OB (8/10) Flashcards
a pt with pre-eclampsia is on a magnesium gtt, when suddenly they go into respiratory arrest, you know respiratory arrest occurs with a plasma magnesium level > __________
15
what are the s/sx of magnesium toxicity you should be monitoring for when the pre-eclamptic pt is on a mg gtt
- chest pain
- blurred vision
- nausea
- sedation
- loss of DTR
when you place the early epidural on pt with pre-eclampsia, if they experience hypotension, what doses of phenylephrine and/or ephedrine should you use to tx?
- ephedrine = 2.5 mg
- phenylephrine 25-50 mcg
what is the tx for magnesium toxicity
calcium gluconate 1 gm over 10 min
why do we do EARLY epidural analgesia on pre-eclamptic pts
- to avoid GETA/instrumentation of possibly difficult airway
- placing epidural prior to drop in plt count
- provides benefical effects on uteroplacental perfusion
- helps to decrease BP and pain control
what are the preferred methods of neuraxial analgesia on the pre-eclamptic pt
- combined spinal epidural
- continuous labor epidural
what is one of the leading causes of maternal mortality with pre-eclampsia
cerebral hemorrhage
complications of pre-eclampsia
- increased risk of maternal M&M
- HELLP
- CVA
- pulmonary edema
- renal failure
- placental abruption
- eclampsia
what is HELLP syndrome
severe form of pre-eclampsia that has:
- hemolysis
- elevated liver enzymes
- low platelets
________________ is the most common autoimmune dz in pregnant women, and also the most common autoimmune disease in women of child bearing age
systemic lupus erythematous
what are the risks of systemic lupus erythematosus and pregnancy
- intrauterine fetal distress/demise
- pre-term delivery
what are the risks of antiphospholipid syndrome (Hughes syndrome) and pregnancy
in utero death
_________________ is a prothrombic d/o that results in arterial and venous thrombosis and characterized by having the lupus anticogulant autoantibody & the anticardiolipid Ab
antiphospholipid syndrome (hughes syndrome)
what are the risks of scleroderma and pregnancy
preterm delivery
how do you manage the pregnant woman with an autoimmune disorder
- multidisciplinary approach
- consider extent of underlying systemic dysfunction
- anesthetic management taken case-by-case
anesthesia management to the parturient with CV disease
- evaluated and followed closely in high acuity centers with multidisciplinary approach
- individualized to each pt
what type of analgesia = analgesia of choice in pregnant woman with CV disease that will not tolerate decreased SVR and decreased venous return?
intrathecal analgesia with lipophilic opioid (fentanyl)
T/F: parturients with infective endocarditis should be placed on prophylactic abx regiment
true
who is at risk for gestational dm
- advanced maternal age
- obesity
- family hx of Type II DM
- prior hx of GDM
- hx of PCOS
- glycosuria
- hx of prior still birth, neonatal death, fetal malformation, or macrosomia
when do they do the oral glucose tolerance test
btwn 24-28 weeks
100 g OGTT is performed after 8 hour fast, and to be dx with GDM, at least of two of the following glucose measurements must be present:
- fasting >/= 95
- 1 hour >/= 180
- 2-hour >/= 155
- 3 hour >/= 140
T/F: pregnancy is characterized by progressive peripheral resistance to insulin in 2nd and 3rd trimester
true
what is the difference btwn normal insulin resistance in pregnancy and GDM
- normal pregn insulin resistance is progressive in the 2nd and 3rd trimesters
- GDM = parturient has insufficient compensatory insulin response
GDM is associated with higher rates of what complications
- gestational HTN
- polyhydraminos
- C/S
how is gestational DM controlled?
diet and oral agents
if mom has gestational diabetes, the babies typically come out ____________ with ___________ blood sugars
big; low
when is the dilutional anemia commonly seen in pregnancy the worst
28-34 weeks
why is there dilutional anemia in pregnancy
RBC increases by 30% but plasma volume increases by 50%
if the mom develops DIC, what will her labs look like?
plt __________
fibrinogen ___________
antithrombin III ____________
PT & aPTT ____________
thrombin & reptilase time ___________
D dimer ______________
fibrin degradation products ___________
- plt = decrease
- fibrinogen = decrease
- antithrombin III = decreased
- PT & PTT = prolonged
- thrombin and reptilase time = prolonged
- D-dimer = increased
- fibrin degradation products = increased
what are the most common causes of DIC in pregnancy
- pre-eclampsia
- placental abruption
- sepsis
- retained dead fetus syndrome
- amniotic fluid embolism
if DIC is due to placental abruption, how do you tx
cryo or FFP
what are the lab goals for the parturient in DIC
fibrinogen > 150 and plt > 100 K
DIC is an abnormal activation of the coagulation system which leads to….
- formation of large amounts of prothrombin
- depletion of coagulation factors
- activation of fibrinolytic system
- hemorrhage
what are absolute contraindications to neuraxial anesthesia
- frank coagulopathy
- refusal
a pregnant woman on lovenox can receive an epidural when?
10-12 hours after last dose
if pregnant woman requires lovenox, after delivery it should not be given until _____________ hours after epidural catheter removed
2
what are some common coagulation diseases requiring thrombophylaxis that the pregnant woman may have
- protein C deficiency (heparin)
- factor V leiden
- protein S deficiency (heparin)
- antithrombin deficiency
T/F: neuraxial is not safe in the parturient with HIV
false
how do you anesthetically manage the pregnant pt with HIV
manage co-existing dz + anesthesia
s/sx of hyperemesis gravidarum
- N/V
- ketonuria
- increased AFT
- weight loss
s/sx of intrahepatic cholestasis of pregnancy
- pruritis
- jaundice
- increased serum bile acid
- hyperbilirubinemia
- mild abn of LFTs
parturient with pruritis and jaundice is an easy dx for what disease
intrahepatic cholestasis of pregnancy
fetal risks with intrahepatic cholestasis of pregnancy
- pre-term delivery
- meconium stain
- fetal bradycardia
- non-reassuring fetal status
_____________ is when parturient has impaired hepatic metabolic activity that can lead to liver failure, DIC, hypoglycemia, and renal insufficiency
acute fatty liver of pregnancy
______________ is a liver dz during pregnancy that is a medical emergency, need to deliver the bby due to high risk of maternal death
acute fatty liver of pregnancy
with _______________ of pregnancy, the mom typically gets relief 2-3 weeks post delivery
intrahepatic cholestasis
for the parturient who comes in for delivery on suboxone, what opioid would be best choice for them?
dilaudid - binds more tightly to the Mu receptor pushing the buprenorphine off the receptor
patients on suboxone, what long acting opioid is best for the parturient? what short acting?
- dilaudid (long)
- sufenta (short)
these both have similar Ki#s to buprenorphine (suboxone = buprenorphine + naloxone)
s/sx of neonata abstinence syndrome
- irritability
- poor feeding
- abnormal sleep patterns
- diarrhea
- fever
- seizures
what are the common causes of antepartum hemorrhage
- placenta previa
- placental abruption
- uterine rupture
- vasa previa
