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OB (Wolfe Summer 24") > OB Final Study Guide > Flashcards

OB Final Study Guide Flashcards

1
Q

Aortocaval compression: At term, this can cause a……

A

10-20% decline in SV and CO

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2
Q

Left Uterine Displacement =

A

elevate the mother’s RIGHT torso 15-30 degrees.

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3
Q

LUD should be used for anyone in their _____ and ____ Trimester.

A

Second and Third

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4
Q

Symptoms of supine hypotension:

A

Hypotension, sweating, bradycardia, pallor, nausea, vomiting

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5
Q

Regiona anesthesia causes_______ ______.

A

Profound HYPOTENSION

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6
Q

Best vasoactive for treating hypotension in parturient:

A

Phenylephrine
-can cause reflex bradycardia

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7
Q

What leads to fetal ion trapping?

A

FETAL ACIDOSIS can increase concentration gradient

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8
Q

_____ _____ can significantly increase the fetal concentration of drugs such as local anesthetics

A

Fetal acidosis

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9
Q

Drug characteristics that FAVOR placental transfer:

A

Low molecular weight <500 Daltons (most anesthetic drugs are smaller than 500 Daltons) Rachel’s powerpoint said 600
High lipid solubility
Non-ionized
Non-polar

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10
Q

_____ and _____ may affect fetal function and transfer across the placenta

A

Inflammation and infection

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11
Q

Meds that CAN cross the Placenta:

A

Local anesthetics (except chloroprocaine d/t rapid metabolism)
IV anesthetics (usually not a problem)
Volatile anesthetics
Opioids
Benzos
Atropine
Beta-blockers
Magnesium (not lipophilic but its small)

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12
Q

Meds that CANNOT cross the placenta:

A

Neuromuscular blockers
Glycopyrrolate
Heparin
Insulin

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13
Q

Magnesium : 5-10 mEq/L =

A

prolonged PR interval widened QRS

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14
Q

Magnesium : 11-14 mEq/L =

A

depressed tendon reflexes

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15
Q

Magnesium : 15-24 mEq/L =

A

SA, AV node block, respiratory paralysis

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16
Q

Magnesium : > 25 mEq/L =

A

Cardiac arrest

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17
Q

Methergine: main points

A

2nd line Uterotonic
Dose: 0.2 mg IM
IV administration can cause significant vasoconstriction, hypertension, and cerebral hemorrhage
Hepatic metabolism
Half-life = 2 hours

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18
Q

Hemabate/Carboprost (prostaglandin F2): main points

A

Third line uterotonic
Dose: 250 mcg IM or injected into uterus
Side effects: N/V, diarrhea, hypotension, hypertension, brochospasm

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19
Q

Uterine blood flow:
Non-pregnant =
Pregnancy at term =

A

Non-pregnant = 100 mL/min
Pregnancy at term = 700 mL/min 10% of CO

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20
Q

Uterine blood flow does _____ _____ therefore, it is dependent on _____,_____,and _____.

A

-does not autoregulate
-MAP, CO, and uterine vascular resistance
(mainly MAP and CO)

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21
Q

CV parameters in parturient: HR steadily _____ (%) _____ baseline during the ___ and _____ trimesters.

A

increases 15-20% above baseline during the 1st an 2nd trimester

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22
Q

CV: both the _____ and the uncorrected _____ are shortened

A

PR interval and QT interval

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23
Q

CO increases by ______ gestation and is __-___% above baseline by the end of ___ weeks.

A

-5 weeks
-35-40%
-12 weeks

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24
Q

At term skin blood flow is __-__ x higher than non pregnant levels

A

3-4

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25
Q

CV: response to adrenergic drugs is _____

A

blunted

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26
Q

CV: _____ _____ can be seen on CXR

A

Cardiac Hypertrophy

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27
Q

CV: ____ ____ are present on auscultation

A

heart murmurs

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28
Q

CV: Decline in ____ _____ osmotic pressure.

A

plasma colloid

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29
Q

Any medications that should not be used in assisted reproduction technology?

A

avoid NSAIDs

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30
Q

Symptoms of aspiration:

A

Hypoxia
Pulmonary edema
Bronchospasm

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31
Q

Best time for non-OB surgery for mom?

A

2nd trimester (ideally delayed 2-6 weeks after delivery

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32
Q

Highest risk for teratogenicity=
Highest risk for preterm delivery=

A

-first trimester
-third trimester

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33
Q

Most common presentation of Placenta Previa:

A

“Painless vaginal bleeding”

All patients with vaginal bleeding are considered to have a placenta previa until proven negative by ultrasound

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34
Q

Complete previa definition:

A

when cervical os entirely covered by placenta or can be some variation of partial cover.

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35
Q

Patient with a history of previous C/S and a current placenta previa are at a very high risk for ______ ______.

A

placenta accreta

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36
Q

Most common injury in ASA Closed Claim Project regarding OB anesthetic claims:

A

Maternal death

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37
Q

Drugs which are the most appropriate in hemodynamically unstable parturient:

A

Ketamine and Etomidate

38
Q

Lung Volume changes during pregnancy:
Inspiratory volume-
Tidal Volume-
RV-
ERV:

A

Inspiratory volume- INCREASED
Tidal Volume- INCREASED BY 40%
RV- DECREASED
ERV: DECREASED

39
Q

Lung Capacity changes during pregnancy:
Inspiratory capacity:
FRC:

A

Inspiratory capacity: INCREASED
FRC: DECREASED

40
Q

Tidal volume is _____ by___%
RR is _____
Minute Ventilation is _____ by ___%

A

increased by 40%
increased
increased by 50%

41
Q

Respiratory:
Increased _____ _____ combined with a decreased _______ can cause rapid maternal ______.

A

-oxygen consumption
-FRC
-hypoxia

42
Q

Side effects of intraspinal narcotics:

A

-N/V
-pruritis
-urinary retention
-sedation
-respiratory depression

43
Q

Diffusion: drugs with less than ____ Da cross the placenta

A

600

44
Q

Bulk Flow: similar to ____ _____ but requires greater energy and is considered “______ ______”

A

-Active transport
-“Facilitated transport”

45
Q

Bulk flow: this mode of transport exhibits: (1-4)

A
  1. saturation kinetics
  2. competitive and noncompetitive inhibition
  3. stereospecificity
    4.temperature influences
46
Q

Active transport definition:

A

Movement of any substance across a cell membrane requiring energy from ATP hydrolysis

47
Q

Pinocytosis definition:

A

An energy requiring process in which the cell membrane invaginates around large macromolecules that exhibit negligible diffusion properties

48
Q

Diffusion: “Breaks” example:

A

when the mother has preeclampsia it may alter the net placental transport

49
Q

Normal anticipated blood loss in vaginal versus c-section delivery:

A

Vaginal - 500mL
C-section - 1000mL

50
Q

APGAR calculation:

A

Appearance (A): Assesses skin color. A score of 0 indicates blue or pale skin, 1 for pink body with blue extremities, and 2 for completely pink skin.

Pulse (P): Measures heart rate. A score of 0 means no heartbeat, 1 for a heart rate below 100 beats per minute, and 2 for a heart rate above 100.

Grimace (G): Evaluates reflexes. A score of 0 reflects no response to stimuli, 1 for minimal response (grimace), and 2 for a strong cry or cough.

Activity (A): Assesses muscle tone. A score of 0 indicates limp muscles, 1 for some flexion, and 2 for active movement.

Respiration (R): Measures breathing effort. A score of 0 means absent breathing, 1 for weak or irregular breathing, and 2 for strong crying.

51
Q

Expected pulse ox and heart rate in newborn:

A

Pulse should be >100 bpm, pulse ox should be >/=95%

52
Q

APGAR:
7-10=
4-6=
0-3=

A

7-10= reassuring
4-6= moderately abnormal
0-3= low

53
Q

All infants receive an APGAR score at __ and ___ minutes after birth. If the score is below ____, additional assessments occur at 10, 15, and 20 minutes. A score of ____ or less at 5 minutes prompts an____ ____ ____ test.

A

-1 and 5 minutes
-7
-5
- arterial blood gas

54
Q

ABG: pH:

A

pH: 7.28 +/- 0.05

Unlikely to be significant if >7.10

55
Q

Magnesium therapy: pathophysiology

A

May compete with calcium for uterine smooth muscle surface binding decreasing contractility.

Prevents increase in intracellular calcium.
Activates adenylcyclase increases cAMP.

56
Q

Magnesium therapy: muscle relaxers

A

Patient is more sensitive to both depolarizing and nondepolarizing muscle relaxants.

patient will need LESS

57
Q

Magnesium therapy: MAC

A

MAC is decreased for inhalational anesthetics

58
Q

Mag therapy: normal treatment range

A

4-7 mg/100 mL

59
Q

Mag toxicity treatment:

A

Treatment with calcium gluconate or CaCl

-Apex says- IV calcium gluconate 1g over 10 minutes (to antagonize Mg+2)

60
Q

Best agents for increasing gastric pH:

A

Sodium Citrate works within minutes to raise gastric pH- lasts ~30 min
H2 blockers (famotidine, ranitidine): Take at least 30 min to work

61
Q

Causes of fetal bradycardia:

A

-Acute hypotension in the fetus stimulates a reflex response, which includes both bradycardia and vasoconstriction.

-supine hypotension syndrome in mom

-Decreased uteroplacental blood flow during fetal distress

62
Q

Most common medical problem of pregnancy:

A

Diabetus

More prevalent in 2nd and 3rd trimesters

63
Q

DM: A1C normal=
risk for vascular disease =

A

4-6% normal
Risk of vascular disease increases at 6.5%

64
Q

More or less C-sections for diabetics?

A

MORE

65
Q

Stiff joint syndrome:

A

Associated with DM I:
nonfamilial short stature, joint contractures and tight skin

C-spine rigidity (atlanto-occipital joint)
Difficult airway/DL

66
Q

Gestational Diabetes
Associated with:

A

Advanced maternal age
Obesity
Family history of DM
History of stillbirth, neonatal death, fetal malformation or macrosomia

67
Q

Risk factors for PDPH:

A

-Younger age
-Larger needle gauge
16-18 ga epidural – 75-80% chance of PDPH
22 ga Quincke – 30-50% chance of PDPH
-Cutting-edge Quincke spinal needle
**pencil point decreased risk it does not cut dura fibers but pushed them apart
-Cephalad or caudal orientation of Quincke needle
-History of PDPH or migraines.

68
Q

Risks factors for dural puncture w/ epidural needle:

A

Experience - Increased risk with training/students
LOR technique - Decreased risk with saline vs. air
Fatigue and haste - Increased risk overnight

69
Q

Treatment for PDHP:

A

Bed rest
-Caffeine
-NSAIDS
-Epidural Blood Patch

70
Q

Epidural blood patch:

A

A
Definitive treatment of PDPH (only way to be 100% sure)

10-20cc sterile blood injected into epidural space

71
Q

VEAL CHOP

A

Variable deceleration
Early deceleration
Accelration
Late acceleration

Cord Compression
Head compression
Okay!
Placental insufficiency

72
Q

Treatment for LAST (local anesthetic systemic toxicity) for 70kg patient:

A

100 ml bolus of lipids over 2-3 minutes
250 ml infusion over 15-20 minutes.

Repeat as necessary, but do not exceed 12 ml/kg total

73
Q

Treatment for LAST (local anesthetic systemic toxicity) for < 70kg patient:

A

1.5 ml/kg bolus over 2-3 minutes
0.25 ml/kg infusion over 15-20 minutes

74
Q
A
75
Q

LAST: epi dose

A

Generally avoid vasopressors, however low dose epi is acceptable at 1 mcg/kg

76
Q

LAST: meds to avoid?

A

Avoid calcium channel blockers, beta blockers, or other local anesthetics

77
Q

LAST: ideal treatment for dysrhythmias

A

AMIO

78
Q

Ideal local anesthetic to administer for C-section:

A

2-chloroprocaine has fastest onset, however 2% lido with epi is another alternative.

79
Q

Placenta Accreta:

A

does not penetrate entire thickness of myometrium

80
Q

Placenta Increta:

A

invades further into myometrium

81
Q

Placenta Percreta

A

completely through myometrium, into serosa, and potentially outside of uterus, with invasion into surrounding structures (e.g. bladder, colon).

82
Q

S/S of uterine rupture:

A

-Maternal abdominal pain and vaginal hemorrhage as well as fetal hypoxia.
-Risk of amniotic fluid embolism leading to DIC
-Vaginal delivery is possible if baby is stable, however, often needs CS

83
Q

Generalized information of Epidural blood patch and how it works:

A

-Definitive treatment of PDPH
10-20cc blood sterile: inserted into epidural space (get loss after ligamentum flavum)
-Increases pressure by compressing subarachnoid spaces, acts as a plug.
-Should have immediate cessation of the headache.
-Clotting factors in blood help seal the hole in the dura
-The mass effect of the blood compresses the CSF giving nearly instant relief

84
Q

Know a historical fact that influences our current practice in OB anesthesia

A

John Snow withheld anesthesia until the 2nd stage of labor and limited administration to brief periods during contractions and attempted to keep the patients comfortable but responsive. Recommended the use of a vaporizing apparatus for the birth.

85
Q

Placenta Previa: pic

A

most dangerous = complete!

86
Q

ABG: pCO2

A

pCO2: 49 +/- 8.4

87
Q

ABG: pO2

A

pO2: 18 +/- 6.2

88
Q

ABG: HCO3-

A

HCO3: 22 +/- 2.5

89
Q

ABG: base excess

A

Base Excess: -4 +/- 2

90
Q

Suction losses =

A

blood in suction canister minus irrigation

91
Q

Sponge losses, blood soaked: Raytex =

A

15 mL

92
Q

Sponge losses, blood soaked: Lap =

A

80 mL

OB (Wolfe Summer 24") (3 decks)

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