Brainscape's Knowledge GenomeTM

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


See full index

Apex Flashcards > obstetrics > Flashcards

obstetrics Flashcards

1
Q

physiology of upper airway swelling in the parturient

A

increased progesterone, estrogen, and relaxin cause vascular engorgement and hyperemia. also larger ECF volume- all lead to upper aw swelling. this affects nasal passages, oropharynx, epiglottis, larynx, trachea

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

what size ett for parturient

A

6-7 ETT r/t narrowed glottic opening

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

what’s the name for a short handled laryngoscope

A

Datta handle

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

should you do an NPA in a parturient

A

no, try to avoid. all of her is engorged ok, including the nasal passages

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

aw edema is made worse by what?

A

pre eclampsia, tocolytics, prolonged trendelenburg

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

FRC in relation to closing capacity for parturient

A

FRC falls below closing capacity in parturient, leading to aw closure during tidal breathing

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

what would you expect the ABG of a parturient to look like

A

pH: no change
PaO2: increased to 104-108mmHg (d/t hyperventilation)
PaCO2 decreased to 28-32
HCO3- decreased to 20mmoL

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

P50 in a parturient shifts to

A

right or is increased, increased O2 to fetus this way
mom p50: 30mmHg
fetus P50: 19mmHg (left, decreased)

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

how much does O2 consumption increase during pregnancy

A

20%

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

changes in HR and SV for parturient

A

both increase, 15 and 30% respectively

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

percent increase in CO during labor stages

A

1st stage: 20%
2nd stage: 50%
3rd stage: 80%

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

SVR and PVR changes during pregnancy

A

decrease in SVR because progesterone produces NO which causes vasodilation and decrease in PVR in response to angiotensin and NE

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

overall effect of progesterone on parturient

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

cardiac axis deviation during pregnnacy

A

left axis deviation due to diaphragm being pushed cephalad so heard is pushed up and left

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

left displacement of uterus should be used during which trimesters

A

both second and third

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

clotting factors that increase in a parturient include

A

1, 7, 8, 9, 10, 12. (pregnancy causes hyper coagulable state- DVT is 6 times higher risk in parturients

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

anticoagulants that decrease during pregnancy include

A

antithrombin and protein s

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

fibrinolytic system in parturient

A

increase in fibrin breakdown but decrease in factors 11 and 13- mom makes more clot but also breaks it down faster

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

how much does PT/PTT decrease in a parturient

A

20%
PT: 9.6-12.9 seconds
PTT: 25-35 seconds

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

how does platelet count change in a parturient

A

remains unchanged or decreases up to 10% (due to hemodilution and consumption)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

do filling pressures (CVP and PAOP) change during pregnancy?

A

no

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

why does creatinine clearance increase in a parturient

A

r/t increased intravascular volume and CO- more creatinine delivered to the kidney per unit of time

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

what happens to creatinine and BUN in parturient

A

decreased

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

why does urine glucose increase in parturient

A

increased GFR and reduced reabsorption in peritubular capillaries

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

why are parturients sensitive to LA’s

A

increased progesterone

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

what is progesterone responsible for

A

lower esophageal sphincter tone
reduced MAC
reduced PaCO2 d/t increased MV
increased RAAS
decreased SVR and PVR

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

how much does MAC get reduced in a parturient

A

30-40%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

GI changes in a parturient:
gastric volume
gastric pH
LES sphincter tone
gastric emptying

A

gastric volume: increased r/t gastrin
gastric pH: decreased r/t gastrin
LES sphincter tone: decreased r/t increased progesterone and estrogen
gastric emptying: no change until labor begins (then decreased)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

how many mL/min is uterine BF in parturient at term

A

700-900mL/min (accounts for 10% of CO)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

what happens to serum albumin in parturients

A

decrease

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

what happens to pseudocholinesterase in parturients

A

decreases but not enough for an aggressive effect when administering drugs like succ.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

how does ICP change in a parturient

A

it doesnt

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

what is uterine blood flow dependent upon

A

MAP, uterine blood flow, and uterine vascular resistance, since it’s a low resistance system, its primarily dependent on MAP and CO

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

2 causes of reduced uterine BF include

A

decreased perfusion (maternal HoTN from sympathectomy, hemorrhage, or aortocaval compression)
increased resistance (uterine contraction, hypertensive conditions)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

which principal describes how drugs traverse placenta and what is the equation

A

ficks principle

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
36
Q

2 most important variables for a drug crossing to the placenta include

A

diffusion coefficient (drug characteristics) and concentration gradient between maternal and fetal circulation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
37
Q

drug characteristics that favor placental transfer include

A

LMW (<500 daltons)
high lipid solubility
non ionized
non polar

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
38
Q

drugs that have significant placental transfer include

A

LA’s (except chlorprocaine d/t rapid metabolism)
IV anesthetics
volatiles
opioids
benzos
atropine
BB’s
mag (not lipophilic but it is small)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
39
Q

drugs that do NOT have significant placental transfer include

A

glyco
heparin
insulin
NMB’s

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
40
Q

describe the 3 stages of labor

A

stage 1: beginning of regular contractions to full cervical dilation (10cm)
stage 2: full cervical dilation to delivery of the fetus (pain in perineum begins during this stage)
stage 3: delivery of placenta

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
41
Q

describe the friedman curve

A
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
42
Q

NPO guidelines for mom

A

can drink clears through labor and eat solids until block is placed

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
43
Q

when does the latent phase of labor end?

A

when the cervix dilates to 2-3cm

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
44
Q

when does the active stage of labor occur?

A

during stage 1 when cervix is dilating from 3-10cm

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
45
Q

which nerve roots are affected by pain during the first stage of labor

A

T10-L1 posterior nerve roots

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
46
Q

which nerve roots are affected during the second stage of labor

A

S2-S4 (vagina, perineum, pelvic floor)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
47
Q

afferent pathway for uterus and cervix is
(and quality of pain)

A

visceral C fibers in hypogastric plexus
dull, diffuse, cramping pain

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
48
Q

regional technique for uterus and cervix is

A

neuraxial (epidural, spinal, CSE)
paravertebral lumbar sympathetic block
paracervical block (comes with high risk of fetal bradycardia)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
49
Q

afferent pathway for perineum is
(and quality of pain)

A

pudendal nerve
sharp, well localized

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
50
Q

regional techniques for perineum include

A

neuraxial
pudendal nerve block

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
51
Q

consequences of uncontrolled pain in parturient include

A

increased catecholamines- HTN and reduced uterine BF
hyperventilation and left shift of HGB dissociation curve- less O2 to fetus

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
52
Q

when doing CSE, do you put LA in intrathecal space

A

yes then you thread the wire

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
53
Q

describe the epidural expansion technique and why its performed

A

saline into epidural space immediately after LA is placed in intrathecal space. increases rostral spread of LA to achieve higher level via compression of subarachnoid space

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
54
Q

which LA reduces the efficacy of morphine and why?

A

2-chlorprocaine (antagonizes mu and kappa in sc)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
55
Q

bupivicaine key facts

A

racemic mixture
minimal tachyphylaxis
low placental transfer due to increased protein binding and increased ionization
greater sensory block relative to other LA’s
cardiac toxicity more common with R enantiomer
cardiac toxicity occurs before seizures
.75% contraindicated d/t risk during IV injection

56
Q

ropivicaine chemical makeup

A

S enantiomer or bupivicaine + substitution of propyl group

57
Q

when compared to bupivicaine, ropiv has decreased

A

risk of CV toxicity, potency, and motor block

58
Q

key facts of levobupiviaine

A

pure S enantiomer of bupiv
less CV toxicity compared to bupiv
not avail in US

59
Q

lidocaine key facts

A

not popular for labor analgesia due to strong motor block
risk of neuro toxicity if given in subarachnoid space

60
Q

2 chlorprocaine key facts

A

fast onset so useful in c/s
minimal placental transfer (metabolized via pseudocholinesterase)
antagonizes mu and kappa
risk of arachnoiditis when used for spinal anesthesia d/t preservatives
solutions without methylparaben and methyl sulfite do not cause neuro toxicity

61
Q

benefits of opioids in neuraxial block (when administered alone) include

A

no loss of sensation or proprioception
no sympathectomy (superior hemodynamic stability)
do not impair moms ability to push

62
Q

spinal bolus of bupivicaine
% for epidural bolus
% for continuous epidural infusion

A

1.5-2.5mg
.0625-.125%
.05-.215%

63
Q

spinal bolus of ropivicaine
% for epidural bolus
% for continuous epidural infusion

A

2-3.5mg
.08-.2%
.08-.2%

64
Q

spinal bolus of levobupivicaine
% for epidural bolus
% for continuous epidural infusion

A

2-3.5mg
.0625-.125%
.05-.125%

65
Q

spinal bolus of lidocaine
% for epidural bolus
% for continuous epidural infusion

A

no no no spinal boluses of lido
.75-1%
.5-1%

66
Q

spinal bolus of fentanyl
epidural bolus
continuous infusion rate

A

15-25mcg
50-100mcg
1.5-3mcg/mL

67
Q

spinal bolus of sufentanil
epidural bolus
continuous infusion rate

A

1.5-5mcg
5-10mcg
.2-.4mcg/mL

68
Q

spinal bolus of morphine
epidural bolus
continuous infusion rate

A

125-250mcg
NA
NA

69
Q

spinal bolus of meperidine
epidural bolus
continuous infusion rate

A

10-20mg
NA
NA

70
Q

spinal bolus of epi
epidural bolus
continuous infusion rate

A

2.25-200mcg
25-75mcg
25-50mcg/h

71
Q

spinal bolus of clonidine
epidural bolus
continuous infusion rate

A

15-30mcg
25-75mcg
25-50mcg/h

72
Q

spinal bolus of neostigmine
epidural bolus
continuous infusion rate

A

NA
500-750mcg
25-75mcg/h

73
Q

3 ways a patient can develop a total spinal

A
  1. epidural dose injected into subarachnoid space
  2. epidural dose injected into subdural space (neither catheter aspiration nor test dose will be able to rule this out. will see a high spinal in 20-25min)
  3. single shot spinal after failed epidural block (possible the LA from the failed epidural can go into intrathecal space)
74
Q

anesthetic management of total spinal

A

vasopressors, IVF, left uterine displacement, leg elevation

75
Q

fetal bradycardia and causes

A

<110
fetal: asphyxia, acidosis
maternal: hypoxemia, drugs that decrease ureteroplacental perfusion

76
Q

fetal tachycardia and causes

A

> 160
fetal: hypoxemia, arrhythmias
maternal: fever, choramnionitis, atropine, ephedrine, terbutaline

77
Q

FHR categorizations
minimal
moderate
marked
absent

A

minimal <5BPM
moderate 6-25BPM (normal, healthy SNS/PSNS)
marked >25BPM
absent

78
Q

things that reduce FHR variability

A

CNS depressants
hypoxemia
fetal sleep
acidosis
ancephaly
cardiac anomalies

79
Q

describe early decelerations and causes

A
80
Q

describe late decelerations and causes

A
81
Q

describe variable decelerations and causes

A
82
Q

VEAL CHOP pneumonic

A

variable decels: cord compression
early decels: head compression
accelerations: ok or give O2
late decels: placental insufficiency

83
Q

category 1 for FHR

A

normal acid base status with no threats to fetal O2
baseline HR 110-160
moderate variability
accelerations absent or present
early decels absent or present
no late or variable decels

84
Q

category 2 for FHR

A

cannot predict a normal acid base status
bradycardia without absence of baseline FHR variability
tachycardia
variable variability
absent or minimal acceleration with fetal stimulation
recurrent or variable decels

85
Q

category 3 for FHR

A

strongly suggests abnormal acid base status with significant threat to fetal O2
bradycardia
absent baseline variability
recurrent late decels
recurrent variable decels
sinusoidal pattern

86
Q

premature delivery is defined as

A

<37w or <259d from last menstrual cycle

87
Q

incidence of prematurity rises with

A

multiple gestations and PROM

88
Q

complications of premature delivery include (5)

A

respiratory distress syndrome
intraventricular hemorrhage
NEC
Hoglycemia
hyperbilirubinemia

89
Q

which steroid is given to increase fetal lung maturity in the setting of preterm labor

A

betamethasone, take effect in 18h and peak effect in 48h

90
Q

MOA of magnesium as it relates to parturient

A

relaxes smooth muscle by turning off myosin light chain kinase in smooth muscle including uterus. hyper polarizes membranes in excitable tissues

91
Q

first sign of magnesium toxicity

A

diminished DTR’s

92
Q

s/sx of hypomagnesemia <1.2mg/dL

A

tetany
seiures
dysrhythmias

93
Q

s/sx of hypomagnesemia 1.2-1.8mg/dL

A

neuromuscular irritability
hypokalemia

94
Q

s/sx of hypermagnesemia 2.5-5mg/dL

A

no s/sx typically

95
Q

s/sx of hypermagnesemia 5-7mg/dL

A

diminished DTR’s
lethargy/drowsiness
flushing
n/v

96
Q

s/sx of hypernagnesemia 7-12mg/dL

A

loss of DTR’s
HoTN
EKG changes
somnolence

97
Q

s/sx of hypermagnesemia >12mg/dL

A

respiratory depression- apnea
complete heart block
cardiac arrest
coma
paralysis
(p.edema can be an issue as mag increases as well)

98
Q

tx of hypermagnesemia

A

diuretics
IV calcium gluconate 1g over 10m
supportive measures

99
Q

endogenous oxytocin is released following stimulation of

A

cervix, vagina, breasts

100
Q

SE of oxytocin admin include

A

water retention (structurally similar to vasopressin), hyponatremia, hypotension, reflex tachycardia, and coronary vasoconstriction

101
Q

half life of oxytocin

A

4-17m

102
Q

methergine
drug class
dose
route of admin
metabolism
half life

A

uterotonic (second line)
.2mg IM
(IV can cause vasoconstriction, HTN, cerebral hemorrhage)
hepatic metabolism
half life 2h

103
Q

hemabate
drug class
dose
SE

A

third line uterotonic
250mcg IM
n/v, HTN, HoTN, diarrhea, bronchospasm

104
Q

when is a GA appropriate?

A

maternal hemorrhage
fetal distress
coagulopathy
patient refusal of regional
contraindication to regional

105
Q

triple prophylaxis for aspiration during GA includes

A

sodium citrate to neutralize gastric acid (15-30mL within 15-30min of induction)
H2 receptor antagonist (ranitidine) to reduce gastric acid secretion 1 hour before induction
gastrokinetic agent (metaclopromide) to hasten gastric emptying and increase LES tone- 1 hour before induction

106
Q

pre oxygenate mom for how long before induction?

A

3-5 min. just do as theyre prepping and draping her since you cant induce until that has been done anyway

107
Q

what to do for maintenance with these patients?

A

low concentration of volatile (.8 MAC) and 50% N2O

108
Q

what is normal amniotic fluid volume

A

~700mL

109
Q

after the first trimester, avoid this group of drugs

A

NSAIDS- they can close the ductus arteriosis!

110
Q

in an ideal world, surgery is delayed until how many weeks until after delivery

A

2-6w

111
Q

best trimester for surgery in a pregnant patient if you HAVE to

A

second trimester

112
Q

when is risk for teratogenicity highest

A

13-60 days

113
Q

when should you avoid N2O

A

first two trimesters. loosely linked to congenital disabilities

114
Q

at how many weeks is a parturient a full stomach

A

~18 weeks

115
Q

define chronic HTN in parturient

A

occurs before 20w gestation. does not return to normal after delivery

116
Q

define gestational HTN in parturient

A

develops after 20w gestation
does not create proteinuria
the only thing to do is if it goes back to normal after delivery you can dx it against chronic HTN

117
Q

define pre eclampsia in parturient

A

includes HTN (mild 140/90, severe 160/110) that develops after 20w gestation. proteinuria is typically present

118
Q

when can preeclampsia be present without proteinuria

A

persistent RUQ or epigastric pain
persistent CNS or visual sx
fetal growth restriction
thrombocytopenia
elevated serum liver enzymes

119
Q

define severe pre eclampsia in parturient

A

BP >160/110
includes seizures
plt count <100,000
HELLP syndrome
pulmonary edema
cyanosis, HA, visual impairment, epigastric pain

120
Q

the patient with pre eclampsia produces up to 7 times this hormone than normal

A

thromboxane (vasoconstriction, platelet aggregation, reduced placental BF)

121
Q

key complications of pre eclampsia include

A

HF, pulmonary edema, ICH, cerebral edema, DIC, proteinuria

122
Q

tx for acute HTN (BP >160/110)

A

labetalol 20mg followed by 40-80mg q10m up to 220mg
hydralazine 5mg IV up to 20mg
nifedipine 10mg PO q20min to a max dose of 50mg
nicardipine infusion starting at 5mg/h and titrated by 2.5mg/h q5m up to a max of 15mg/h

123
Q

pre eclamptic patients and sympathomimetics/methergine

A

exaggerated response

124
Q

anesthetic management for eclampsia

A

load 4g mag over 10 min
1-2mg/h infusion

125
Q

HELLP syndrome and overview

A

hemolysis, elevated liver enzymes, low platelet count
definitive tx is placental delivery
patients are at higher risk of DIC and intra abdominal bleeding
assess for thrombocytopenia before placing block

126
Q

OB risks of cocaine use include

A

spontaneous abortion
premature labor
placental abruption
low APGAR

127
Q

which BB to use if patient uses/is on coke

A

labetalol (try to avoid B1/B2 otherwise is SVR is high asf)

128
Q

compare and contrast placenta accreta, increta, precreta

A

accreta: attaches to surface of myometrium
increta: invades myometrium
precreta: extends beyond uterus

129
Q

define placenta previa

A

attaches to lower uterine segment
partially or completely covering cervical os
associated with painless vaginal bleeding
potential for hemorrhage
often requires c/s
risk factors: previous c/s, multiple births

130
Q

risk factors for placental abruption (partial or complete) includes

A

PIH
pre eclampsia
chronic HTN
cocaine use
smoking
excessive ETOH use

131
Q

s/sx placental abruption

A

maternal pain, vaginal hemorrhage, fetal hypoxia
risk of AFE leading to DIC
vaginal delivery possible if fetus is stable
(obtain large bore IV’s and prepare for c/s)

132
Q

MOST common cause of PPH

A

uterine atony

133
Q

risk of uterine atony increased by

A

multiparty
multiple gestations
polyhydraminos
prolonged oxytocin infusion before surgery

134
Q

describe the APGAAR score (5 categories)

A

normal: 8-10
moderate distress: 4-7
impending demise: 0-3

135
Q

RR/breathing for new born

A

RR 30-60BPM
breathing takes 30s, normal RR takes 90s

136
Q

immediately after delivery, what is neonatal SpO2? what does it rise to after 10 minutes?

A

60%
rises to 90% after 10m

137
Q

a mom is requiring a forceps delivery with a .125% bupiv epidural infusion already running. what is the best plan of action

A

bolus 3% chlorprocaine or a pudendal nerve block if there was no epidural

Apex Flashcards (71 decks)

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