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Apex > Obstetrics > Flashcards

Obstetrics Flashcards

1
Q

Why do most parturients have mild respiratory alkalosis?

A

Progesterone increases Mv up to 50%

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2
Q

Airway edema in OB patients is made worse by:

A

Pre-Eclampsia
Tocolytics
Reverse T (duh)

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3
Q

FRC is reduced in pregnant women as a function of:

A

Decreased expiratory reserve

Decreased residual volume

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4
Q

How is closing volume impacted by pregnancy?

A

Increases above FRC, causing airway closure during tidal breathing

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5
Q

How does an ABG differ in a pregnant woman?

A

PaO2 increases
PaCO2 decreases
Bicarb decreases

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6
Q

In pregnancy the oxyhemoglobin dissociation curve shifts to the:

A

Right

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7
Q

How is closing capacity impacted by pregnancy?

A

Remains unchanged, because although the closing volume increases, the residual volume decreases

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8
Q

Respiratory rate increases by:

A

10%

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9
Q

Minute ventilation increases by:

A

50%

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10
Q

Why does minute ventilation increase?

A

Mostly because tidal volume increases by 40%

The increase in rate is small (10%)

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11
Q

All of the lung volume decrease except:

A

closing capacity and vital capacity

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12
Q

Oxygen consumption is increased by _____% in a term pregnant woman

A

20%

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13
Q

Oxygen consumption is increased by _____% in the first stage of labor

A

40%

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14
Q

Oxygen consumption is increased by _____% in the second stage of labor

A

75%

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15
Q

What hormones contribute to vascular engorgement and hyperemia?

A

Progesterone
Estrogen
Relaxin

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16
Q

In the 1st stage of labor, CO increases by ___%

A

20%

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17
Q

In the 2nd stage of labor, CO increases by ___%

A

50%

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18
Q

In the 3rd stage of labor, CO increases by ____%

A

80%

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19
Q

Which hemodynamic parameters are unchanged during pregnancy?

A

MAP and SBP

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20
Q

Which hemodynamic parameters are altered during pregnancy?

A

DBP, SVR, and PVR DECREASE

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21
Q

How long does it take for CO to return to PRE-LABOR values postpartum?

A

24-48 hours

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22
Q

How long does it take for CO to return to PRE-PREGNANCY values postpartum?

A

2 weeks

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23
Q

The cardiac axis on a maternal ECG may show what abnormality?

A

A L axis deviation, because the gravid uterus pushes it up and to the L

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24
Q

Why are parturients so prone to consumptive coagulopathies?

A

The have increased clotting factors (hence the hypercoagulable state)

BUT

They also have more fibrin breakdown, meaning they clot easier AND break down clots faster

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25
Q

Coag in pregnant women will show:

A

Decreased PT (20%) and decreased PTT (20%)
Normal-ish platelets

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26
Q

Pregnant women are more sensitive to which drugs?

A

Local Anesthetics
Volatile Anesthetics
(because of increased progesterone)

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27
Q

How is gastric emptying impacted by pregnancy?

A

It isn’t, but it does decrease after onset of labor

28
Q

Uterine blood flow accounts for ____% of cardiac output

A

10

29
Q

What is a normal uterine bloodflow at term?

A

700-900 ml/min

30
Q

Which drug characteristics favor placental transfer?

A

LMW (<500 daltons)
High lipid solubility
Non-Ionized
Non-Polar

31
Q

Which drugs do NOT cross the placenta?

A

Paralytics, Glyco, Heparin, Insulin

32
Q

Which LA reduces the efficacy of epidural morphine?

A

2-Chloroprocaine

33
Q

Which opioid has LA properties?

A

Demerol

34
Q

Why isn’t lidocaine preferred for epidurals?

A

It produces a strong motor block, and can cause neurotoxicity if inadvertently injected intrathecally

35
Q

What is the dose range for spinal bupivacaine?

A

1.5 - 2.5 MILLIGRAMS

36
Q

What is the dose range for spinal ropivicaine?

A

2 - 3.5 MILLIGRAMS

37
Q

There are three ways to develop a total spinal:

A
  1. Epidural dose injected intrathecally
  2. Epidural dose injected subdural (delayed s/s)
  3. Spinal injection after failed epidural
38
Q

How can you prevent a subdural injection?

A

You really can’t. Neither aspiration or a test dose will rule it out

39
Q

What is the classic presentation of a subdural injection?

A

Symptoms of excessive cephalad spread 10-25 min after epidural placement

40
Q

Why do subdural injections cause total spinals?

A

Because the potential space is so much small, so the LA rapidly travels up and down

41
Q

What is the treatment for mag toxicity?

A

Diuretics
1g Calcium

42
Q

What are the side effects of pitocin?

A

Water intoxication
Hypotension
Reflex Tachycardia
Coronary Vasoconstrict.

43
Q

What is the half life of pitocin?

A

4-17 min

44
Q

What are the side effects of methergine?

A

Vasoconstriction
Hypertension
Cerebral Hemorrhage

45
Q

What is the half life of methergine?

A

2 hours

46
Q

What is the dose of Methergine?

A

0.2mg

47
Q

What is the dose of hemabate?

A

0.25 mg

48
Q

What are the side effects of Hemabate?

A

N/V
Diarrhea
Hypotension
HTN
Bronchospasm

49
Q

How much higher is the mortality from general anesthesia in pregnancy?

A

17x higher than the general population

50
Q

During a general anesthetic, the risk of neonatal acidosis increases when the time from incision to delivery exceeds:

A

3 min

51
Q

Triple prophylaxis against aspiration includes:

A

Bicitra
Reglan
Ranitidine

52
Q

Should a defasciculating dose be given in pregnancy?

A

Surprisingly no. Myalgia is reduced in pregnancy

53
Q

What is normal amniotic fluid volume?

A

700ml

54
Q

When should NSAIDs be avoided in pregnancy?

A

After the first trimester

55
Q

Which surgeries have the highest incidence of preterm labor?

A

Intraabdominal and Pelvic

56
Q

What is the best time for a pregnant patient to have surgery?

A

The second trimester

57
Q

At what gestational age are women considered a full stomach?

A

18-20 weeks

58
Q

Chronic cocaine use is associated with which blood dyscrasia?

A

Thrombocytopenia

59
Q

Which obstetric pathologies are associated with DIC?

A

AFE
Placental Abruption
Intrauterine Demise

60
Q

What is the neonatal IV dose of epinephrine?

A

10-30mcg/kg

61
Q

What is the neonatal intratracheal dose of epinephrine?

A

0.05 - 0.1 MG/kg

62
Q

What is the bolus dose of IVF for a neonate?

A

10 ml/kg

Includes PRBCs

63
Q

Which local anesthetic DOES NOT cross the placenta

A

2-Chloroprocaine because it’s metabolized so quickly

64
Q

Immediately after delivery, neonatal SpO2 should be:

A

> 60%

65
Q

After ten minutes, neonatal SpO2 should be:

A

90%

66
Q
A

Apex (46 decks)

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