Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

High Yield Facts for the Final FRCA > Obstetric Anaesthesia > Flashcards

Obstetric Anaesthesia Flashcards

1
Q

Immediately after giving a test dose for a labour epidural in a healthy multiparous parturient, you notice she has difficulty breathing and a reduced GCS. What is the most appropriate immediate management?

  1. Left lateral tilt and 6mg bolus of ephedrine
  2. Intralipid
  3. Removal of epidural catheter
  4. Immediate rapid sequence induction and caesarean section
  5. Immediate rapid sequence induction and monitor patient
A
  1. Immediate rapid sequence induction and monitor patient

This lady has signs of a total spinal and so needs ventilatory support.

While the CTG is normal, she can be monitored and caesarean section delayed, but this needs to be a senior clinician decision.

Intralipid is indicated only if displaying signs of toxicity.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What are your anaesthetic concerns regarding a patient with anterior placenta praevia undergoing caesarean section?

A

High risk of significant blood loss

  • Arterial line for blood pressure monitoring
  • Wide bore IV access
  • Cross match blood and consent for transfusion
  • Rapid infusor ready
  • Regional anaesthesia associated with reduced blood loss
  • Consent for rapid conversion to general anaesthesia in case of major haemorrhage
  • Consider cell salvage
  • Tranexamic acid
  • Senior anaesthetic input required
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What are the forms of abnormal placental adherence?

A

Most common: Placenta accreta

  • Placenta is adherent to the uterine wall

Intermediate: Placenta Increta

  • Placenta invading into but not through through uterine wall

Least common: Placent Percreta

  • Placenta invading through the uterine wall
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What are the types of placenta praevia?

A
  • Grade 1 - No contact with internal cervical os
    - 10% of patients with a low-lying placenta at 20 weeks will have placenta previa at term
  • Grade 2 - Contact with margin of internal cervical os
  • Grade 3 - Partial coverage of internal os
  • Grade 4 - Completely obstructs cervical os
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What are the common risk factors for developing placenta praevia?

A
  • Low lying placenta
    • Multiparous
    • Geriatric pregnancy (Age over 40 years)
    • Smoking
    • Previous placenta praevia
    • Previous termination of pregnancy or caesarean section
    • Endometrial pathology:
      • Scarring
      • Endometritis
      • Previous manual removal of placenta
      • Known fibroid
    • Assisted conception
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What normal cardiovascular changes are seen during pregnancy?

A
  • Cardiac output increases by 30-50%
  • Systemic vascular resistance falls by 30%
  • Systolic blood pressure falls by 10mmHg
  • CVP remains the same because venodilation is compensated for by increased blood volume
  • Physiological multivalvular regurgitation due to chamber enlargement and physiological volume overload
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What is the most common cause of maternal death during pregnancy?

A

The MBRRACE-UK: Saving lives, improving mothers’ care report in 2020 found that cardiac disease is the leading cause of maternal death during pregnancy and in the first six weeks after delivery

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What is the incidence of venous air embolism during caesarean section?

A

25% (using doppler ultrasound and echocardiography)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What proportion of ASA1 women undergoing caesarean section demonstrate ischaemic ECG changes?

A

Approximately 35%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What criteria must be met for a diagnosis of post-partum cardiomyopathy?

A

New onset left ventricular failure between the last month of pregnancy and five months post partum

Absence of another identifiable cause of cardiomyopathy

Ejection fraction of less than 45%

Post partum cardiomyopathy is very similar to dilated cardiomyopathy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What ECG signs might you expect to see in a normal, uncomplicated pregnancy?

A

Left axis deviation
Sinus tachycardia
T wave inversion
Q waves
Atrial and ventricular ectopics

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What are the risk factors for post-partum cardiomyopathy?

A

Pre-existing hypertension
Obesity
Multiple pregnancy
Multiparous
Maternal age over thirty years old
Afro-Carribean ethnicity
Cocaine abuse

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What are the anaesthetic implications of combined-spinal-epidural anaesthesia in an obstetric patient with cardiomyopathy?

A

Avoid tachycardia
Avoid hypotension
Avoid fluid overload
Maintain preload
Avoid aortocaval compression with left lateral tilt
Invasive arterial monitoring
Maintain sinus rhythm

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What are the complications of combined spinal-epidural anaesthesia?

A

Failure of spinal
Failure of epidural
Misplacement or migration of epidural catheter
Damage to spinal needle or catheter
Subarachnoid spread of drug
Neurological damage
- Paraesthesia
- Subdural haematoma
- Cauda equina syndrome
- Aseptic meningitis
Post-dural puncture headache
Infection
- Bacterial meningitis
- Abscess (epidural, subdural)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What are the disadvantages of uterotonic drugs for a patient with cardiomyopathy?

A

Oxytocin
- decreased SVR
- tachycardia
- coronary vasoconstriction

Ergometrine
- vasoconstriction, including coronary, pulmonary and systemic

Avoid ergometrine in patients with cardiomyopathy, and give oxytocin slowly

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

In which obstetric conditions is disseminated intravascular coagulation most commonly seen?

A

Placenta praevia
Placental abruption
Amniotic fluid embolism
Eclampsia

17
Q

Can you give oxytocin to a woman with congenital heart disease?

A

It depends on the condition

Ideally not, but also yes, if you give a small amount slowly or omit the bolus dose altogether

You have to weight up the effects of oxytocin* against the alternative treatments for haemorrhage, which usually involve giving lots of fluid or blood, with wobbly blood pressure

*Oxytocin decreases systemic vascular resistance, resulting in a tachycardia, and also causes fluid retention, because it’s incredibly similar to ADH in its structure

18
Q

Which drugs can safely be given to a pregnant woman with heart failure?

A

Diuretics
Digoxin
Hydralazine
Nitrates

19
Q

How should anticoagulation in the peripartum period be managed for women with mechanical heart valves?

A

Unfractionated heparin should be stopped 4–6 hours before planned delivery
It should then be restarted 4–6 hours after delivery if there are no bleeding complications

There remains significant debate about how best to manage the bleeding vs thrombosis risk seen in pregnant women, but this is the current advice specific to delivery or caesarean section.

20
Q

Which patients are at high risk of aortic aneurysm and dissection?

A

Marfan syndrome
Turner syndrome
Loeys–Dietz syndrome
Ehlers–Danlos type 4
Bicuspid aortic valve with aortic dilatation
Previous complex aortic surgery such as coarctation repair

21
Q

When considering parturients with congenital heart defects, what is the definition of pulmonary artery hypertension?

A

Mean pulmonary artery pressure of more than 25mmHg

22
Q

What are your main priorities in a parturient with congenital cardiac disease?

A

Early identification
Risk assessment
Optimisation
Regular monitoring for deterioration
MDT planning of delivery,
Close monitoring for deterioration in the post-partum period

23
Q

How is severity of pulmonary stenosis classfied?

A

Peak velocity (m/s)

Mild = <3
Moderate = 3-4
Severe = >4

Pressure gradient (mmHg)

Mild = <36
Moderate = 36-64
Severe = >64

It’s a good idea to check there isn’t significant tricuspid regurgitation to ensure your pulmonary pressure values aren’t overestimated

24
Q

What are the maternal complications of antepartum haemorrhage?

A

Coagulopathy
Infection
Anaemia
Shock
Renal tubular necrosis
Post partum haemorrhage
Prolonged hospital stay
Psychological sequelae
Sheehan’s syndrome
Complications of transfusion
Death

25
Q

What are the causes of bleeding before 24 weeks?

A

Ectopic pregnancy
Incomplete miscarriage
Septic miscarriage

26
Q

What preoperative interventions can be used to prevent blood loss during surgery?

A

Intravenous iron therapy
EPO injection
Preoperative blood transfusion - either of their own blood collected previously or donor blood*
*Of course this depends on whether the patient would be amenable to transfusion at all.

27
Q

What intra-operative interventions can be used to prevent blood loss during surgery?

A

Cell salvage
Use of other blood products such as cryopreciptitate (depending on what the patient will accept)
Tranexamic acid injection and infusion

28
Q

What are the risk factors for placental abruption?

A

Hypertension or pre-eclampsia
Cocaine use
Smoking
Amphetamine use
Previous uterine surgery
Previous placental abruption
Multiple pregnancy
Multiparous
Maternal age >35 or <25
Trauma
Thrombophilia

29
Q

What are the obstetric causes of DIC?

A

Haemorrhage
Chorioamnionitis
Pre-eclampsia
Intrauterine death
Amniotic fluid embolism
Acute fatty liver

30
Q

What surgical interventions may be employed in major obstetric haemorrhage?

A

Examination under anaesthesia
Reduction of uterine inversion
Repair of trauma to genital tract
Intrauterine balloon tamponade
Haemostatic compression sutures
Uterine artery ligation
Emergency hysterectomy

31
Q
A

High Yield Facts for the Final FRCA (22 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions