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Advanced Principles II > Obstetrics II > Flashcards

Obstetrics II Flashcards

1
Q

How does pregnancy effect WBC count?

A

Causes benign leukocytosis, so WBC count isn’t a reliable indicator of infection

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2
Q

Are parturients at higher or lower risk for intraoperative awareness?

A

Oddly enough, higher. Because RSI for OB patients doesn’t include versed or opiods, for the baby’s sake

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3
Q

How are plasma cholinesterases impacted by pregnancy?

A

They decrease by 25%, but increased blood volume offsets this decrease and prolonged NMB is uncommon

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4
Q

How does pregnancy impact protein binding levels?

A

Decreases it, due to lower albumin and alpha glycoprotein concentrations. Results in a larger fraction of unbound, free drug -> increased risk of drug toxicity

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5
Q

Do pregnant women need a higher or lower loading dose of a medication?

A

Usually has to be higher, because clearance is dramatically increased and the volume of distribution is larger

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6
Q

Most structural abnormalities from teratogens occur when exposure falls between which days?

A

31-71, during organogenesis

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7
Q

Which infections are teratogenic?

A

CMV, Herpes, Parvo, Rubella, Syphilis, Toxoplasmosis, VEEV

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8
Q

What is the etiology of most developmental defects?

A

Genetic transmission and chromosomal abnormality

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9
Q

Airway edema in parturients is made worse by:

A

Pre-E
Tocolytics
Prolonged Tburg

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10
Q

Why is FRC reduced in pregnancy?

A

As the rib cage widens and tidal volume increases, the volume at end expiration is much lower

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11
Q

How does a decrease in FRC impact airway closure?

A

In pregnant women, the FRC is BELOW the closing capacity, which means the airways close off during tidal breathing

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12
Q

How does progesterone impact tidal volume?

A

It’s a respiratory stimulant
It increases minute ventilation by 50%

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13
Q

What increases more: tidal volume or respiratory rate?

A

Vt increases by about 40%
RR increases by about 10%

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14
Q

What hormones contribute to vascular engorgement and hyperemia in pregnancy?

A

Estrogen
Progesterone
Relaxin

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15
Q

What type of laryngoscope handle is useful in pregnant women?

A

Datta handle (short)

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16
Q

How does progesterone impact vasculature?

A

It causes nitric oxide release, leading to vasodilation

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17
Q

Does PT/PTT increase or decrease during pregnancy?

A

Decrease (takes less time to form a clot)

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18
Q

What is the most common cause of thrombocytopenia in pregnancy?

A

Gestational thrombocytopenia

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19
Q

How is BP effected during pregnancy?

A

MAP and SBP stay the same. DBP decreases.

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20
Q

What % of CO goes to the uterus?

A

10%

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21
Q

What is uterine blood flow in ml/min?

A

700ml/min

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22
Q

Is uterine blood flow autoregulated?

A

No. Almost entirely dependent on MAP and CO.

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23
Q

Is uterine blood flow reduced by phenylephrine?

A

No

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24
Q

How efficiently a drug will traverse any given membrane is determined by which principle?

A

Fick’s Principle

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25
Q

What are drug characteristics that favor maternal transfer?

A

Molecular Weight < 500
High Lipid Solubility
Non-ionized
Non-polar

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26
Q

Which drugs have no placental transfer?

A

NMBAs
Heparin
Glycopyrrolate
Insulin

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27
Q

Does phenylephrine cause more or less fetal acidosis than ephedrine?

A

Less

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28
Q

What afferent pathway innervates the uterus and cervix?

A

Visceral C fibers from the hypogastric plexus

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29
Q

Which LA reduced the efficacy of spinal morphine?

A

2-Chloroprocaine
It antagonizes mu and kappa receptors in the spinal cord

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30
Q

How are bupivacaine, ropivacaine, and levobupivacaine related?

A

Ropivacaine is the R-enantiomer of bupivacaine, which is a racemic mixture of both the R and S enantiomer
Levobupivacaine is just the S enantiomer

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31
Q

Compare ropivacaine to bupivacaine in terms of spinal anesthesia

A

Decreased risk of CV tox
Decreased potency
Decreased motor block

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32
Q

Why isn’t lidocaine frequently used in labor epidurals?

A

It causes high degree of muscle blockade (which makes it ideal for C/S)
Also, it crosses the placenta to a greater degree than the alternatives

33
Q

Can you use lidocaine for a Spinal?

A

No. Its associated with neurotoxicity in the intrathecal space

34
Q

Which opioid possesses LA properties?

A

Meperidine

35
Q

There are three ways you can get a total spinal:

A
  1. Epidural dose in the subarachnoid space
  2. Epidural dose in the subdural space
  3. Single shot spinal after a failed epidural
36
Q

How can you rule out subdural catheter placement during an epidural placement?

A

You can’t. It’s just bad luck.

37
Q

How does a subdural epidural catheter placement manifest?

A

Within 10-25 min the patient will experience symptoms of a total spinal

38
Q

Why do subdural catheters result in higher sensory blocks?

A

Because its a very low volume space. An epidural dose will fill the entire space up to the cervical level

39
Q

What are the symptoms of a total spinal?

A

Dyspnea, difficulty phonating, hypotension, loss of consciousness from hypotension

40
Q

What is the initial treatment for a total spinal?

A

pressors, fluids, leg raise, uterine displacement

41
Q

What are some differential diagnoses for a total spinal?

A

Anaphylaxis, eclampsia, AFE

42
Q

Why is magnesium a smooth muscle relaxant?

A

It antagonizes calcium, interfering with muscle contraction and hyperpolarizing membranes in excitable tissues

43
Q

What is the first clinical sign of magnesium toxicity?

A

Loss of DTRs

44
Q

How does magnesium impact NMBA?

A

Potentiates them

45
Q

What are the initial treatments for hypermagnesemia?

A

Calcium gluconate
Diuretics (to speed up excretion)
Supportive Measures

46
Q

What is the second line uterotonic?

A

Methergine

47
Q

What is the third line uterotonic?

A

Hemabate

48
Q

What is the correct methergine dose?

A

0.2mg IM

49
Q

What is the correct dose of hemabate?

A

250mcg IM

50
Q

Which uterotonic should be avoided in asthmatics?

A

Hemabate
A is for Asthma

51
Q

Which uterotonic causes diarrhea?

A

Hemabate

52
Q

What can happen if you give oxytocin too quickly?

A

CV Collapse

53
Q

What can happen if you give methergine IV?

A

Vasoconstriction, hypertension, cerebral hemorrhage

54
Q

What is another name for Hemabate?

A

Prostaglandin F2, Carboprost

55
Q

How does general anesthesia impact maternal mortality?

A

17x higher!!!!

56
Q

What are some situations where a general anesthetic is necessary for a C/S?

A

Hemorrhage
Fetal Distress
Coagulopathy
Refusal of regional
Contraindications to regional

57
Q

Does general anesthesia result in greater or less hemodynamic stability?

A

More stability than neuraxial

58
Q

Triple prophylaxis against aspiration includes which three drugs?

A

Bicitra (neutralizes gastric acid)
Ranitidine (reduces gastric acid secretion)
Reglan (increases emptying and LES tone)

59
Q

Does pregnancy increase or decrease the incidence of myalgia from Succinylcholine?

A

Decreases it. A defasciculating dose usually isn’t needed

60
Q

Normal amniotic fluid volume is approximately:

A

700 ml

61
Q

What is the best gestational age to perform a non-obstetric surgery?

A

Ideally the 2nd trimester
Less chance of teratogenicity than 1st T
Less chance of PTLD than 3rd T

62
Q

What is a normal maternal PaCO2?

A

30

63
Q

How long after delivery should elective surgery be delayed?

A

2-6 weeks

64
Q

Define chronic hypertension

A

Occurs before 20 wks
At risk of developing Pre-E

65
Q

Define gHTN

A

Develops after 20 wks with no s/s of pre-E

66
Q

When is proteinuria not required for a diagnosis of Pre-E?

A

Severe features:
RUQ pain
CNS s/s
IUGR
Thrombocytopenia
Elevated Liver Enzymes

67
Q

What maternal age is most susceptible to pre-E?

A

<20 and >35

68
Q

On a molecular level, what is so different about a pre-E placenta vs a normal one?

A

Normal placentas produce thromboxane and prostacyclin in equal amounts
Pre-E placentas produce 7x more thromboxane than prostacyclins

69
Q

An increase in thromboxane causes:

A

Increased Platelet Aggregation
Vasoconstriction
Increased uterine irritability
Decreased placental blood flow

70
Q

What is the labetalol regimen for severe HTN?

A

20mg IV initially
Then 40-80 mg q10min
Max dose 220mg

71
Q

What is the hydralazine regimen for severe HTN?

A

5mg IV q20 min
Max 20mg

72
Q

What is the Nifedipine regimen for mild hypertension?

A

10mg PO q20 min
Max dose 50mg

73
Q

Patients with severe Pre-E have an exaggerated response to _______ and _______

A

sympathomimetics
methergine

74
Q

How does magnesium protect end organs?

A

Fibrin deposits reduce organ perfusion. Magnesium decreases the rate of deposition

75
Q

What is Cocaine’s MOA?

A

It inhibits NE reuptake in the synaptic cleft, increasing SNS tone throughout the body

76
Q

Cocaine is associated with what blood dyscrasia?

A

Low platelets

77
Q

Risks for uterine atony include:

A

Multiple gestation
Pitocin use
Multiparity
Polyhydramnios

78
Q

DIC is associated with an increased incidence of:

A

AFE
Abruption
IUFD

Advanced Principles II (5 decks)

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