OB I Flashcards
What makes a pregnancy high risk?
- Hypertensive disorders
- antepartum hemorrhage
- diabetes, cardiac, renal, thyroid, neurologic disease, asthma, obesity, drug abuse
- advanced maternal age
- prematurity
- multiple gestation
- fetal malpresentation, placental abruption, compression of umbilical cord, intrauterine infections
What is the maternal mortality rate?
most frequent causes?
What are the anesthesia related complications?
- Maternal mortality in US is 7.5 per 100,000 live births
- pregnancy-induced HTN
- hemorrhage
- PE
- Anesthesia related complications- accounted for 5.2% of maternal deaths
- airway problems/aspiration
- LA toxicity or high block
How is hypertension defined in pregnancy?
What can it cause?
- 7-10% of all pregnancies are complicated by HTN
- mild HTN >140/90 or a rise in SBP of 30 mmHg above baseline or rise in DBP of 15 over baseline
- Severe HTN >160/110
- HTN can cause:
- abruptio placentae
- DIC
- hepatic failure
- cerebral hemorrhage
- others on separate card
What are the complications caused by hypertension during pregnancy?
Neurological
pulmonary
CV
- Neurological
- HA
- visual disturbances
- hyperexcitability
- sz
- intracranial hemorrhage
- cerebral edema
- Pulmonary
- upper airway edema
- pulmonary edema
- CV
- decreased intravascular volume
- increased arteriolar resistance
- heart failure
What are the complications caused by hypertension during pregnancy?
Hepatic
Renal
Hematological
- Hepatic
- impaired function
- elevated enzymes
- hematoma
- rupture
- Renal
- proteinuria
- Na retention
- decreased GFR
- renal failure
- Hematological
- coagulopathy
- thrombocytopenia
- platelet dysfunction
- prolonged PPT?
- DIC
- coagulopathy
How does maternal HTN during pregnancy affect the fetus?
Impaired uteroplacental perfusion
What conditions predispose a woman to pregnancy-induced hytension (PIH)?
- Primaparity
- maternal age >40
- african american race
- chronic HTN
- chronic renal disease
- Insulin-dependent diabetes
- history of preeclampsia (maternal- familial)
- Obesity
- multiple gestation
What is preeclampsia?
What can it cause?
When does it return to normal?
- Condition characterized by:
- vasoconstriction
- hypovolemia
- coagulation abnormalities
- poor organ perfusion
- Defines as new onset HTN that occurs after the 20th week gestation with proteinuria
- Can cause:
- cerebral bleeds
- pulmonary edema
- hepatic rupture
- HELLP syndrome
- Returns to normal within 3 months after delivery
How is preeclampsia categorized (mild vs severe)?
- Mild
- HTN:
- 140/90 or greater or
- increase of 30 mmHg above systolic or
- 15 above diastolic
- Proteinuria: >500 mg/day
- HTN:
- Severe
- HTN:
- 160/110 or greater
- Proteinuria:
- >5 g/day and/or
- oliguria (UOP < 500 ml/day)
- evidence of severe end-organ damage
- oliguria
- cerebral disturbances
- pulmonary edema
- epigastric pain or impaired liver fxn
- intrauterine growth retardation
- HTN:
What is Eclampsia?
When does it usually occur?
What are early manifestations?
Treatment?
- Preeclampsia (HTN, edema, and proteinuria) with seizures
- Life-threatening emergency
- most common in 3rd trimester
- Early CNS manifestations are HA and visual disturbances
- Treatment:
- Oxygen (ABC’s)
- LUD
- IV access
- Mag sulfate
- antihypertensives
- fluid balance
- coag studies
- fetal monitoring and resuscitation
How is preeclampsia treated?
- Mainstay of therapy is to control HTN, prevent seizures, and deliver fetus
- Treatment of maternal HTN (a-line)
- goal is DBP <110
- labetalol and hydralazine commonly used
- other options Nitroglycerine or nifedipine
- want to gradually decrease BP- may cause fetal distress to drop too quick
- Seizure prophylaxis with Magnesium sulfate
- Correct hypovolemia (hydration, foley)
- Correct coagulation abnormalities
- Correct acid/base and electrolyte abnormalities
- assure fetal viability
How does Magnesium sulfate work?
- drug of choice for hyperreflexia, prevention and control of sz related to preeclampsia and eclampsia
- Causes relaxation of vascular, bronchial and uterine smooth muscle
- decreases cerebral irritability and prevents/treats sz
- mildly sedates
- vasodilates (caution hypotension)
- decreases uterine tone
- potentiates the action of depolarizing and non depolarizing muscle relaxants
- croses placenta and causes neonatal hypotonia and respiratory depression
What is the Magnesium sulfate dose?
What are the maternal side effects?
How can you reverse Magnesium sulfate?
- Dose:
- bolus 4 g IV over 10 minutes
- maintenance: 1 6/hr IV infusion
- Maternal side effects:
- flushing
- HA
- dizziness
- skeletal muscle weakness
- deep tendon reflex depression
- respiratory depression
- pulmonary edema
- **monitor serum levels for toxicity
- Revers the effects of Mag sulfate by administering Calcium
- Calcium gluconate 1 gm or calcium chloride 300 mg
How does magnesium therapy affect the anesthetic management?
- It potentiates depolarizing and non-depolarizing neuromuscular blockers
- Never administer defisiculating dose of NMB
- Standardize dose of Sch to 1 mg/kg
- Administer 1/2 to 1/3 maintenance dose of non-depolarizers
- Dose by PNS
- Mag sulfate antagonizes vasoconstrictive effects of alpha agonists, so ephedrine and phenylephrine are less effective
What are the key points in managing the anesthetic for a preeclamptic or eclamptic patient?
- Assess sz control and neurologic status
- assess airway
- correct hypovolemia with colloid fluid bolus (250-500 ml)
- control BP (DBP <100)
- Consider A-line, CVP, SWAN
- continuous FHR monitoring
- oxygen to parturient
- Lab workup:
- CBC
- renal profile
- liver function tests
- Pt/PTT
- FDP- fibrin degredation products
- FSP- fibrin split products
- TEG
- platelet count
What are the different breech presentations?
A. Complete
B. Incomplete
C. Frank
What is this position?
Transverse Lie position
How is Occiput posterior position different from normal position?
Occiput anterior (normal presentation) pictured here
Occiput posterior
