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AP III > OB (9/10) > Flashcards

OB (9/10) Flashcards

1
Q

a pt with a placenta previa should be instructed to NOT….

A
  1. have vaginal exam
  2. have intercourse
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2
Q

T/F: a parturient with a placenta previa can deliver vaginally

A

false

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3
Q

_______________ is painless vaginal bleeding

A

placenta previa

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4
Q

risk factors for placenta previa

A
  1. uterine myomectomy
  2. advanced maternal age
  3. previous C/S
  4. multiparity
  5. previous previa
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5
Q

how is a placenta previa confirmed?

A

ultrasound

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6
Q

how do you anesthetically manage a parturient with placenta previa

A

based on…
1. amount of bleeding
2. stability of mother
3. maturity of fetus (delay delivery until 37 weeks if possible)

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7
Q

how does a placental abruption present

A
  1. painful vaginal bleeding
    or
  2. pain with no bleeding (bc concealed behind placenta)
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8
Q

S/Sx: of placental abruption

A
  1. painful vaginal bleeding
  2. decreased BP
  3. decreased fetal heart tones
  4. uterine tenderness
  5. back pain
  6. preterm labor
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9
Q

risk factors for placental abruption

A
  1. HTN
  2. preeclampsia
  3. advanced maternal age
    4 tobacco use
  4. cocaine use
  5. trauma
  6. PROM
  7. chorio
  8. bleeding in early pregnancy
  9. previous abruption
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10
Q

management of placental abruption

A
  1. emergency! due to risk of death in mother and fetus
  2. 2 lg bore ivs
  3. assess volume and clotting factors
  4. cross match
  5. GETA with etomidate for C/S
  6. support BP with fluids and pressors
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11
Q

causes of uterine rupture

A
  1. trauma
  2. excessive fundal pressure
  3. extensive cervical lac
  4. intrauterine manipulation
  5. forceps use
  6. manual placenta extration
  7. version
  8. inappropriate use of pit
  9. Grand maltip
  10. uterine anomaly
  11. placenta percreta
  12. tumors
  13. fetal problems (macrosomia, malposition)
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12
Q

treatment for uterine rupture

A
  1. repair
  2. arterial ligation
  3. hysterectomy
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13
Q

common causes of POSTpartum hemorrhage

A
  1. uterine atony
  2. genital trauma (at birth)
  3. retained placenta
  4. placenta accreta
  5. uterine inversion
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14
Q

________________ is when the placenta is adhered to the myometrium without invasion of myometrium

A

placenta accreta vera

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15
Q

________________ placental adherence with invasion of myometrium

A

placenta increta

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16
Q

_____________ placental adherence with invasion to the uterine serosa or other pelvic structures

A

placenta percreta

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17
Q

what is the most common type of accreta

A

placenta accreta vera

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18
Q

RF for accreta

A
  1. previous C/S
  2. uterine trauma
  3. D&C following miscarriage
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19
Q

pt has a history of previous C/S and comes in with previa; this should draw high suspicion of what?

A

accreta

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20
Q

tx of accreta

A

C/S with possible hysterectomy without delay

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21
Q

risk factors of uterine inversion

A
  1. uterine atony
  2. inappropriate fundal pressure
  3. excessive umbilical cord traction
  4. short umbilical cord
  5. uterine anomalies
22
Q

Treatment of uterine inversion

A
  1. immediate replacement of uterus!
  2. consider: terbutaline, magnesium, IV/SL nitroglycerine
  3. general anesthesia
23
Q

risk of postpartum hemorrhage increases significantly due to retained placenta when delivery of placenta is longer than _______________ min

A

30

24
Q

anesthesia tx for retained placenta

A
  1. heavy dose existing CLE
  2. nitroglycerin (SL/IV)
  3. GETA/IV sedation
25
Q

preterm labor is defined as labor between ________________ weeks gestation, and is defined as ____________ contractions in ___________ min or ___________ contractions in __________ min

A

20-37; 4 in 20; 8 in 60

26
Q

intervention for preterm labor

A
  1. tocolytics (mag sulf)
  2. corticosteroid therapy
  3. neuraxial would aid with controlled vaginal delivery
27
Q

what corticosteroids (and doses) would be administered for preterm labor

A
  1. betamethasone 12 mg IM q24h x2
    or
  2. dexmethasone 6 mg IM q12h x4
28
Q

what is the leading cause of pregnancy related 1st trimester death

A

ruptured ectopic hemorrhage

29
Q

causes of ectopic pregnancy

A
  1. altered fallpian tube transport
  2. prior tubal surgery
  3. pelvic inflammation
  4. previous pelvic surgery
  5. IUD use
  6. delayed ovulation
  7. hormonal changes
  8. smoking
  9. hx of infertility
  10. assisted reproductive procedure
30
Q

early phase amniotic fluid embolism sx

A
  1. pulmonary vasospasm
  2. low CO
  3. VQ mismatch
  4. hypoxemia
  5. hypotension
31
Q

early phase of amniotic fluid embolism lasts less than _____________ min

A

30

32
Q

sx of 2nd phase amniotic fluid embolism

A

LV failure and pulm edema, then disruption of normal clotting cascade

33
Q

what tx has increased survival of moms with amniotic fluid emboli?

A
  1. 1 mg of atropine
  2. 8 mg ondansetron
  3. 30 mg ketorolac

“AOK”

34
Q

what types of LA are most likely to cause ion trapping in the acidotic fetus

A

amides (ones with 2 “i” in the name)

35
Q

if you are having to do CPR on pregnant woman and the uterus is above the umbilicus, what should you do

A

perform aortocaval decompression via manual left uterine displacement or left lateral tilt

36
Q

planning for labor analgesia in parturient

A
  1. perform pre-anesthetic eval (OB prenatal record, ask about HA, pre-existing numbness in LE)
  2. thorough airway assesment
  3. family hx of MH?
  4. surgical hx
  5. previous hx of labor analgesia - difficult placement? effective? complications
  6. pt VS
  7. NPO status
37
Q

contraindications to neuraxial

A
  1. refusal/inability to cooperate
  2. increased ICP
  3. infection at site
  4. frank coagulopathy
  5. hemorrhage
  6. fetal instabiliyt
  7. inadequate training
38
Q

ideally informed consent for laboring neuraxial analgesia should be obtained before ____________________

A

pts pain is severe or pt has received any analgesics

39
Q

factors that affect the parturients decision to get an epidural

A
  1. pitocin (causes intense contraction with pain)
  2. prolonged labor
  3. unfavorable fetal positions (transverse, OP)
  4. small pelvis
  5. macrosomia
  6. primigravida
  7. IV meds are inadequate
  8. substance abuse hx (need epidural whether they want it or not)
  9. MD or RN preference
  10. when mom enters transition phase of labor
40
Q

how many mg of lidocaine is in an epidural test dose?

A

15 mg/mL (1.5% solution) in 3-5 mL (45-75 mg)

41
Q

how many mcg of epi in an epidural test dose

A

1:200,000 epi = 5 mcg/mL

3-5 mL = 15 - 25 mcg

42
Q

what is the most common local used for epidural analgesia

A

bupivicaine

43
Q

common loading dose of epidural is ________% bupivicaine and infusion = _______% bupiv + ___________

A

0.25; 0.125 + 2 mcg/mL fentanyl

44
Q

bupivicaine in epidural will give pain relief in ___________ minutes, will peak at ________ min and lasts approximately _______ min

A

8-10; 20; 90

45
Q

__________________ is ONLY used in epidurals and gives you less of a motor block than bupivicaine

A

ropivicaine - used for “walking epidural”

46
Q

what does adding fentanyl to for continuous epidural

A

dilutes the LA and you get less of motor block –> allows mom to move legs

47
Q

concentration for ropivicaine in continuous epidural

A

0.08-0.2%

48
Q

benefits of ropivicaine in epidural over bupivicaine

A
  1. less cardiodepressant and less arrhythmogenic
  2. safer (cleared more rapidly)
  3. less motor block
49
Q

what are the different epidural infusion modes

A
  1. continuous infusion with basal rate
  2. PCEA
  3. timed intermittent bolus injection
50
Q

s/e of neuraxial analgesia

A
  1. hypotension
  2. pruritus (most common)
  3. N/V
  4. fever
  5. shivering
  6. urinary retention
  7. delayed gastric emptying

AP III (25 decks)

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