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ABA Applied Exam > OB > Flashcards

OB Flashcards

1
Q

What is the risk of placenta accreta in women with placenta previa?

A

3% for first repeat C-section

up to 67% for fifth repeat C-section

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2
Q

When should elective delivery take place for placenta previa?

A

36-37 weeks

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3
Q

What is Sheehan syndrome?

A

pituitary failure after severe obstetric hemorrhage

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4
Q

When is magnesium used for neuroprotection?

A

threatened preterm delivery between 24-28 weeks

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5
Q

When should steroids be given to promote fetal lung maturity?

A

threatened preterm delivery between 24-34 weeks

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6
Q

What are the respiratory changes associated with pregnancy?

A

increased minute ventiltion due to increased tidal volume (respiratory alkalosis)

decreased FRC

capillary engorgement causing airway swelling

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7
Q

What are the cardiovascular changes associated with pregnancy?

A

increased cardiac output (up to 80% increase immediately post-partum)

decreased SVR

aortocaval compression (after 20 weeks)

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8
Q

What are the GI changes associated with pregnancy?

A

decreased LES tone

decreased gastric motility during labor

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9
Q

What are the hematological changes associated with pregnancy?

A

physiologic anemia (greater increase in plasma volume than RBC volume)

increased fibrinogen and clotting factors (except II, V, XI, and XIII)

decreased ATIII

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10
Q

What is the anesthetic of choid for placenta accreta?

A

neuraxial has better post-op hematocrit

**unless percreta suspected, then GA**

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11
Q

What are the primary causes of post-partum hemorrhage?

A

ATONY!

retained placenta

uterine inversion

surgical trauma

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12
Q

What are the undesirable effects of oxytocin?

A

decreased SVR

anti-diurectic effect (homology to ADH)

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13
Q

What is the risk of blood salvage during C-section?

A

amniotic fluid embolus

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14
Q

What are the causes of DIC in an obstetric patient?

A

hemorrhagic shock

AFE

placental abruption

IUFD

sepsis

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15
Q

What are the major components of AFE syndrome?

A

hypoxemia

hypotension

seizures

hemorrhage

cardiopulmonary arrest

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16
Q

What are the major complications associated with pre-eclampsia?

A

CHF

pulmonary edema

acute renal failure

liver rupture

intracerebral hemmorhage

post-partum hemmorhage

DIC

17
Q

How is magnesium given for seizure prophylaxis in pre-eclampsia?

A

4-6 g bolus dose

1-2 g/hr infusion until 24 h post-partum

**therapeutic range, 4-6 mEq/L, DTRs lost at 10 mEq/L**

18
Q

What is the minimum platelet count for epidural placement in a pre-eclamptic patient?

A

about 80,000

**trend is important**

19
Q

When should ECV be considered?

A

a breech presentation recognized prior to labor at 36 weeks or later

20
Q

What improves the success rate of ECV?

A

neuraxial anesthesia

tocolytics (terbutaline more than NTG)

21
Q

What are the mainstays of mitral stenosis treatment during pregnancy?

A

heart rate reduction (beta blockers)

cautious use of diuretics

22
Q

What is the normal fetal heart rate?

A

120-160 bpm with variability

23
Q

What causes early decelerations? Lates? Variables?

A

early decelerations: vagal response to fetal head compression

late decelerations: uteroplacental insufficiency

variable decelerations: umbilical cord compression

24
Q

What are the hemodynamic goals for intra-operative management of the pregnant patient with mitral stenosis?

A

avoid tachycardia

maintain sinus rhythm (for atrial kick)

avoid marked decreass in SVR (causes reflex tachycardia)

avoid increases in PVR (hypoxia, hypercarbia, acidosis)

avoid volume overload

25
Q

What normal parts of a GA C-section should be avoided in a patient with mitral stenosis?

A

ephedrine (tachycardia)

nitrous oxide (increased PVR)

bolus dosing of pitocin (increased PVR, infusion OK)

methergine and hemabate (increased PVR)

26
Q

What is the dose of epinephrine for neonatal resuscitation?

A

0.01 - 0.03 mg/kg

27
Q

What does the umbilical artery blood gas represent? Umbilical vein?

A

umbilical artery: fetal conditions

umbilical vein: maternal and uteroplacental conditions

28
Q

Should ephedrine or phenyephrine be used to treat maternal hypotension during anesthesia?

A

both are fine, outcomes are similar, but ephedrine shows more fetal acidosis

ABA Applied Exam (12 decks)

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