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Apex Review > Obstetrics 3 > Flashcards

Obstetrics 3 Flashcards

1
Q

Fifteen minutes after a patient’s epidural as dosed, the patient becomes hypotensive and experiences respiratory arrest. What is the MOST likely etiology?
a. epidural catheter migration
b. loss of accessory respiratory muscle strength
c. subdural injection
d. eclampsia

A

C. subdural injection
this patient has experienced a total spinal

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2
Q

Describe the ways that a patient can develop a total spinal.

A

an epidural dose injected into the subarachnoid space
an epidural dose injected into the subdural space (s/sx may be delayed)
a single-shot spinal after a failed epidural block

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3
Q

Describe the treatment for a total spinal.

A

treatment is supportive and includes airway management, IVF, vasopressors, left uterine displacement, and leg elevation

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4
Q

___________________ will rule out subdural placement.

A

Neither catheter aspiration nor a test dose

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5
Q

Symptoms of a total spinal will include

A

dyspnea, difficulty phonating, and hypotension; loss of consciousness occurs as a result of cerebral hypoperfusion secondary to severe hypotension

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6
Q

Differential diagnosis for high spinal includes

A

anaphylactic shock, eclampsia, and amniotic fluid embolism

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7
Q

________ are causes of late decelerations.

A

maternal acidosis and preeclampsia

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8
Q

______ is consistent with early decelerations.

A

Fetal head compression

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9
Q

______ is a surrogate measure of fetal wellbeing.

A

Fetal heart rate

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10
Q

Fetal heart rate provides an indirect method to asess

A

fetal hypoxia and acidosis

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11
Q

_________ is a function of uterine and placental blood flow

A

Fetal oxygenation

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12
Q

The fetus responds to stress with

A

peripheral vasoconstriction, hypertension, and a baroreceptor-mediated reduction in heart rate

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13
Q

Normal fetal heart rate is

A

110-160

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14
Q

Bradycardic fetal heart rate is

A

<110

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15
Q

Tachycardic fetal heart rate is

A

> 160

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16
Q

What are the three types of fetal decelerations

A

early
late
variable

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17
Q

Which fetal decelerations put the fetus at risk?

A

late and variable

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18
Q

An absence of variability may indicate

A

fetal distress

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19
Q

Causes of lack of variability include

A

CNS depressants, hypoxemia, and acidosis

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20
Q

Variability is an indicator of

A

oxygenation, normal acid-base status
intact central nervous system
& SNS & PNS are functioning in a healthy way

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21
Q

Fetal causes of bradycardia include

A

asphyxia and acidosis

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22
Q

Maternal causes that lead to fetal bradycardia include

A

hypoxemia
drugs that decrease uteroplacental perfusion

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23
Q

Fetal causes of tachycardia include

A

hypoxemia
arrhythmias

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24
Q

Maternal causes that can lead to fetal tachycardia include

A

fever
choriomnionitis
atropine
ephedrine
terbutaline

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25
Q

What is normal variability?

A

6-25 bpm

26
Q

What is the mnemonic VEAL CHOP?

A

Variable decels: Cord compression
Early decels: Head compression
Accelerations: Ok or give oxygen
Late decels: Placental insufficiency

27
Q

According to the American College of Obstetrics and Gynecologists, which findings are predictive of poor fetal status?
a. sinusoidal pattern
b. no late or variable decelerations
c. bradycardia without absence of baseline variability
d. absent baseline variability

A

A & D.

28
Q

Someone trained in fetal monitoring must monitor and document fetal status

A

before and after any anesthetic procedure

29
Q

Describe Category 1 for evaluation of fetal heart rate.

A

suggest normal acid-base status with no threat to fetal oxygenation

30
Q

Describe Category 2 for evaluation of fetal heart rate.

A

Is not 1 or 3 and cannot predict a normal or abnormal acid-base status

31
Q

Describe Category 3 for evaluation of fetal heart rate.

A

suggest abnormal acid-base status with a significant threat to fetal oxygenation

32
Q

Describe Category 1 findings.

A

Baseline heart rate between 110-160
moderate variability
accelerations absent or present
early decelerations absent or present
No late or variable decelerations

33
Q

Describe category 2 findings.

A

Bradycardia without the absence of baseline FHR variability
tachycardia
variable variability
absent or minimal acceleration with fetal stimulation
recurrent variable decelerations

34
Q

Describe category 3 findings.

A

bradycardia
absent baseline variability
recurrent late deceleration
recurrent variable deceleration
sinusoidal pattern

35
Q

The first sign of magnesium toxicity is

A

diminished deep tendon reflexes

36
Q

Premature delivery is defined as delivery before

A

37 weeks gestation

37
Q

The leading cause of perinatal morbidity and mortality is

A

premature delivery

38
Q

The incidence of prematurity rises with

A

multiple gestations and premature rupture of membranes

39
Q

Select fetal complications of prematurity include

A

respiratory distress syndrome, intraventricular hemorrhage, and NEC

40
Q

_______ may be used to delay labor by suppressing uterine contractions (up to 24-48 hours).

A

Tocolytic agents

41
Q

Examples of tocolytic agents include

A

beta-agonists
magnesium sulfate
calcium channel blockers
nitric oxide donors

42
Q

In the setting of preterm labor, ________ are given to hasten fetal lung maturity.

A

corticosteroids (betamethasone)

43
Q

Tocolytic agents or corticosteroids are seldom given after

A

33 weeks of gestation

44
Q

Side effects of beta agonists include

A

hyperglycemia resulting from glycogenolysis in the liver
hypokalemia from intracellular potassium shift
cross the placenta and may increase FHR
newborn of a hyperglycemic mother is at risk of post-delivery hypoglycemia

45
Q

What are examples of beta agonist tocolytics?

A

ritodrine and terbutaline

46
Q

How do beta agonists prevent uterine contraction?

A

beta-2 stimulation increases intracellular cAMP–> turns on protein kinase, turns of MLCK–> relaxes the uterus
also increases progesterone release which contributes to additional myometrial relaxation

47
Q

How to calcium channel blockers work to prevent uterine contraction?

A

Blocks the influx of Ca+2 into the uterine muscle–> reduces Ca2+ release from the SR–> turns off myosin light-chain kinases–> relaxes uterine muscle

48
Q

_______ is the first-line calcium channel blocker agent.

A

PO Nifedipine

49
Q

Co-administration of calcium channel blockers with ______ can contribute to skeletal muscle weakness.

A

Magnesium

50
Q

How do nitric oxide donors work?

A

nitric oxide is a vasodilator that is essential in maintaining smooth muscle tone
increases cGMP–> turns off myosin light-chain kinases–> relaxes uterine muscle

51
Q

_______ are rarely used due to hypotension.

A

Nitric oxide donors

52
Q

How does magnesium sulfate work?

A

calcium antagonist–> relaxes smooth muscle by turning off MLCK in the vasuclature, airway, and uterus
also hyperpolarizes excitable tissues

53
Q

The ______ eliminate Mg2+, so mothers with ______ should be closely monitored

A

kidneys; renal insufficiency

54
Q

What is the normal range of magnesium?

A

1.8-2.5 mg/dL

55
Q

Hypomagnesemia can lead to

A

tetany, seizures, and dysrhythmias

56
Q

We start to see diminished deep tendon reflexes at a magnesium level of

A

5-7 mg/dL

57
Q

We see a loss of deep tendon reflexes, hypotension, EKG changes, and somnolence, at a magnesium of

A

7-12 mg/dL

58
Q

We see respiratory depression, complete heart block, cardiac arrest, coma, and paralysis at a magnesium level of

A

> 12 mg/dL

59
Q

Additional side effects of hypermagnesemia include

A

skeletal muscle weakness (potentiates NMBD)
pulmonary edema
reduced responsiveness to ephedrine and phenylephrine

60
Q

Treatment for hypermagnesemia includes

A

supportive measures
diuretics (to facilitate excretion of Mg2+)
IV calcium gluconate 1 g over 10 minutes (to antagonize Mg2+)

61
Q

List 6 complications of premature delivery

A

NEC
intraventricular hemorrhage
respiratory insufficiency
hypocalcemia
hypoglycemia
hyperbilirubinemia

62
Q

Anesthetic considerations for the use of methergine include:
a. IV administration is safe
b. tocolysis
c. administration of 0.2 mg
d. risk of water intoxication

A

c. - should always be given IM

Apex Review (224 decks)

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