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Anesthesia > OB Specialty Exam > Flashcards

OB Specialty Exam Flashcards

1
Q

What is uterine blood flow a term pregnancy?

A

700-800 ml/min

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2
Q

When is the fetus most susceptible to teratogenic effects?

A

3-8 weeks

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3
Q

How should you treat respiratory depression in an infant born to a heroin addict?

A

Controlled ventilation

NOT naloxone - don’t want withdrawal

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4
Q

What is the dose of naloxone for a non-addicted newborn?

A

0.1 mg/kg

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5
Q

When do amniotic fluid embolisms occur?

A

During labor, delivery, c-section or postpartum

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6
Q

Symptoms of amniotic fluid embolism

A

Tachypnea, respiratory distress, cyanosis, shock, generalized bleeding (DIC), CV collapse, seizure, pulmonary edema, coma, decreased BP

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7
Q

What are 3 major pathophysiological manifestations of AFE?

A

Acute pulmonary embolism
DIC
Uterine atony

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8
Q

What 4 clinical features are you likely to see in an AFE?

A

Dyspnea
Hypoxemia
CV collapse
Coma

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9
Q

Why is morphine not routinely used for labor epidurals?

A

Long onset time (30-60 minutes)

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10
Q

Why are high doses of epidural morphine not used?

A

Increased risk of delayed respiratory depression

Analgesia only effective for first stage of labor

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11
Q

What is placenta previa?

A

The placenta covers the opening to the cervix

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12
Q

When does onset of hemorrhage usually begin with placenta previa?

A

Near end of 2nd trimester or beginning of 3rd

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13
Q

What is the incidence of placenta previa?

A

1 in 200 pregnancies

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14
Q

What is the major symptom of placenta previa?

A

Painless vaginal bleeding

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15
Q

How is placenta previa diagnosed?

A

Ultrasound

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16
Q

What is the appropriate anesthetic plan for a primipara with placenta previa, active bleeding, and active labor?

A

C section + GETA

consider intubating with ketamine 0.5-1.0 mg/kg for hemodynamic stability

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17
Q

What kind of regional anesthesia is inefficient at covering 2nd stage labor pain?

A

Pudendal block

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18
Q

What events occur in 1st stage labor? 2nd? 3rd?

A

1st - dilation of cervix
2nd- delivery of baby
3rd-delivery of placenta

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19
Q

What causes first stage labor pain?

A

Visceral pain from uterine contractions and cervical dilation

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20
Q

Sensory dermatomes for labor pain (stages 1-3)?

A

1- T10-L1
2- T10-S4
3- T10-S4

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21
Q

What causes second stage labor pain?

A

Stretching and compression of pelvic and perineal structures

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22
Q

What sensory level is needed for a c-section?

A

T4

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23
Q

What level is needed for a tubal ligation?

A

T4-5

Down to T10 can be adequate unless it doesn’t cover traction on viscera

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24
Q

What is a normal fetal scalp PaCO2?

A

40-50 mmHg (same as mom)

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25
Q

What is a normal fetal scalp pH?

A

7.25-7.35

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26
Q

What is a normal fetal scalp SO2?

A

30-50%

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27
Q

What is a normal fetal scalp PO2?

A

18-22 mmHg

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28
Q

What is the most common direct cause of pregnancy related deaths?

A

Hypertensive disorders of pregnancy

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29
Q

What are the most common morbidities encountered in obstetrics?

A

Severe hemorrhage and severe preeclampsia

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30
Q

What are the categories scored for APGAR?

A 
A- activity (muscle tone)
P- pulse
G- grimace
A- appearance (skin color)
R- respirations
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31
Q

What APGAR scores are considered normal?

A

7-10

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32
Q

What is average expected blood loss for a vaginal birth?

A

600 mL

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33
Q

What is average expected blood loss for a c-section?

A

1000 mL

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34
Q

What procedures generally require general anesthesia?

A

Bimanual massage of the uterus, manual extraction of retained placenta, reversion of inverted uterus, repair of a major laceration

T6 level

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35
Q

What three drugs are commonly used to treat uterine atony?

A

Pitocin 20-30 Units/L
Methergine 0.2 mg IM
Hemabate (carboprost) 0.25 mg IM

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36
Q

Which muscle relaxants are safe to give to pregnant women?

A

Sux - undetectable in baby

Most are fine (highly ionized)
Atracurium and vecuronium are next best

37
Q

Do inhalational agents cross the placenta?

A

Yes - a lot. However, little fetal depression occurs when <1 MAC and delivery occurs within 10 minutes

38
Q

Do induction agents cross the placenta?

A

Yes! Thiopental, ketamine, propofol, benzos.

Usual induction doses not very detrimental/little fetal effects

39
Q

Do opiates cross the placenta?

A

Definitely! Can cause fetal respiratory depression. Morphine does this more than fentanyl. Don’t give to mom until baby is out.

Demerol - bad!! Toxic metabolite not cleared by baby - seizures

40
Q

Do local anesthetics cross the placenta?

A

Yes, to some degree. Some ion trapping if fetus is acidotic. Esp. with lidocaine.
Highly protein bound LAs (bupivacaine, Ropivacaine) don’t cross much.

41
Q

Which anticholinergics cross the placenta?

A

Atropine, scopolamine

Glycopyrrolate - NO!

42
Q

Which first line vasopressor is recommended for pregnant women?

A

Phenylephrine

43
Q

How is pregnancy induced hypertension defined?

A

Systolic >140 or diastolic >90.

Or

Increase sbp by 30 or dbp by 15 above patient’s baseline

44
Q

What is the classic triad of symptoms in pre-eclampsia?

A

Proteinuria, HTN, edema

45
Q

When does pre-eclampsia typically occur? When does it resolve?

A

Occurs after 20 weeks, resolves 48 hours after delivery

46
Q

What EKG changes are seen with excessive magnesium administration?

A

Widened QRS

Also - PQ interval prolongation, SA and AV block, cardiac arrest

47
Q

What is used to treat magnesium toxicity?

A

Calcium

48
Q

What percentage of pregnancies are affected by preeclampsia?

A

7%

49
Q

What is the therapeutic range for MgSO4?

A

4-8 mEq/L

50
Q

Which of the following anti HTN drugs used to treat severe PIH is not capable of causing increased postpartum hemorrhage?
Nitroprusside, nifedipine, NTG, labetalol, diazoxide

A

Labetalol

51
Q

What does HELLP stand for?

A

Hemolysis
Elevated Liver enzymes
Low Platelets

52
Q

What does VBAC stand for?

A

Vaginal birth after c-section

53
Q

What is a normal maternal PaCO2 in the third trimester?

A

27-32 mmHg

54
Q

What is the most common cause of breech presentation?

A

Prematurity

55
Q

What percent of maternal peripartum deaths are attributable to anesthesia?

A

2-3%

56
Q

What is a normal fetal heart rate?

A

120-160 bpm

57
Q

What is a normal fetal heart rate variability?

A

5-10 bpm

58
Q

What is the incidence of gestational diabetes?

A

2-3%

59
Q

What are two indications for magnesium in pregnant patients?

A

Anticonvulsant for preeclampsia

Tocolytic agent (prevent preterm delivery)

60
Q

What is the therapeutic blood level for magnesium?

A

4-8mEq/L

61
Q

What are the side effects of magnesium?

A

Sedation, respiratory paralysis, increased sensitivity to nondepolarizng NMBD, antagonism of alpha adrenergic agonists, antagonism of NMDA receptors

62
Q

Are early decelerations in fetal HR a problem? What causes them?

A

No. Caused by head compression -> Vagal response (NOT hypoxia)

63
Q

Are late decelerations in fetal HR a problem? What causes them?

A

Yes!

Caused by uteroplacental insufficiency -> hypoxia -> central chemoreceptors -> Vagal discharge

64
Q

What is a normal oxyhemoglobin p50 for a healthy person?
A pregnant woman?
A fetus?

A
  • 27 mmHg normal
  • 30 mom
  • 19 baby
65
Q

What causes a rightward shift in the oxyhemoglobin dissociation curve?

A

Increase in

  • CO2
  • H+ ions
  • 2,3 DPG
  • elevation
  • temperature
66
Q

What is an appropriate volume of hyperbaric bupivacaine (0.75%) for a spinal for c-section? How long will it last?

A

1.6-1.8 mL (12-13.5 mg)

Lasts 120-180 minutes

67
Q

What is an appropriate volume of local anesthetic solution for an epidural for c-section?

A

15-25 mL

68
Q

What are 3 commonly used LAs for use in epidurals for c-section?

A

3% chloroprocaine
2% lidocaine + epi 1:200,000
0.5% bupivacaine or Ropivacaine

69
Q

Name 4 side effects of intrathecal opioids

A
  • pruritus
  • nausea/vomiting
  • sedation
  • respiratory depression
70
Q

FDA drug classification for use during pregnancy:

Controlled studies show no risk.

A

Category A

71
Q

FDA drug classification for use during pregnancy:

No evidence of risk in humans. Either animal findings show risk but human findings do not; or no adequate human studies have been done, animal findings are negative

A

Category B

72
Q

FDA drug classification for use during pregnancy:

Risk cannot be ruled out. Human studies are lacking, potential benefits may justify potential risk

A

Category C

73
Q

FDA drug classification for use during pregnancy:

Positive evidence of risk. Investigational or post-marketing data show risk to the fetus. Potential benefits may outweigh the potential risk.

A

Category D

warfarin, valproic acid, lithium

74
Q

FDA drug classification for use during pregnancy:

Contraindicated in pregnancy. Studies in animals or humans have shown fetal risks which clearly outweigh any possible benefits to the patient

A

Category X

thalidomide

75
Q

How does Rh- incompatibility occur?

A

When the woman is Rh negative and the baby inherits Rh positive blood from the father

76
Q

When does maternal sensitization to Rh positive blood occur?

A

Very late in pregnancy or during childbirth. (mixing of baby’s and mom’s blood)

Also: miscarriage, induced abortion, or ectopic pregnancy, or amniocentesis

77
Q

What is Rh iso-immunization?

A

Development of antibodies against Rh positive proteins following a blood transfusion

78
Q

Is Rh incompatibility bad for mom, baby, or both?

A

Baby.

79
Q

What are 3 major symptoms of Rh incompatibility in the newborn?

A

1) anemia
2) swelling of the body (associated with heart failure and respiratory problems)
3) kernicterus (neurologic syndrome)

80
Q

How is Rh incompatibility prevented?

A

Immune globulin injection (RhoGam) at week 28 of pregnancy

81
Q

How are newborns treated for Rh incompatibility?

A

If mild: aggressive hydration, phototherapy

If swelling present: amniocentesis, intrauterine fetal transfusion, early induction of labor, treatment for congestive failure and fluid retention

If kernicterus: exchange transfusion, phototherapy

82
Q

Under what weight is considered low birth weight?

A

Under 2500 grams (5.5 lbs)

83
Q

What is the extra risk with bupivacaine in regional anesthesia?

A

High potential for local anesthetic toxicity if injected IV. Difficult resuscitation due to high protein binding and lipid solubility

84
Q

Which opioid produces the worse fetal respiratory depression?

A

Morphine

85
Q

Before what week is birth defined as preterm?

A

37 weeks

86
Q

What kind of labor pain is covered by a pudedal block?

A

2nd stage labor pain

87
Q

Wha are 3 complications of a pudendal nerve block?

A

1) hit the fetus with a needle
2) IV injection
3) retro peritoneal hematoma

88
Q

What are the top 6 risk factors for maternal morbidity?

A

1) advanced maternal age (>34)
2) non-white ethnic group
3) multiple pregnancies
4) history of HTN
5) previous postpartum hemorrhage
6) emergency C-section

Anesthesia (5 decks)

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