Obstetric Anesthesia Part 1: Forkner Flashcards
What is important information to have about the pregnant patient? (4)
Gravida and parity
Gestational age
Cervical exam
Pt specific concerns such as prior cesarean, multiple gestation, placental abnormalities, preeclampsia, etc.
Who is the patient, baby or mom?
mom
Define gravida and parity.
Gravida = number of times pregnant
Parity = number of babies born
Parity (# # # #)
What does each # represent?
- full-term births
- pre-term births
- losses (spontaneous or otherwise)
- living children
When is gestational age, or, when full-term starts?
38 weeks from gestation
36-37 week babies do worse than 38-39 week babies. True or false
True
What information does the cervical exam include?
Dilation (from 0 - 10 cm)
Effacement: means thinning of the cervix
Station: means where the baby is relative to the cervix
Immediately after delivery CO increases as much as ____%.
80%
Left axis deviation on EKG at term because of displacement of diaphragm by uterus, which also increases the risk of ________.
arrhythmia
What is aortocaval compression also called?
supine hypotensive syndrome
Gravid uterus in supine women causes aortoiliac compression in ___-___% of women.
However it compresses the IVC in _____% of women.
15-20
100%
All women are affected by IVC compression.
What are the respiratory changes in a pregnant woman relating to:
minute ventilation
RR
tidal volume
lung volumes
FRC
increased MV
increased RR
increased TV
DECREASED lung volumes
decreased FRC
What is the most common cause of anesthesia-related mortality?
Loss of airway
Why is gastric emptying more difficult in the pregnant pt?
Upward displacement of the stomach promotes incompetence of the gastroesophageal sphincter.
Gastrin secreted by _____ makes stomach contents more acidic.
the placenta
What are the hematologic changes to:
Red blood cell mass
Hb
Hct
Platelet count
increases ~20%
normal
normal
platelets decrease
Pregnant women experience _____ coagulation and _______ anti-clotting activity.
increased
increased
Note: Pregnant women in a constant state of “chronic compensated disseminated intravascular coagulation” which can easily turn into uncompensated DIC.
Decrease in plasma cholinesterase, not enough to affect succinylcholine clearance significantly. True or false?
True
What is the leading cause of mortality worldwide?
What is the leading cause of death according the the CDC?
What is the leading cause of anesthesia-related maternal mortaility?
hemorrhage
cardiovascular disease
failure to secure the airway
Note: Maternal mortality is on the rise due to rising cesarean rate and more advanced maternal age/comorbidities.
What are other anesthesia-related maternal mortality causes besides failure in securing the a/w? (3)
Pulmonary aspiration of gastric contents
High spinal
Intravascular injection of LA leading to seizure/heart failure
What is the safest and most effective medical intervention for labor pain?
lumbar epidural
What are factors that tend to worsen labor pain? (3)
OP (occiput posterior) delivery, or, face up
Use of oxytocin
Use of forceps
Opioids cannot be given to the pregnant pt. True or false?
False, can be given but are higher risk for baby and mother and are not as effective as epidurals. However, can be best option when epidural is not possible.
Note: If baby gets opioid and cord gets cut, the baby gets the drug and cannot rid of it leading to respiratory depression.
Where does pain during Stage 1 of labor arise from?
uteral and cervical visceral pain which is dull, intense, and crampy pain
The uterus and cervix are innervated by spinal levels ___-____.
T10 - L1
Note: T10 is level of belly button.
Where does pain during stage 2 of labor arise from?
Somatic pain that is sharper, well-localized from the compression of perineal tissue as well as the uterus and cervix as baby passes the vagina.
The perineum is innervated at spinal levels ____ - ____.
sacral innervation at S2-S4
During stage 3 of labor, sudden, severe pain should cause concern for _____ ______.
uterine inversion, which rarely occurs
What is stage 4 of labor?
Puerperal period from after delivery of the placenta until return to non-pregnant physiology usually 2-6 weeks after delivery.
Puerperal: (py-ûrpr-l)