Obstetrics 6 Flashcards
All the risk factors for placental abruption
increase the driving pressure to the placenta
Placental abruption is a
partial or complete separation of the placenta from the uterine wall before delivery
With placental abruption, ______ is possible if the fetus is stable
vaginal delivery
Anesthetic management for the placental abruption includes
obtain large-bore IV access
have blood products available
prepare for C-section
Placental abruption increases the risk of
amniotic fluid embolism leading to DIC
What is the MOST common cause of postpartum hemorrhage?
a. uterine atony
b. retained placenta
c. disseminated intravascular coagulopathy
d. uterine inversion
A. uterine atony
Risk factors for uterine atony include
multiparity
multiple gestations
polyhydramnios
prolonged oxytocin infusion before surgery
Etiologies of uterine bleeding include
retained placenta
laceration
uterine inversion
coagulopathy
placenta previa
placental abruption
abnormal placental implantation
Risk factors for maternal DIC include
amniotic fluid embolism, placental abruption, intrauterine fetal demise
Describe treatments for obstetric bleeding
uterine massage
oxytocin
ergot alkaloids
manual massage
intrauterine balloon
Describe what drugs are considered minimally cardiovascular depressive in the bleeding obstetric patient.
ketamine
etomidate
midazolam
opioids
In the hemodynamically unstable patient, it may be prudent to
convert a regional anesthetic to a general anesthetic with RSI
Five minutes following delivery, a newborn has an irregular respiratory rate with a heart rate of 105. He is grimacing, has some flexion in the extremities, and has a pink body with blue extremities. Calculate his Apgar score.
6
(1+2+1+1+1)
The Apgar score at 1 minute correlates with
fetal acid-base status
The Apgar score at 5 minutes may be predictive of
neurologic outcome
The Apgar score is used to
assess the newborn and guide resuscitative efforts
Describe normal, moderate distress, and impending demise Apgar scroes.
normal: 8-10
moderate distress: 4-7
Impending demise: 0-3
Describe the points assigned for heart rate with Apgar scores.
absent: 0
<100 bpm: 1
>100 bpm: 2
Describe the points assigned for respiratory effort for Apgar scores.
absent: 0
slow, irregular: 1
normal, crying: 2
Describe the points assigned for muscle tone for Apgar scores.
limp: 0
some flexion of extremities: 1
active motion: 2
Describe the points assigned for reflex irritability for Apgar scores.
Absent: 0
grimace: 1
cough, sneeze, or cry: 2
Describe the points assigned for color for Apgar scores.
pale, blue: 0
body pink, extremities blue: 1
completely pink: 2
_____ of all newborns require some degree of resuscitation, and _ require full CPR.
10%; 1%
______ protects against hypothermia
Radiant heat
The normal respiratory rate for newborns is
30-60 bpm
The normal heart rate for newborns is
120-160 bpm
A heart rate <100 bpm significantly
reduces cardiac output and impairs tissue perfusion for the neonate
Breathing begins about _____ after delivery, and a normal pattern is established at
30 seconds; 90 seconds
Immediately after delivery, the normal SpO2 for neonates is _____. It should rise to _____ after 10 minutes.
60%; 90%
Supplemental oxygen for the neonate increases the risk of
an inflammatory response; if assisted ventilation is required, use room air instead of 100% fiO2
If _____________, the use of supplemental O2 must be balanced with the risk of inflammatory response.
bradycardia or inadequate oxygenation persists
_______ is the best indicator of adequate ventilation
The resolution of bradycardia
While ______ should be removed from the airway, there is no clinical benefit gained from removing ____________
thick meconium; thin or watery meconium
If ventilation does not improve cardiovascular performance, then emergency drugs can be given through three possible routes:
umbilical vein
endotracheal tube
intraosseus
Describe the dosage of PRBCs, NS, and LR for neonates.
10 mL/kg over 5-10 minutes
Describe the dose of IV epinephrine for the neonate
1:10,000
10-30 mcg/kg IV
