OB Notes (Jay) Flashcards
What is the classic triad in assessing amniotic fluid embolism?
- Acute hypoxemia
- Severe hypotension
- Coagulopathy
Other symptoms:
- Pulmonary edema
- Cyanosis
- CV arrest
- DIC
- Fetal distress
- Seizures
What does amniotic fluid contain? (3)
- Prostaglandins
- Leukotrienes
- Fetal debris
What is the treatment for parturient suffering amniotic fluid embolism? (3)
- Supportive with aggressive cardiopulmonary resuscitation
- CPR (not effective before delivery of fetus)
- Immediate cesarean
What is the critical period of organogenesis?
2-8 weeks
When should elective surgeries be deferred until?
Should be deferred until after delivery
If surgery is necessary wait until 2nd or 3rd trimester.
What drugs are OK during the first trimester? (3)
- Tylenol
- Benadryl
- Phenergan
What is cerclage?
It is the reinforcement of the cervix to prevent premature cervical dilation in a patient with an incompetent cervix.
Painless dilation of the cervix occurs in the midtrimester of preggnancy. The membranes bulge through the cervix and rupture, followed by delivery of severely premature infant.
What is the spinal level blockade goal in a regional block in a cerclage?
T8–belly button
When may an LMA be safely used for a cerclage?
<15-18 weeks
Greater than 18 weeks, an ETT with RSI must be used.
What is a category A drug defined as?
Adequate and well-controlled human studies have failed to demonstrate a risk to the fetus in the first trimester of pregnancy (and there is no evidence of risk in later trimesters.)
What is a category B drug defined as?
Animal reproduction studies have failed to demonstrate risk to the fetus and there are no adequate and well-controlled human studies in pregnant women
What is a category C drug defined as?
Animal reproduction studies HAVE sown an adverse effect on the fetus and there are no adequate studies in humans, but potential benefits may warrant use of the drug in pregnant women despite potential risks.
What is a category D drug defined as?
**There is positive evidence of human fetal risk. **
Potential benefits may warrant use of the drug in pregnant women despite potential risks.
What is a category X drug defined as?
Studies in humans or animals HAVE demonstrated fetal abnormailities and there is positive evidence of human fetal risk based on adverse reaction data.
Risks involved in use of the drug in pregnant women CLEARLY outweigh potential benefits.
What drugs start with an “A” and should be avoided during the first trimester of pregnancy? (5)
ACE inhibitors
Alcohol
Androgens
Anti-thyroid drugs
Aspirin
What drugs should be avoided during the first trimester of pregnancy? (6)
TAP CAP
Thalidomide
Androgens
Progestins
Corticosteroids
Aspirin
Indomethacin
Phentoin (aka Dilantin for seizures)
Is valproic acid safe during pregnancy?
No
Is tetracycline safe during pregnancy?
No
What drugs are safe during pregnancy? (11 types)
Allergy
Constipation
Cold and flu
Diarrhea
First aid ointment
Headache (Tylenol)
Heartburn
hemorrhoids
N&V
Rashes
Yeast infestion
What does hyperventilation do to placental blood flow?
Maternal hyperventilation causes respiratory alkalosis and hypocapnia causing maternal cerebral and placental vasoconstriction.
The oxyhemoglobin curve is shifted to the left which increases the affinity of maternal hemoglobin for oxygen and reduces amound of oxygen available for transfer of the fetus.
What is average end-tidal CO2 in third trimester?
32-36 mmHg
Note: Normal is 35-45 mmHg.
What is the plan for GA c-section? (8)
- Administer non-particulate antacid. Also consider giving Reglan or an H2 blocker for high-risk patients
- Perform left uterine displacement
- Denitrogenate with high flow O2 for 3-5 minutes
- Perform RSI
- Use 50% nitrous
- After delivery, increase nitrous to 70% or reduce the volatile to decrease vasodilation?
- Insert OG tube before completion of surgery
- Reverse NMB and extubate awake
What is placenta previa?
What problems can arise?
It is an abnormally low implantation of the placenta in the uterus.
Hemorrhhage often occurs near the end of the second trimester or beginning of third trimester.
What is the anesthetic plan for placenta previa? (2)
Persistent bleeding, active labor, and/or fetal maturity all lead to C-SECTION
If fetus is immature, and bleeding is slowed or stopped, management may be expectant with:
bed rest
avoidance of sex or vaginal exams
steroids for lung maturation
tocolysis with magnesium
