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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
CV: response to adrenergic drugs is _____
blunted
26
CV: _____ _____ can be seen on CXR
Cardiac Hypertrophy
27
CV: ____ ____ are present on auscultation
heart murmurs
28
CV: Decline in ____ _____ osmotic pressure.
plasma colloid
29
Any medications that should not be used in assisted reproduction technology?
avoid NSAIDs
30
Symptoms of aspiration:
Hypoxia Pulmonary edema Bronchospasm
31
Best time for non-OB surgery for mom?
2nd trimester (ideally delayed 2-6 weeks after delivery
32
Highest risk for teratogenicity= Highest risk for preterm delivery=
-first trimester -third trimester
33
Most common presentation of Placenta Previa:
“Painless vaginal bleeding” All patients with vaginal bleeding are considered to have a placenta previa until proven negative by ultrasound
34
Complete previa definition:
when cervical os entirely covered by placenta or can be some variation of partial cover.
35
Patient with a history of previous C/S and a current placenta previa are at a very high risk for ______ ______.
placenta accreta
36
Most common injury in ASA Closed Claim Project regarding OB anesthetic claims:
Maternal death
37
Drugs which are the most appropriate in hemodynamically unstable parturient:
Ketamine and Etomidate
38
Lung Volume changes during pregnancy: Inspiratory volume- Tidal Volume- RV- ERV:
Inspiratory volume- INCREASED Tidal Volume- INCREASED BY 40% RV- DECREASED ERV: DECREASED
39
Lung Capacity changes during pregnancy: Inspiratory capacity: FRC:
Inspiratory capacity: INCREASED FRC: DECREASED
40
Tidal volume is _____ by___% RR is _____ Minute Ventilation is _____ by ___%
increased by 40% increased increased by 50%
41
Respiratory: Increased _____ _____ combined with a decreased _______ can cause rapid maternal ______.
-oxygen consumption -FRC -hypoxia
42
Side effects of intraspinal narcotics:
-N/V -pruritis -urinary retention -sedation -respiratory depression
43
Diffusion: drugs with less than ____ Da cross the placenta
600
44
Bulk Flow: similar to ____ _____ but requires greater energy and is considered "______ ______"
-Active transport -"Facilitated transport"
45
Bulk flow: this mode of transport exhibits: (1-4)
1. saturation kinetics 2. competitive and noncompetitive inhibition 3. stereospecificity 4.temperature influences
46
Active transport definition:
Movement of any substance across a cell membrane requiring energy from ATP hydrolysis
47
Pinocytosis definition:
An energy requiring process in which the cell membrane invaginates around large macromolecules that exhibit negligible diffusion properties
48
Diffusion: "Breaks" example:
when the mother has preeclampsia it may alter the net placental transport
49
Normal anticipated blood loss in vaginal versus c-section delivery:
Vaginal - 500mL C-section - 1000mL
50
APGAR calculation:
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
Expected pulse ox and heart rate in newborn:
Pulse should be >100 bpm, pulse ox should be >/=95%
52
APGAR: 7-10= 4-6= 0-3=
7-10= reassuring 4-6= moderately abnormal 0-3= low
53
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.
-1 and 5 minutes -7 -5 - arterial blood gas
54
ABG: pH:
pH: 7.28 +/- 0.05 Unlikely to be significant if >7.10
55
Magnesium therapy: pathophysiology
May compete with calcium for uterine smooth muscle surface binding decreasing contractility. Prevents increase in intracellular calcium. Activates adenylcyclase increases cAMP.
56
Magnesium therapy: muscle relaxers
Patient is more sensitive to both depolarizing and nondepolarizing muscle relaxants. patient will need LESS
57
Magnesium therapy: MAC
MAC is decreased for inhalational anesthetics
58
Mag therapy: normal treatment range
4-7 mg/100 mL
59
Mag toxicity treatment:
Treatment with calcium gluconate or CaCl -Apex says- IV calcium gluconate 1g over 10 minutes (to antagonize Mg+2)
60
Best agents for increasing gastric pH:
Sodium Citrate works within minutes to raise gastric pH- lasts ~30 min H2 blockers (famotidine, ranitidine): Take at least 30 min to work
61
Causes of fetal bradycardia:
-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
Most common medical problem of pregnancy:
Diabetus More prevalent in 2nd and 3rd trimesters
63
DM: A1C normal= risk for vascular disease =
4-6% normal Risk of vascular disease increases at 6.5%
64
More or less C-sections for diabetics?
MORE
65
Stiff joint syndrome:
Associated with DM I: nonfamilial short stature, joint contractures and tight skin C-spine rigidity (atlanto-occipital joint) Difficult airway/DL
66
Gestational Diabetes Associated with:
Advanced maternal age Obesity Family history of DM History of stillbirth, neonatal death, fetal malformation or macrosomia
67
Risk factors for PDPH:
-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
Risks factors for dural puncture w/ epidural needle:
Experience - Increased risk with training/students LOR technique - Decreased risk with saline vs. air Fatigue and haste - Increased risk overnight
69
Treatment for PDHP:
Bed rest -Caffeine -NSAIDS -Epidural Blood Patch
70
Epidural blood patch:
A Definitive treatment of PDPH (only way to be 100% sure) 10-20cc sterile blood injected into epidural space
71
VEAL CHOP
Variable deceleration Early deceleration Accelration Late acceleration Cord Compression Head compression Okay! Placental insufficiency
72
Treatment for LAST (local anesthetic systemic toxicity) for 70kg patient:
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
Treatment for LAST (local anesthetic systemic toxicity) for < 70kg patient:
1.5 ml/kg bolus over 2-3 minutes 0.25 ml/kg infusion over 15-20 minutes
74
75
LAST: epi dose
Generally avoid vasopressors, however low dose epi is acceptable at 1 mcg/kg
76
LAST: meds to avoid?
Avoid calcium channel blockers, beta blockers, or other local anesthetics
77
LAST: ideal treatment for dysrhythmias
AMIO
78
Ideal local anesthetic to administer for C-section:
2-chloroprocaine has fastest onset, however 2% lido with epi is another alternative.
79
Placenta Accreta:
does not penetrate entire thickness of myometrium
80
Placenta Increta:
invades further into myometrium
81
Placenta Percreta
completely through myometrium, into serosa, and potentially outside of uterus, with invasion into surrounding structures (e.g. bladder, colon).
82
S/S of uterine rupture:
-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
Generalized information of Epidural blood patch and how it works:
-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
Know a historical fact that influences our current practice in OB anesthesia
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
Placenta Previa: pic
most dangerous = complete!
86
ABG: pCO2
pCO2: 49 +/- 8.4
87
ABG: pO2
pO2: 18 +/- 6.2
88
ABG: HCO3-
HCO3: 22 +/- 2.5
89
ABG: base excess
Base Excess: -4 +/- 2
90
Suction losses =
blood in suction canister minus irrigation
91
Sponge losses, blood soaked: Raytex =
15 mL
92
Sponge losses, blood soaked: Lap =
80 mL

OB (Wolfe Summer 24") (3 decks)

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