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Anesthesiology > Obstetrics > Flashcards

Obstetrics Flashcards

1
Q

Are pregnant women more or less sensitive to local anesthetics for neuraxial anesthesia?

A

More sensitive (lower doses needed). Uterine compression of IVC causes epidural vein congestion which means less epidural space and lower doses needed; also compresses intrathecal space; progesterone makes nerve fibers more sensitive to LAs

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2
Q

Is the MAC increased or decreased during pregnancy and by how much?

A

Decreased by 40%

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3
Q

What does a baseline ABG look like for a pregnant women?

A

7.45/30-32/19-20
Decreased PaCO2 (from increased MV - increased TV and mildly increased RR)
Increased bicarb from compensation

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4
Q

Proteinuria > 300 mg/day is worrisome for what?

A

Preeclampsia

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5
Q

How are tidal volumes affected in pregnancy?

A

Increased due to increased AP diameter of the chest

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6
Q

How is the oxygen-dissociation curve affected in pregnancy?

A

Mother: shifted to the right due to increased 2,3-DPG
Fetus: shifted to the left due to fetal hemoglobin

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7
Q

What makes up FRC?

A

Expiratory reserve volume (ERC) + residual volume (RV)

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8
Q

How is FRC affected by pregnancy?

A

Decreased because expiratory reserve volume (ERV) is decreased

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9
Q

Is there autoregulation involved with uterine blood flow?

A

No; dependent on MAP

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10
Q

What is the normal value for placental oxygen tension?

A

~40mmHg

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11
Q

When do you worry about aortalcaval compression?

A

Around 28 weeks

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12
Q

How do you treat aortalcaval compression?

A

Left uterine displacement (since IVC is to the right of the aorta), avoid T-berg

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13
Q

Difference between fetal respiratory depression with morphine vs. fentanyl?

A

Morphine is more likely to cause respiratory depression (along with meperidine -> late peaking = >2 hours after birth); fentanyl presents near the time of delivery

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14
Q

What standard induction agent does not readily cross the placenta and affect the fetus?

A

NMB (both succinylcholine and non-depolarizing) because they are hydrophilic

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15
Q

How do most local anesthetics affect the fetus? Which ones are exceptions to this rule and why?

A

Most local anesthetics are “trapped” in the fetus because fetal pH (more ionized) is lower than maternal pH; exceptions are chloroprocaine (quickly metabolized) and bupivicaine/ropivicaine (highly protein bound)

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16
Q

What is oxytocin used for and what side effects do you worry about?

A

Induces contractions
SE: hypotension, possible uterine rupture or fetal hypoxia from increased contraction strength, maternal water intoxication

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17
Q

What is methylergonovine and what side effects do you worry about?

A

Induces contractions

SE: hypertension (rhymes!)

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18
Q

What is carboprost (Hemabate) and what side effects do you worry about?

A

Prostaglandin analogue to induce contractions

SE: Bronchospasms

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19
Q

What is magnesium used for in pregnancy and what side effects do you worry about?

A

Tocolytic

SE: can potentiate NMB

20
Q

What would >15 mEq/L of magnesium in serum lead to?

A

SA or AV nodal block

21
Q

What is terbutaline and what side effects do you worry about?

A

Beta-2 agonist, tocolytic

SE: tachycardia, hypokalemia

22
Q

Is ephedrine and/or phenylephrine safe during pregnancy?

A

Yes

23
Q

What mediates the pain of the latent phase of labor?

A

Latent phase: 0-3cm

Mediated by T10-T11

24
Q

What mediates the pain of the active phase of labor?

A

Active phase: 3-10cm

Mediated by T10-L1

25
Q

What mediates the pain of the second stage of labor?

A

Child being delivered

T10-L1 as well as the pudendal nerves (S2-S4)

26
Q

Why are NSAIDs contraindicated during pregnancy?

A

Can theoretically close the ductus arteriosis

27
Q

How would you run an epidural for a patient with Eisenmenger’s syndrome for labor?

A

Run only fentanyl (avoid sympathectomy which would be fatal to the patient). AVOID meperidine - has local anesthetic properties

28
Q

Would you perform neuraxial anesthesia for a patient with idiopathic intracranial hypertension?

A

Yes (safe and effective)

29
Q

What anesthetic gas should be avoided prior to delivery?

A

High-dose nitrous oxide to avoid risk of diffusion hypoxia of the newborn

30
Q

Why do we use nitrous oxide for OB anesthesia?

A

N2O does not cause uterine relaxation and allows us to decrease our halogenated volatile anesthetics (decreases uterine tone); beware of high-doses for diffusion hypoxia of the newborn

31
Q

Variable, Early, and Late decelerations are due to what?

A

VEaL CHoP
Cord compression
Head compression
Placental insufficiency

32
Q

What hematologic finding do you worry about in preeclampsia?

A

Thrombocytopenia with platelet dysfunction; can have elevated INR, d-dimer, PT/PTT

33
Q

What are the same anti-hypertensives used during pregnancy?

A

Alpha methyldopa, labetalol, hydralazine, and oral nifedipine

34
Q

What is the most common cause of preeclampsia mortality?

A

Cerebral hemorrhage

35
Q

What do we use in preeclampsia to prevent progression to eclampsia?

A

Magnesium (calcium inhibition and NMDA inhibition)

36
Q

How do you clinically follow magnesium administration for preeclampsia?

A

Monitor for decreased DTRs

37
Q

What are the effects of magnesium in pregnancy?

A
  1. Prolongs muscle relaxant (inhibits Ca++)
  2. Decreases DTRs
  3. Venodilates (decreases BP)
  4. Tocolytic
38
Q

What effects do you see of magnesium drips with the following serum levels? 4-7 mEq/L, 7-10 mEq/L, 10-13 meQ/L, 15-25 mEq/L, >25 mEq/L?

A
  1. Flushing and vasodilation
  2. DTRs are lost
  3. Respiratory depression
  4. Heart block
  5. Cardiac arrest
39
Q

During C-section, OB cannot delivery baby and ask for relaxation of the uterus. What do you do?

A

Give nitroglycerin IV (short acting and rapid onset)

40
Q

What is placenta accreta vs. increta vs. percreta?

A

Accreta: placenta attaches to myometrium
Increta: invaded into the myometrium
Percreta: through the myometrium

41
Q

What is a placenta previa?

A

Placenta attaches to the uterus low (near or on the os) leading to antepartum painless bleed

42
Q

Difference between ACLS in pregnant and non-pregnant women?

A

Uterus should be displaced off the IVC with left uterine displacement (everything else is the same)

43
Q

When should urgent and elective cases happen during pregnancy?

A

Second trimester (highest rate of spontaneous abortion is in the first and third trimester)

44
Q

When does organogenesis occur?

A

GA 2-8 weeks

45
Q

When can you start using fetal heart rate monitoring?

A

After week 16

46
Q

What is the definition of a category A, B, C, D, and X drug for pregnancy?

A 
A: Safe
B: Safe in animals with no humans or not safe in animals but safe in humans
C: no data but potential benefits
D: possible risk but potential benefits
X: Unsafe
47
Q

What risk to the fetus is there with chronic benzo use during the first trimester?

A

Cleft palate

Anesthesiology (21 decks)

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