OB Anesthesia

Question 1

Ritodrine

Answer 1

Beta agonist. Slows contractions

Question 2

Betamethasone

Answer 2

Steroid to mature fetal lungs

Question 3

Side FX of: 1) Pitocin 2) methergine 3) hemabate 4) Cytotec/Misoprost

Answer 3

Pit: hypoTN, tachy, SIADH
Methergine: HTN
Hemabate: Asthma/bronchoconstriction
Cytotec: ?

Question 4

preop GI ppx in pregnancy

Answer 4

H2 blocker (famotidine)
non-particulate antacid (bicitra)
dopamine agonist (metoclopromide)

Question 5

Spinal Bupivicaine dose
1) C/S
2) labor intrathecal pump

Answer 5

1) 1.4-1.8 mL at 0.75%
2) 1 mL/hr at 0.25%

Question 6

Spinal duramorph dose

Answer 6

0.1 mg Duramorph (provides analgesia as well as up to 0.4 and has less puritis)

Question 7

spinal fentanyl dose

Answer 7

10-25 mcg

Question 8

Category 1 tracing

Answer 8

110-160 bpm,
moderate variability (6-25),
no lates/variables

Question 9

Category 2 tracing

Answer 9

anything that falls in the grey area that isn’t defined by either Cat 1 or Cat 3

Question 10

Category 3 tracing

Answer 10

any bradycardia, absent baseline variability
recurrent late or variable decelerations

Question 11

ACOG MTP ratio

Answer 11

6 pRBC: 4 platelets : 1 jumbo FFP

Question 12

Contraindications to Spinal anesthesia

Answer 12

Absolute Contraindications
• Patient refusal
• Infection at the site of injection
• Uncorrected hypovolemia
• Allergy
• Increased intracranial pressure

Relative Contraindications
• Coagulopathy
• Sepsis
• Fixed cardiac output states
• Indeterminate neurological disease

Question 13

What are the system-by-system effects of pre-E? (Canned answer)

Answer 13

add answer

Question 14

Spinal levels 1st stage labor

Answer 14

T10 - L1

Question 15

Spinal levels 2nd stage labor

Answer 15

S2 - S4

Question 16

What drug can you give to help relax a uterus (tx for uterine inversion, retained placenta)

Answer 16

Nitroglycerin

Question 17

Can you place an epidural if chorioamnionitis is suspected?

Answer 17

Yes, if abx have been given

Question 18

List of drugs to avoid in pregnancy (cross placenta AND have bad effects)

Answer 18

BZDs (1st trimester)
Ephedrine (fetal acidosis)
Local anesthetics (ion trapping)
Atropine or neostogmine alone (both cross and affect the heart. Can give together. Just don’t give glucose with neo)
BBs (esmolol ok b/c short acting)

Question 19

Important physical exam step before co-loading

Answer 19

Listen to lungs. Make sure they aren’t “wet”

Question 20

Vasopressor of choice for spinal induced hypotension. Why?

Answer 20

Phenylephrine. Ephedrine causes fetal acidosis

Question 21

Pre-E pt wants an epidural. What labs do you want? Are you going to treat her BP prior to epidural placement?

Answer 21

Plt count, LFTs, coags.
No! Epidural will drop pressure. Can TX after I’d you still need to.

Question 22

Special consideration: uterine atony 2/2 magnesium or tocolytics. What can you give?

Answer 22

Calcium gluconate

Question 23

What are you worried about with molar pregnancy?

Answer 23

Molar can cause hypertension and thyrotoxicosis (bHCG mimics TSH).
CHF, DIC (no neuraxial), and PE.