Obstetric Patient Part 3

Question 1

Postpartum hemorrhage is defined as EBL greater than

Answer 1

500 mL for vaginal delivery

1000 mL for C-section

Question 2

PPH is the result of

Answer 2

uterine atony (80%)
uterine abnormalities
placental retention 
lacerations
uterine inversion
coagulation abnormalities

Question 3

Uterine atony is associated with

Answer 3

multiparity
prolonged oxytocin infusion
polyhydramnios
multiple gestation

Question 4

PPH treatment includes

Answer 4

uterotonics
surgical intervention
intrauterine balloon

Question 5

Uterotonics are used to treat PPH because

Answer 5

they stimulate uterine contractions

Question 6

Uterotonics used to treat PPH include

Answer 6

oxytocin
methergine- 0.2 mg IM
prostaglandins (hemabate, carboprost)- 250 mcg IM or into uterus
Misoprostal- 800-1000 mcg

Question 7

Additional postpartum hemorrhage treatments may include

Answer 7

antifibrinolytics- TXA
massive transfusion protocol- cell salvage
surgical intervention- retained placenta, nitroglycerin, hysterectomy
intrauterine balloon- tamponade

Question 8

Preeclampsia occurs in _____ % of pregnancies

Answer 8

5-7%

incidence increased >25% in past 20 years

Question 9

Preeclampsia is characterized by

Answer 9

systolic HTN >140 mmHg (after 20 weeks gestation)
diastolic HTN >90 mmHg (after 20 weeks gestation)
proteinuria
platelet count <100,000
impaired liver function and/or severe RUQ pain
renal insufficiency
pulmonary edema
cerebral or visual disturbances

Question 10

Etiology of preeclampsia is

Answer 10

not well understood- failure of normal angiogenesis resulting in decreased placental perfusion

Question 11

Preeclampsia results in

Answer 11

increased vascular tone & sensitivity to catecholamines
pronounced upper airway edema during labor
CNS effects- HA, hyperexcitability & hyperreflexia
thrombocytopenia
hepatocellular necrosis

Question 12

Management of preeclampsia is directed at

Answer 12

avoiding uteroplacental hypoperfusion

Question 13

Management of preeclampsia includes

Answer 13

magnesium sulfate

hypertension management- decrease intracranial hemorrhage myocardial ischemia

Question 14

Magnesium sulfate is used to treat preeclampsia as it works to

Answer 14

reduce incidence of seizures
tocolytic
venous dilation
reduction in uterine activity

Question 15

The only way to end disease process of preeclampsia is

Answer 15

delivery

-regional preferred to general anesthesia

Question 16

______ is a complication of preeclampsia

Answer 16

HELLP

Question 17

HELLP results in

Answer 17

hemolysis
elevated liver enzymes
low platelet count

Question 18

HELLP is associated with

Answer 18

progressive and sudden deterioration in maternal & fetal condition

Question 19

Signs of HELLP include

Answer 19

hypertension
proteinuria
N/V

Question 20

Obesity leads to an increased risk for

Answer 20

hypertension
diabetes
complicated labor- fetal macrosomia, failed induction/progression, difficult or failed neuraxial techniques, prolonged procedures, infectious complications

Question 21

Abnormal placental implantation includes

Answer 21

placenta previa
placenta accreta
placenta abruption

Question 22

Placenta previa occurs when the placenta

Answer 22

implants on lower uterine segment and covers opening to the cervix

Question 23

S/S of placenta previa includes

Answer 23

painless vaginal bleeding
-hemodynamically significant blood loss
-increases risk in postpartum bleeding
Cesarean section indicated

Question 24

Placenta accreta is when the placenta

Answer 24

implants into the myometrium (normally implants into endometrium)

Question 25

Placenta increta describes growth

Answer 25

through the myometrium and into surrounding organs

Question 26

Placenta accreta is associated with

Answer 26

massive hemorrhage
-uterine artery embolization
Cesarean hysterectomy

Question 27

Placenta abruption is the

Answer 27

separation of placenta form the uterus during delivery

Question 28

Placenta abruption occurs more frequently in women with

Answer 28

hypertension & preeclampsia

Question 29

Signs of placenta abruption include

Answer 29

hemorrhage
uterine irritability
abdominal pain
fetal hypoperfusion & distress

Question 30

Open venous sinuses allows amniotic fluid to enter circulation in placenta abruption resulting in

Answer 30

increased incidence of DIC

Question 31

An amniotic fluid embolus is a

Answer 31

rare event that can occur during

• labor, vaginal delivery, or C section
• occasionally associated with placenta abruption

Question 32

Signs of amniotic fluid embolus include

Answer 32

anxiety, dyspnea, hypoxia, hypotension, cardiovascular collapse & coagulopathy

Question 33

Treatment of amniotic fluid embolus is

Answer 33

supportive

Question 34

Prematurity is considered to be

Answer 34

L&D before 37 weeks gestation

• significant cause of morbidity
• 50% of all perinatal deaths

Question 35

_____ gestation accounts for 70% of all premature births

Answer 35

34-36 weeks

Question 36

Birth weight below ______ is associated with long-term complications

Answer 36

1500 g

Question 37

Complications of low birth weight includes

Answer 37

respiratory distress syndrome
intracranial hemorrhage
hyperbilirubinemia

Question 38

1-2% of pregnant women will require

Answer 38

surgery for non-obstetric cases

Question 39

Surgery is avoided in _______ when possible

Answer 39

first trimester due to teratogenicity

Question 40

Anesthetic management considerations of the parturient for nonobstetric cases includes

Answer 40

alterations in maternal physiology
maintenance of uterine perfusion
prevention of premature labor
maternal/fetal mediation considerations

Question 41

Describe apgar scoring system.

Answer 41

8-10 normal
4-7 moderate distress or impairment
0-3 need for immediate resuscitation

Question 42

______ often results in spontaneous respiration

Answer 42

tactile stimulation

Question 43

15% of newborns require

Answer 43

resuscitation

-vast majority require assisted ventilation only