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A1 > OB final study guide > Flashcards

OB final study guide Flashcards

1
Q

When does AO compression become a significant issue?

A

18 weeks?

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2
Q

What are the symptoms of supine HOTN syndrome?

A

LOC
Decreased venous return
Decreased CO, fetal perfusion, perfusion to lower extremities

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3
Q

What is the best vasoactive for treating HOTN in the parturient?

A

Phenyl?

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4
Q

What is ion trapping?

A

When a drug passing the placenta and is unable to come back to the mother
Occurs in acidotic baby and alkalotic mother?

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5
Q

Which meds cross the placenta?

A

All except;
NMBs
Glyco
Heparin
Insulin
That leaves: Beta blockers, mag, atropine, TIVA, volatile anesthetics

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6
Q

What are the symptoms of mag toxicity?

A

1- seizures from hypo
5- drowsy
8- DTR loss, EKG changes
15- Respiratory depression
>20- Cardiac arrest

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7
Q

What are the indications, dose, and contraindications for oxytocin, methergine, and carboprost?

A

Indications: UTEROTONIC- increases contractility
Pitocin-
Methergine- .2mg IM, cx
Carboprost- 250mcg IM,

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8
Q

Normal uterine blood flow

A

700-900ml/min

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9
Q

CV parameters in the parturient

A

Increase CO, BV, O2 consumption, SV, HR,
Decreased DBP, SVR, PVR
Same: Map, SBP, CVP, PAOP

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10
Q

What medications shouldn’t be used in assisted reproduction technology?

A
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11
Q

What are the symptoms of aspiration?

A

Dyspnea
Hypoxia
Cyanosis
Shock

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12
Q

Consequences of GA on fetus

A

Teratogeniticity

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13
Q

What are the different types of previa?

A

Total
Partial
Marginal
Low lying

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14
Q

What is the most common injury in ASA closed claim project regarding OB claims?

A

Nerve damage

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15
Q

What drugs are most appropriate for the hemodynamically unstable pregnant pt?

A

Ketamine
Etomidate

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16
Q

Changes in lung volumes and capacities

A

Increased: RR, PaO2, Mv,
Decreased: FRC, ERV, RV, TLC
Unchanged: Vt, Vc, CC, PH

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17
Q

S/e of spinal narcotics

A

Itching/ pruritis
N/v
Sedation
Respiratory depression

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18
Q

Normal EBL in the vaginal vs c/s labor

A

Vaginal- 600ml
C/s- 1000ml

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19
Q

How to calculate APGAR

A

0,1, or 2 each
normal 8-10
impending demise- <3
HR
Respiratory effort
Muscle tone
Reflex irritability
Color

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20
Q

Which agent increases gastric PH?

A

Sodium citrate

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21
Q

What causes fetal bradycardia?

A

Fetal hypoxia
Placental insufficiency (cord compression, hypovolemia)

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22
Q

Anesthetic considerations for the diabetic patient

A

Macrosomia
Higher risk of C/s
Shoulder dystocia
Maternal trauma/ peri laceration

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23
Q

Symptoms of PDPH

A

Headache10-72 hours after epidural

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24
Q

VEAL CHOP

A

*Variable- Cord compression
Early decels- Head compression
Accelerations- Ok, give o2
*Late decels- Placental insufficiency

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25
Q

S&S AO compresion

A

HOTN

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26
Q

Treatment of LAST

A

100ml bolus, followed by
1.5ml/kg bolus, then .25ml/kg infusion

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27
Q

What si the most dangerous previa?

A

Complete?

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28
Q

What is the ideal LA for emergent C/s?

A

2-chlorprocaine because it is quickly metabolized and therefore unlikely to pass into the placenta

29
Q

S&S uterine rupture

A

Frank blood
Pain unrelieved by a functional epidural

30
Q

How does the blood patch work?

A

10-20cc of blood patches the whole with platelets and other clotting factors

31
Q

What is the cost of IV iron?

A

$7/vial

32
Q

How do you calculate blood loss based on soaked raytecs or laps?

A

Raytec 15
Lap 80

33
Q

Airway edema is made worse by ___

A

Pre eclampsia
Tocolytics
Prolonged Tburg

34
Q

The uterus receives ___ of CO

A

10%

35
Q

IV fluid volumed is increased by ___

A

35%

36
Q

DVT is ___ more likely in pregnant women

A

6x

37
Q

Sensitivity to MAC and LA are ___

A

enhanced; they require less MAC and less LA d/t progesterone

38
Q

Is UBF autoregulated?

A

No
Depends on CO, MAP, and uterine resistance

39
Q

Uterine blood flow formula

A

UBF= (U. artery pressure- U. venous pressure)/ U. vascular resistance

40
Q

What can cause reduced UBF?

A

Decreased perfusion: maternal HOTN from hemorrhage, AO compression, sympathectomy
Increased resistance: uterine contraction, HTN

41
Q

Drug characteristics that favor placental crossing

A

LMW <500 Daltons
Non ionized
Non polar
Lipid soluble

42
Q

Stages of labor

A

1- beginning of dilation and contractions to 10cm dilated (latent is 0-3cm, active is 3cm- to delivery)
2- 10cm dilated- delivery of newborn (pain starts)
3- begins with delivery of newborn and ends with delivery of the placenta

43
Q

Pain pathways for 1 and 2 stages

A

1- T10-L2
2- S2-S4
Total- T10-S4

44
Q

Is N2O safe?

A

Yes
When used alone, will preserve uterine contractility, does not cause neonatal depression
Will not cause hypoxia, loss of airway reflexes, of LOC

45
Q

Lidocaine is not used for continuous spinal neuraxial analgesia because ___

A

Tachyplaxis
More likely to cross the placenta
Strong motor block ?

46
Q

What is the presentation of a total spinal?

A

Dyspnea
Difficulty phonating
HOTN
LOC
Rapid sensory and motor block

47
Q

What can cause late decels?

A

Placental insufficiency
Maternal hotn, hypovolemia, acidosis, pre eclampsia

47
Q

Normal FHR, causes of brady and tachy

A

110-160
Brady- acidosis, asphyxia
Tachy- hypoxemia, arrhythmias

48
Q

Normal FHR variability

A

6-25

49
Q

What can reduce FHR variability

A

CNS depressants
Hypoxemia
Fetal sleep
Acidosis
Anencephaly
Cardiac anomalies

50
Q

Category 1,2,3 of evaluation of FHR

A

1- safe
2- risk
3- siginificant threat to fetal oxygenation (brady, absent variability, reccurent late or variable decels, sinusoidal pattern)

51
Q

What is sinusoidal pattern?

A

A regular, smooth, undulating wave
Signifying a compromised fetus

52
Q

Triple prophylaxis during RSI for the parturient

A

Sodium citrate to neutralize gastric acid
famotidine, ranitidine H2 blocker reduce gastric secretion
Reglan gastrokinetic

53
Q

Give pitocin ____

A

after placenta delivery

54
Q

Avoid NSAIDS when

A

First trimester
Will close the PDA

55
Q

Consequences of pre eclampsia

A

Proteinuria
DIC
ICH/ cerebral edema
HF/ pulmonary edema

56
Q

Seizure proph for pre eclampsia mag dose

A

4 mg over 10 min
1 mg/hr

57
Q

HELLP

A

Hemolysis
Elevated liver enzymes
Low platelets

58
Q

Risk factors of previa

A

Previous c/s
History of multiple births

59
Q

Risk factors for placental abruption

A

PIH
HTN/ pre eclampsia
Cocaine/ etoh/ smoking

60
Q

Most common cause of PPH

A

Uterine atony (thats why we always give pitcoin)

61
Q

Risk factors for uterine atony

A

Multiparity
Polyhdraminos
Prolonged oxytocin before surgery
Multiple gestations

62
Q

SPO2 rises to 90 by when?

A

10 minutes
Before that, 60

63
Q

Normal therapeutic range for mag

A

4-7

64
Q

Mean maternal weight over a normal pregnancy increases how much?

A

12kg

65
Q

CO returns to normal by when?

A

2 weeks

66
Q

CO is greatest when?

A

80% increase immediately after birth

67
Q
A

A1 (124 decks)

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