = 10
Lowest score = 0

110
Q

Is Apgar scoring a predictor of long term outcome?

A

NO

111
Q

Which local anesthetic is most likely to cause ion trapping and accumulating in the fetus in fetal acidosis?

A

Lidocaine

112
Q

What is ion trapping?

A

Happens with decreased fetal ph which will favor the ionized form of local anesthetics (NH3+) because it is basic. Since ionized form cannot pass the placental barrier, it gets trapped in the acidotic fetus

113
Q

Why is lidocaine more likely to cause ion trapping than ropivacaine or bupivacaine?

A

It is less protein bound than ropiv or bupiv

114
Q

Why is chlorprocaine the preferred anesthetic for bolusing in a parturient?

A

It is quickly metabolized by plasma esterases so it will not accumulate in an acidotic fetus

115
Q

How does magnesium cause lower blood pressure?

A
  1. By competing with calcium in vascular smooth muscle cells thereby decreasing actin-myosin crosslinking
  2. By increasing endothelial intracellular NO and prostaglandin I2 which have vasodilatory properties
116
Q

At what level of magnesium does AV block and myocardial depression occur?

A

> 10 g/dl

117
Q

What other receptors does magnesium inhibit?

A

NMDA

118
Q

What does a time sensitive operation mean when talking about doing an operation during pregnancy?

A

It needs to be done within 1-6 weeks.

119
Q

What is the best option for decreasing risk of miscarriage for an operation?

A

Delaying surgery until the second trimester

120
Q

What causes higher risk of abortion and preterm labor in the perioperative period?

A

Manipulation of the uterus
Surgery
The condition necessitating surgery
NOT anesthesia

121
Q

Which surgeries have the lowest risk of preterm labor?

A

Extremity surgery

Surgery that does not mess with the uterus

122
Q

Why should regional anesthesia be used in pregnancy?

A

Decreased aspiration risk
Decreased use of opioids
Does not decrease risk of preterm labor

123
Q

When is the risk of preterm labor the highest?

A

3rd trimester

124
Q

When is variability in FHR seen?

A

25-27 weeks

125
Q

Is there evidence for preoperative use of tocolytics to prevent preterm labor?

A

No

126
Q

What anesthetic techniques have been shown to decrease the risk of preterm labor?

A

None

127
Q

What happens to MAC in pregnancy?

A

It decreases by 25-40%

128
Q

What happens to alveolar ventilation in pregnancy?

A

Increases by 70% due to the effects of progesterone

129
Q

What happens to PaCO2?

A

Decreases by 10 mmHg due to hyperventilation

130
Q

What happens to arterial oxygen tension?

A

Increase by 10 mm Hg

131
Q

What happens to plasma volume?

A

Increase by 40%

132
Q

What happens to maternal P50 in pregnancy?

A

It increases from 27 to 30 (decrease in hemoglobin affinity for oxygen)

133
Q

What is the fetal P50?

A

19-21 mm Hg, so the gradient is larger faciliating offloading of maternal oxygen to fetal hemoglobin

134
Q

What is the side effect of CSE compared to epidural anesthesia?

A

Worse opioid induced pruritis

135
Q

What are the advantages of CSE?

A

More rapid onset of pain control (2-5 minutes)

Provides good analagesia for c-section and delivery

136
Q

Who is CSE contraindicated in?

A

Patients who need a safely functioning epidural

  • difficult airway
  • high likelihood of C-section
  • fetal distress
137
Q

What works better for somatic pain/.

A

Local anesthetic

138
Q

What should be tried as second line for uterine atony?

A

Carboprost

Given IM at intervals of 15-90 minutes, max of 8 times

139
Q

What is ex utero intrapartum treatment?

A

performed when the fetus needs life-saving measures like bronchoscopy, echo, trach, ECMO
Hysterotomy is performed and just the head is delivered to do whatever needs to be done

140
Q

What is required for ex utero intrapartum treatment?

A

Uterine relaxation to faciliate procedure and maintain uteroplacental sufficiency and fetal gas exchange

Techniques: High volatile
NTG
CSE + NTG boluses of infusion

Side effects: maternal hypotension and hemorrhage

141
Q

What is the first line for uteral relaxation for retained placenta ?

A

IV NTG

142
Q

What is the preferred technique for uterine relaxation in a bleeding patient?

A

Regional anesthesia rather than high volatile and other vasodilatory agents that may make this worse

143
Q

What is the leading cause of maternal death in the US?

A

CV complications: cardiomyopathy,

144
Q

What is responsible for the increased risk of aspiration and GERD in pregnant patients?

A

Progesterone - causes smooth muscle relaxation, LES tone relaxation, decreased intestinal motility

145
Q

What does relaxin do?

A

Causes remodelling of collagen in the pelvis causing separation of pubic symphysis and widening of the pelvic inlet

146
Q

What does oxytocin do?

A

Causes uterine contraction

Milk production

147
Q

What is the anesthetic of choice for cervical cerclage when the cervix is dilated and there are bulging membranes?

A

General since volatile relaxes uterine muscle to facilitate replacement of the membranes.

Take great caution to avoid increases in intraabdominal and intrauterine pressure (coughing, retching)

148
Q

How quickly does NTG provide uterine relaxation?

A

40-90 seconds

149
Q

What is the half-life of NTG?

A

1-3 minutes

150
Q

What are the indications for uterine relaxation?

A 
Twin in weird position needing delivery
Breech position for delivery of head
C section of fetus with abnormality
Oxytocin overdose
Retained placenta/products
Inverted uterus
151
Q

What is not a reason for uterus relaxation?

A

Placental abruption

152
Q

What is atosiban?

A

Antagonist of oxytocin and vasopressin - tocolytic

not FDA approved because showed to have higher rate of neonatal mortality

153
Q

When does indomethacin cause PDA closure in gestation?

A

after 32 weeks

154
Q

Why is magnesium contraindicated as a tocolytic in patients with myasthenia gravis?

A

It antagonizes calcium (reduces influx) thereby decreasing the release of acetylcholine from alpha motor neurons
It decreases the sensitivity of acetylcholine receptors to acetylcholine

155
Q

What is the mechanism of action of nifedipine?

A

Blocks voltage gated calcium channels - not in myocardium

156
Q

What are the potential side effects of nifedipine?

A

Pulmonary edema
Flushing
AV block
Nausea

157
Q

What is in high circulating levels in pre-eclampsia?

A

Thromboxane A2

158
Q

What is low in pre-eclampsia?

A

Prostagland I2

159
Q

What is the pathophysiology of pre-eclampsia?

A

Vascular hyperreactivity –> uterine constriction, uteroplacental insufficiency
Intravascular volume depletion
Decreased renal blood flow from increased vascular resistance
Pulmonary edema due to capillary leakage and increased inflammation
Platelet activation and coagulopathy with prolonged PTT

160
Q

What are the risk factors for maternal death?

A

African american or hispanic
BMI > 29
Multigestation
Advanced maternal age

161
Q

What can ritodrine stimulate to happen in the fetus?

A

Hypoglycemia due to hyperinsulinemia from maternal hyperglycemia

162
Q

What are the maternal side effects of ritodrine and terbutaline?

A

Pulmonary edema, SVT, myocardial ischemia, hyperglycemia, hypokalemia, tremor, ileus, N/V, hallucinations

163
Q

What happens to dead space in the parturient?

A

Decreases due to increased cardiac output

164
Q

What is the most common and reliable sign of uterine rupture?

A

Nonreassuring fetal heart tones

165
Q

What are the fetal side effects of ritodrine and terbutaline?

A

Myocardial ischemia and hypertrophy
Tachy
Hyperglycemia
Hyperinsulinemia

166
Q

What are the neonatal effects of ritodrine and terbutaline?

A 
Hypoglycemia
IVH
Hyperbilirubinemia
Hypocalcemia
Hypotension
167
Q

What electrolyte abnormality does oxytocin cause?

A

Hyponatremia because resembles ADH so causes natriuresis and water retention

168
Q

What is placenta accreta is associated with the most EBL?

A

Placenta percreta - may invade through uterine serosa to other pelvic structures

169
Q

What is placenta increta?

A

When chorionic villi invade the myometrium

170
Q

What is the highest risk factor for placenta accreta?

A

Prior c section with placenta overlying the scar

171
Q

What should you avoid in general anesthesia for pregnant people?

A

Hypocapnia (hyperventilation)
Hypoxia
Hypotension

172
Q

Which 2 factors are unchanged in pregnancy?

A

II and V (thrombin)

173
Q

Which factors are decreased in pregnancy?

A

Factor XI and Factor

XIII

174
Q

What happens to platelets in pregnancy?

A

Decreased by 10%

175
Q

What happens to factor VIII in pregnancy?

A

increases

176
Q

What are the signs/symptoms of AFE?

A

1st phase: Pulmonary vasospasm –> RHF

2nd phase: LHF –> pulmonary edema, coagulopathy, shock, utetotonicity, fetal bradycardia

177
Q

What is the pathophys of AFE?

A

Leukotrienes spilled into maternal circulation casuing massive mast cell degranulation and immune response

178
Q

What is the incidence of PDPH after spinal?

A

1-11%

179
Q

What is the incidence of PDPH after epidural needle puncture of dura?

A

52%

180
Q

What are the characteristics of a PDPH?

A

Fronto-occipital radiating to neck, worse with upright position, occurring with 24-48 hours after puncture, associated with cranial nerve deficits

181
Q

How long do symptoms usually last?

A

1 week but can persist for months to years

182
Q

What are the risk factors for PDPH?

A 
Female gender
Lower BMI
Previous PDPH
Age under 40
Pregnancy
Larger needle
Provider inexperience
Air used for loss of resistance
183
Q

What are the other analgesia options for labor?

A 
Remifentanil infusion
Nitrous
Saddle block (intrathecal injection and leave patient sitting for awhile)
Perineal infiltration
Pudendal nerve block
Cervical block
Lumbar paravertebral
184
Q

What are lumbar paravertebral blocks associated with?

A

Lower risk of bleeding

185
Q

What happens to d-dimer in pregnancy?

A

It increases due to more fibrin split products from elevated fibrinogen

186
Q

What is the cause for increased blood volume in pregnancy?

A

Sodium retention via the RAAS because of increased metabolic demands

187
Q

When is maternal CO the highest?

A

Immediate following delivery due to uterine autotransfusion

188
Q

What accounts for the increase in CO in the first trimester?

A

Heart rate

189
Q

What accounts for the increase in CO in the second trimester?

A

Increased SV

190
Q

What are the effects of adding epinephrine to bupivacaine epidural?

A

Increases duration and intensity of block through alpha 1 agonism
Decreases the minimum local anesthetic concentration (the amount needed to create a good block) likely through alpha 2

191
Q

What are the risk factors for placental abruption?

A 
Paternal and maternal tobacco abuse
Cocaine
HTN
advanced maternal age
increase parity
trauma
PROM
chorio
bleeding in early pregnancyhistory of abruption
192
Q

What population has a higher incidence of abruption?

A

AA with respiratory disease

193
Q

Why is nasal instrumentation contraindicated in pregnancy?

A

Engorgement of tissues and risk of epistaxis

194
Q

What is the PO2 of the umbilical artery?

A

16

195
Q

What is th PCO2of the umbilical artery?

A

55

196
Q

What is the pO2 of the umbilical veins?

A

28

197
Q

What is the PCO2 of the umbilical veins?

A

40

198
Q

How much does MAC decrease in pregnancy by full term?

A

40%

199
Q

What plays a role in decreasing MAC in pregnancy?

A

Progesterone

B-endorphins released during labor and delivery

200
Q

What is MLAC?

A

Minimum local anesthetic toxicity - the local analgesic concentration leading to satisfactory analgesia in 50% of patients

201
Q

What happens to MLAC in pregnancy?

A

Reduced by 30 % (due to hormones)

202
Q

What are the effects of the enlarged uterus?

A

Obstruction of IVC
Engorgement of epidural venous plexus (higher risk for intravascular injections)
Decreased CSF
Decreased potential volume of epidural space
Increased epidural space pressure

203
Q

What happens to oxygen consumption and minute ventilation ?

A

They both increase

204
Q

What is PaCO2 in pregnancy?

A

28-32 mmHg

205
Q

What happens to P50 for hemoglobin?

A

It increases from 27 to 30

206
Q

What happens to closing capacity and vital capacity in pregnancy?

A

Nothing

207
Q

When does FRC return to normal after delivery?

A

48 hours

208
Q

When do MAC levels return to normal?

A

The third day after delivery

209
Q

What might you see on chest film of a pregnant lady?

A

Prominent vascular markings due to higher pulmonary blood volume and an elevated diaphragm

210
Q

What happens to dead space?

A

Decreased

211
Q

What happens to shunting?

A

Increases

212
Q

What happens to induction time?

A

Decreased due to pulmonary vascular engorgement and higher minute ventilation

213
Q

Why should smaller ETT be used in pregnant women?

A

Engorgement of respiratory mucosa have higher risk of bleeding/trauma

214
Q

What is the average blood loss of a vaginal delivery?

A

400-500 ml

215
Q

What is the average blood loss of a c-section?

A

1L

216
Q

What is the blood volume pregnant woman?

A

90 ml/kg

217
Q

How much is cardiac output increased in pregnancy?

A

40 % - 20% heart rate and 20% stroke volume

218
Q

When dos cardiac output return to normal?

A

2 weeks after delivery

Anesthesia MM/TL (36 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions