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Anesthesia > Obstetrics > Flashcards

Obstetrics Flashcards

1
Q

Preeclampsia risk factors (6)

A

Hydatidiform mole, multiple gestational, obesity, polyhydramnios, diabetes, primigravidas

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2
Q

Define mild preeclampsia

A

Systolic > 140, diastolic > 90, proteinuria >2 gm/day, edema

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3
Q

What vasopressor should be used with mag toxicity and why?

A

Ephedrine, magnesium antagonizes the effects of alpha agonists

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4
Q

What happens to cardiac output at term, during labor, and immediately after delivery?

A

40% increase at term, 45% during labor, 60-80% increase following delivery

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5
Q

How much does plasma volume increase? Red cell volume?

A

40% plasma, 20% red cell volume

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6
Q

During pregnancy, what H&H signifies true anemia?

A

</= 33/11

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7
Q

What 3 changes happen to the GI system during pregnancy?

A

Acidity and gastric volume increase, gastric motility decrease (2/2 progesterone), GE sphincter tone decreases

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8
Q

When does aortocaval compression occur?

A

20 weeks

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9
Q

What happens in supine position after 20 weeks and why?

A

Aortocaval compression 2/2 a 50% increase in femoral venous pressure that causes a 10-15% decrease in SV and CO

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10
Q

During pregnancy, when is the H&H lowest and why?

A

30-34 weeks 2/2 plateau in volume expansion

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11
Q

What changes happen to RBF, GFR, and BUN/Cr? When?

A

They increase by 50% leading to a decrease in BUN and creatinine; 16 weeks

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12
Q

What happens to total protein and albumin/globulin ratio during pregnancy and its importance

A

Decreased; lower albumin may result in higher free blood levels of substances

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13
Q

Why happens to pseudocholinesterase levels during pregnancy? Does this affect your anesthetic?

A

Decreased, response to moderate doses of succinylcholine is not prolonged

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14
Q

What happens to SV, HR, and SVR during pregnancy?

A

SV increases by 25%, HR increases less, SVR decreases by 20%

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15
Q

What CNS changes occur during pregnancy?

A

40% decrease in MAC, 30-50% decrease in local requirements

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16
Q

What 3 changes occur to the airway during pregnancy?

A

Capillary swelling leads to mucosal enlargement, tissues become more friable, breast enlargement can cause head positioning difficulty

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17
Q

What happens to minute ventilation during pregnancy and why?

A

Increases by 50%; progesterone increased tidal volume with little change in RR

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18
Q

What acid/base changes occur during pregnancy?

A

PaCO2 is ~32 but pH is unchanged because of compensatory metabolic acidosis (HCO3 25 –> 21)

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19
Q

How does inhalational induction change during pregnancy and why?

A

Increased ratio of minute ventilation to FRC causes rapid induction and emergence

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20
Q

What happens to FRC during pregnancy?

A

Decreases 20% due to decrease in residual volume; closing capacity exceeds FRC in ~50% of supine women late in pregnancy

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21
Q

What happens to vital capacity during pregnancy?

A

Unchanged as inspiratory capacity increases and expiratory reserve volume decreases

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22
Q

What happens to PaO2 during pregnancy?

A

Increases by 10

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23
Q

What happens to airway resistance during pregnancy?

A

Decreases 2/2 progesterone

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24
Q

What happens to tidal volume during pregnancy?

A

Increase by 45%

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25
Q

What happens to oxygen consumption and CO2 production during pregnancy?

A

Consumption increase 30-40%, CO2 production increase 30-40%

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26
Q

What coagulation factors increase during pregnancy?

A

Factors I (fibrinogen), II, VII, VIII, IX, X

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27
Q

What is the range for leukocytosis after 12 weeks?

A

10500-16000

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28
Q

Which coagulation factors decrease during pregnancy?

A

Factors XI, XIII

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29
Q

What is the non-pregnant UBF?

A

50-200 ml/min

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30
Q

What is pregnant UBF?

A

10% of CO, 600-700 ml/min

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31
Q

How much must UBF decrease to see fetal distress?

A

50%

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32
Q

Name drugs that do not cross the placenta (5)

A

heparin, insulin, glycopyrrolate, non-depolarizing relaxants, succinylcholine

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33
Q

What is the 1st stage of labor?

A

start of contractions to complete cervical dilation

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34
Q

What nerves are involved in 1st stage of labor and what do they innervate?

A

T10-L1 visceral pain of contractions and cervical dilation –> uterus, cervix, upper vagina

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35
Q

What is the 2nd stage of labor

A

complete cervical dilation up until delivery

36
Q

What nerves are involved in the 2nd stage of labor and what do they innervate?

A

S2-S4 (pudendal) somatic pain of distention of birth canal, vulva, and perineum–> perineal area

37
Q

What are the complications associated with paracervical block, what is the incidence, and when can it be used?

A

10-40% of fetal bradycardia and acidosis because high fetal blood levels cause cardiotoxicity; can be used in 1st stage of labor

38
Q

What are aortocaval compression symptoms?

A

n/v, tachycardia, hypotension, sweating; may not have symptoms if uterine artery hypoperfusion and hypotension is present without compromise of maternal CO

39
Q

What is frank/complete/incomplete breech?

A

buttocks presenting, buttocks and feet presenting, one or both feet presenting

40
Q

Breech presentation increases maternal risk of…

A

maternal mortality 2/2 hemorrhage, infection, and retained placenta

41
Q

Breech presentation increases risks to fetus…

A

asphyxia due to cord compression and intracranial hemorrhage due to trauma

42
Q

Define severe preeclampsia

A

> /= 160/110, >5 gm proteinurea/day, edema (can include pulmonary edema leading to CHF)

43
Q

What are the characteristics of eclampsia?

A

Hypovolemia, thrombocytopenia, DIC, CNS changes

44
Q

What CNS changes can be seen with eclampsia?

A

Convulsions, coma, hypoxic cerebral encephalopathy

45
Q

When does preeclampsia present and end?

A

24 weeks and ends within 48 hours of delivery

46
Q

What is the treatment for preeclampsia?

A

3-5 gm loading dose of magnesium given over 15 min and 1gm/hr maintenance

47
Q

What is the magnesium goal for preeclampsia treatment?

A

4-6 mEq/L

48
Q

What are magnesium side effects?

A

Skeletal muscle relaxation, anticonvulsant, sedation, tocolytic, vasodilator

49
Q

What does magnesium cause skeletal muscle relaxation?

A

It decreases the release of acetylcholine and decreases the sensitivity of the motor end plate to acetylcholine

50
Q

What are the magnesium side effects for the infant?

A

Flaccidity, respiratory depression, apnea

51
Q

How does magnesium treatment change your anesthetic

A

Increased sensitivity to depolarizing and non-depolarizing relaxants; decrease succinylcholine does by 50%

52
Q

How is preeclampsia treated?

A

Bed rest, magnesium, hydralazine

53
Q

Benefits of hydralazine vs SNP for treatment of preeclampsia

A

Hydralazine increases uterine and renal blood flow, starts to work in 15-20 min, lasts for 2 hours; SNP decreases uterine blood flow and increases risk of fetal CN toxicity (crosses placenta)

54
Q

What is placenta previa and what is the incidence?

A

When the placenta is located over or very near the internal cervical os; 0.1%-1.0% incidence that increases with age

55
Q

What is abruptio placenta and what is the presentation?

A

Separation of placenta from uterine wall after 20 weeks; presents as hypotension and fetal distress

56
Q

What are the symptoms of uterine rupture?

A

Severe abdominal pain, hypotension, loss of fetal heart tones

57
Q

Risk factors for uterine atony (4)

A

Retained placenta, multiparity, large infants, polyhydramnios

58
Q

What is the treatment for uterine atony?

A

Uterine massage, oxytocin, prostaglandin F2-alpha, ergots, misoprostol, hysterectomy with ligation of internal iliac artery

59
Q

What is placenta acreta?

A

Abnormal adherence of placenta to myometrium

60
Q

What are the risks to fetus with benzodiazepines and nitrous?

A

Cleft palate; inhibits methionine synthetase impairing DNA synthesis

61
Q

What is ritodrine/terbutaline? Uses? Side effects?

A

Beta agonists used for tocolysis; increased HR and CO (b1) & hyperglycemia and hypotension (b2) also causes pulmonary edema, hypokalemia, arrhyhmias

62
Q

Why is ethanol used during pregnancy? What is its use associated with?

A

It’s a tocolytic that works by inhibiting oxytocin; increases the risk of gastric aspiration; administered in D5W

63
Q

What side effect is ritodrine and magnesium use associated with?

A

Chest pain

64
Q

What is prostaglandin synthetase used for? Side effects?

A

Used for tocolysis; can cause premature closure of PDA, primary pulmonary HTN, and inhibits cyclooxygenase which may lead to bleeding problems

65
Q

What is normal FHR variability and what does it indicate?

A

Normal variability is 7-14 beats/min; it is best indication of fetal well being –> absence happens with prematurity,sleeping baby, CNS damage, hypoxia, drug effects

66
Q

Early deceleration

A

FHR slowing begins at onset of contraction and ends at the conclusion, caused by fetal head compression leading to bagel stimulation, benign

67
Q

Late deceleration

A

FHR dip starts after onset if contraction an persists after he conclusion, indicate uteroplacental insufficiency

68
Q

Variable deceleration

A

FHR dips not associated with contractions, due to umbilical cord compression, if last more than 1 minute indicative of severe fetal acidosis with imminent in utero death

69
Q

What is scalp pH normal range?

A

7.20-7.25

70
Q

When and how is L/S ratio helpful?

A

L/S ratio is = until 35 weeks, if L/S ratio is >/= 2 respiratory distress syndrome is unlikely

71
Q

APGAR

A

A - appearance, P - pulse, G - grimace, A - activity, R - respirations

72
Q

Most common nerve injury during pregnancy and symptoms

A

Common peroneal nerve compressed between head of fibula and stirrups; foot drop, loss of extension of toes, loss of eversion

73
Q

Mechanism of sciatic nerve injury during labor and symptoms

A

External rotation of legs (distance between sciatic notch and fibula is increased); decreased strength in muscles below the knee and decreased sensation of lateral 1/2 of leg and all foot except arch

74
Q

Mechanism of femoral nerve injury during labor and symptoms

A

Excessive angulation of thigh; unable to flex the hip or extend the knee, decreased sensation to superior aspect of thigh and antero-medial aspect of leg

75
Q

What drugs increase/decrease FHR variability?

A

Increase - ephedrine; decrease with fetal CNS depressants (benzos, barbs, opioids, anesthetics) and block parasympathetic (atropine)

76
Q

Define “ion trapping”

A

If the fetus becomes acidotic local anesthetic (weak bases) gets trapped in the ionized form on the fetal side

77
Q

With a maternal PaO2 of 600 mm Hg what will the fetal PaO2 be?

A

No more than 50 mm Hg

78
Q

How much will an FiO2 of 21% –> 100% change the venous O2? Arterial O2?

A

Umbilical venous 28 –> 47, umbilical arterial 15 –> 25

79
Q

Pathophysiology of preeclampsia

A

Thromboxane over production causes vasoconstriction, platelet aggregation, increased uterine activity and impaired uteroplacental blood flow; uterine ischemia causes release of renin which promotes angiotensinogen to angiotensin I

80
Q

Drugs increasing uterine tone (5)

A

PGF2 alpha, ergots, oxytocin, ketamine, amide local anesthetics

81
Q

Drugs that decrease uterine tone (5)

A

Beta 2 agonists, ethanol, magnesium, methylxanthines, potent anesthetics

82
Q

Incidence of PDPH

A

40-50% in the first week PP

83
Q

Modalities for diagnosing central venous thrombosis

A

MRV/CTV

84
Q

PDPH risk factors

A

Young, female, pregnant, non-smoker, dural thickness

85
Q

PDPH conservative treatment

A

Caffeine (increase CSF production and vasoconstricts), theophylline, hydrocortisone, gabapentin

86
Q

Full stomach

A

12 weeks

Anesthesia (16 decks)

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