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Obestetrics > OB- Clow > Flashcards

OB- Clow Flashcards

1
Q

What 2 things need to be considered starting at 20 weeks?* 14 weeks (2nd trimester)

A
  1. LUD
  2. RSI

Rob said for both - LUD & RSI start in the second trimester. 14 weeks

LUD anywhere between 14-26 weeks

(MAC decreases ~ 8-12 weeks)

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2
Q

Mom vs baby on oxyghemoglobin curve

Normal P50

A

mom = shifted right (right = release to baby) [30]
baby = left (left=love) [10]

27

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3
Q

CO2 goals for pregnant patient

A

normocarbic 35-45

hyperventilating reduces maternal CO and uterine blood flow and can compromise fetus

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4
Q

how does dead space change in mom?

A

increases 40%

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5
Q

T/F- TV/dead space ratio increases with pregnancy

A

false its unchanged - both increase 40%

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6
Q

How many cc’s of LA does it take to get to a T4 level on a pregnant patient for an epidural

what if they aren’t pregnant?

A

pregnant = 20cc
non-pregnant = 30cc

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7
Q

T/F- estrogen is the main stimulatory hormone in pregnancy

A

true - increases CO, NV, and angiotensin

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8
Q

what hormone is responsible for 3rd spacing?

A

aldosterone - increases total body water

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9
Q

path of blood flow from mom to baby

which deliver oxygenated blood vs return deoxygenated blood?

A

mom > uterine arteries > placenta > 1 umbicial vein (oxygenated) > baby > 2 umblical arteries (deoxygenated) > placenta > uterine veins > mom

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10
Q

uterine blood flow is inversely proportional to what?

what would cause this

A

uterine vascular resistance (increase resistance, decreased blood flow)

catecholamines (alpha stimulation: epi, neo, ephedrine)

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11
Q

why should you try and give IV meds to mom during contractions?

A

bc uterine contraction → decreased UBF → less to baby → more to mom

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12
Q

about how much blood gets autotransfused to mom during a contraction

A

500mls

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13
Q

T/F- acceleration of fetal HR in response to stimualtion is a good sign

A

TRUE

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14
Q

Pregnancy drug category:

in controlled human studeis, drug does not demonstrate risk to fetus in any trimester

3 examples

A

A - safe

folic acid, levothyroxine, doxylamine (unisom, but can actually treat pregnancy induced NV)

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15
Q

Pregnancy drug category

Use of drug in pregnant women demonstrates risk to human fetus, but potential benefit to mother may outweigh risk to fetus

4 examples

A

Category D - ONLY used in serious/lifethreating condidtion when alternatives are unavailable

+evidence of fetal risk, but benefits may outweigh risks

Lisinopril, Losartan, Lithium, Phenytoin

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16
Q

Pregnancy drug category

In animal studies, drug is associated with adverse effect and there are no controlled human studies

or

there are no animal or human studies

3 examples

A

Category C

only use if potential benefit outweighs potential risk

fluconazole, metoprolol, sertraline

*sertraline = zoloft = SSRI (enzyme inhibition)
*fluconazole = azole antifungal (enzyme inhibition)

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17
Q

what pregnancy drug catagory would it be if there are no animal or human studies for the drug

A

Category C

or animal studies +adverse effect but no human studies

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18
Q

What pregnancy drug category details a drug that is contraindicated in women who are pregnant or may become pregnant

A

X

methotrexate (chemo), simvastatin, warfarin

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19
Q

Pregnancy drug category

In animal studies, drug does NOT demonstrate risk to fetus and there are no controlled human studies

or

in animal studies, drug is associated with adverse effect but in controlled human studies, drug does not demonstrate risk to fetus in any trimester

3 examples

A

B “should be ok”

zofran, amoxicillin, loratadine

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20
Q

Radation is safe up to what?

A

50mGy

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21
Q

Whats the test dose for epidurals

A

45mg lido (3cc of 1.5% (15mg x 3)
+/- 15mcg epi (3cc of 1:200,000 [5mcg x 3 = 15mcg]

22
Q

What’s the first thing you should do if your called to treat breakthrough pain for a laboring mom with an epidural

A

check the catheter site to see if it migrated before bolus’ing/increasing rate

23
Q

If need to convert to surgical anesthesia and someone asks you to pull up”fast lido” what’s that ?

A

20mls lido/2mls bicarb

some might ad a swirl of epi and/or opioids

24
Q

Spinal level for PPTL

A

T5-T6

25
Q

2 characteristics of tetracaine that make it not a great option in OB

A

slow onset and stonger motor block

26
Q

Why does bicarb speed the onset?

A

it makes the drug less ionized at phisologic pH , therefore speeding the onset

27
Q

mneumonic for amides that cross the placenta from highest to lowest

A

MELRUB
Mepivacaine
Etidocaine
Lidocaine
Ropivacaine
Bupivacaine (most protein bound)

28
Q

which local anesthetic crosses the placenta the least of any?

A

chloroprocaine (metabolized in blood by esters before it can get to baby)

29
Q

Say you have a T10 level and need to get to a T4- how much LA should you inject into the epidural?

A

1-2cc/ level
6 levels x 1.5cc = 9ccs

30
Q

when is mom most likely to have symptoms of a PDPH?

A

usually 2nd day PP

31
Q

If mom cardiac arrests, the fetus should be delivered within how many minutes of arrest

2 adjustments u need to make compared to non-pregnant

A

5 mins

LUD and compressions with hands slightly above center of sternum

(CPR will be more effective once baby is out due to less aortocaval compression → better blood return/volume)

32
Q

What 2 structures does the epidural space lay between?

A

ligamentum flavum → epidural space → dura matter

→ subdural space → arachnoid membrane → subarachnoid space → pia matter → spinal cord

33
Q

What 2 structures does the subarachnoid space lay between?

A

arachnoid membrane → SA space → pia matter

→spinal cord

34
Q

why should you wait to continue doing spinal if mom starts a contraction?

A

bc contraction will elevate the spina llevel

35
Q

50%nitrous increases your MAC by how much?

A

2x (50%nitrous doubles your MAC)

36
Q

Crash section- baby should be out in what time frame

A

3 minutes or less

37
Q

If you cant intubate and have to result to an LMA (proseal) to secure airway - what do you need to consider?

A

they will have to avoid fundal pressure (increased risk of aspiration)

38
Q

If pt can’t dorsiflex their foot (footdrop) after vaginal hysterectomy, what nerve is injured

what is compressed in what position?

A

Common peroneal

head of the fibula is compressed by the strap in lithtomy position

39
Q

what nerve injury if after vag hyster, lateral thigh has decreased sensation?

A

lateral fem cutaneous

40
Q

How does pitocin work?

what is the mechanism that causes hypotension?

A

increases permeability to calcium ions, increasing the number of contracting fibrils and increases uterine tone post delivery (increases contraction strength and frequency if used for induction)

well pitocin increases the conductance of calcium and calcium can stimulate the nitric oxide pathway and result in vascualr relaxation- BAM

41
Q

What should you never give pitcoin with?

A

D5W - never give with water (water intoxication)

42
Q

how does methergin work?

who should it be avoided in?

A

it increases uterine tone by direct alpha adrenergic stimulation

HTN, pre-eclamptic, pulm htn
*light sensitive

43
Q

dose of methergine

A

0.2mg IM

comes in 0.2mg/mL vial - give whole CC - IM!!!

44
Q

methergine
onset:
duration:
1/2 life:

can it be repeated? when?

A

onset 2-4 mins
duration 2-4 hours
1/2 life 2 hours

can be repeated in 2-4 hours

45
Q

Dosing of hemabate (Carboprost)

can you repeat?

who should you avoid it in?

A

0.25mg (250mcg) IM

repeat q 15-30 mins - max of 2mg (8 doses total)

asthmatics (bronchospasm)

46
Q

How does mag sulfate relax the uterus?

A

it competes with calcium for entry into the SR → less calcium = uncoupling of the acin-myosin unit → muscle relaxation

*hyperpolarizes the neurons and reduces seizure risk for preeclamptic patients

47
Q

antidote for mag toxicity

A

calcium gluconate

48
Q

mnumonic for treatin amniotic fluid embolism

A

AOK for AFE

Atropine 1mg (tx vagal response)
Odansetron 8mg (suppress serotonin effects [vagal] from platelet degrandulation)
Ketorolac 30mg (inhibit thromboxane A2 which is ultimately causing pulm vasoconstriction)

platelets degranulate and rlease serotonin (vagal) and thromboxane A2 (pulm vasoconstriction)

49
Q

What’s etopic pregnancy?

A

when the fetus implants outside of the uterus (in a fallopian tube)

50
Q

risk of doing non-ob surgery in the 1st trimester

A

misscarriage 30-50%

51
Q

What is puerperium

A

the time period after placental delivery to 6 weeks post partum

52
Q

2 most common causes of OB mortality (non-anesthesia related)

A

PE & PrEeclampsia (24%/20%)

Obestetrics (4 decks)

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