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My OB > Quiz 1 > Flashcards

Quiz 1 Flashcards

1
Q

Neurological changes in pregnancy (4)

A
  • MAC is decreased.
  • Epidural space becomes smaller.
  • Cerebrospinal fluid volumes are decreased and epidural veins are engorged.
  • Increased sensitivity to local anesthetics.
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2
Q

REspiratory changes in pregnancy (net, rate, TV, MV, FRC, PaCO2)

A

Net effect is increased ventilation.

  • Tidal volume increased ~40% at term.
  • Respiratory rate increased ~15%.
  • Minute ventilation increased ~50%.
  • FRC decreases by ~20%

PaCO2 decreased to 28-32 mm Hg secondary to hyperventilation, i.e. respiratory alkalosis.
-Compensatory metabolic acidosis

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3
Q

P50 of hemoglobin increases from ___ to ___ mmHg.

Aids delivery of oxygen to fetus

A

27

30

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4
Q

maintain _____carbia during anesthesia. Why?

A

normo

decreased PaCO2 causes uterine constriction and decreased placental blood flow

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5
Q

cardiovascular changes in pregnancy. Why increase in volume?

A
  • Increased plasma volume (~45%) in excess of red cell mass (RBC vol inc ~20%)
  • increased cardiac output (inc 40%; 15-30% inc. HR and 30% inc. stroke volume)
  • Peripheral vascular resistance drops about 15%

Inc. renin > inc. aldosterone > sodium/H20 retention

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6
Q

CO changes in 4 different phases of labor:

A

Latent Phase – inc. 15%

Active Phase – inc. 30%

Second Stage – inc. 45%

Postpartum – inc. 80%

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7
Q

Response to ________ drugs is blunted.

A

adrenergic

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8
Q

Supine Hypotension Syndrome

A

hypotension, pallor, nausea and vomiting and diaphoresis when they lie flat

These effects may be seen as early as 20 weeks gestation

Place patient in left lateral uterine tilt position

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9
Q

Coag changes in pregnancy: Increased? decreased? labs?

A

I, VII, VIII, IX, X, XII

XI, XIII

PT, PTT dec. 20%

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10
Q

Renal blood flow and glomerular filtration increased by about ____ by 16th week, remains elevated until delivery

A

50%

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11
Q

Hepatic changes in pregnancy

A

20% decrease in pseudocholinesterase levels.
Simultaneous increase in volume of distribution counters any clinically significant prolongation of NMB with succinylcholine

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12
Q

Fetal stores are about ___ ml of O2 and consumption is ___ ml/min

A

42

21

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13
Q

Compensatory mechanisms (redistribution, anaerobic metabolism) the fetus at term can survive ___ min of total O2 deprivation

A

10

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14
Q

Placental blood has a PaO2 of 40mm Hg, how is this compensated for?

A

the fetal oxy-hemoglobin dissociation curve is left shifted and the maternal curve is right shifted

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15
Q

how is transfer of CO2 accomplished?

A

simple diffusion across the placenta

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16
Q

Uterine blood flow represents ___% of cardiac output. 80% of this blood goes to the placenta, the rest goes to the ___________.

A

10 (600-700 ml per min in the parturient).

myometrium

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17
Q

Three Factors influence UBF:

A
  • Systemic blood pressure
  • Uterine vasoconstriction
  • Uterine contractions
18
Q

drugs that mildly reduce UBF via maternal hypotension (2)

A

Propofol and thiopental

19
Q

Ketamine has no net effect at doses ____ mg/kg

A

<1.5

20
Q

Volatile agents dec. UBF secondary to hypotension but at < __ MAC the effect is minor

A

1

21
Q

High serum ________________ levels can result in uterine vasoconstriction

A

local anesthetic

22
Q

look at slide 29 and 33, 34 OB1

A

.

23
Q

Most common cause of postpartum maternal palsy is

A

cephalopelvic disproportion

24
Q

Backaches from? (2)

A
  • lumbar lordosis to counterbalance growing uterus.

- laxity of sacrococcygeal, sacroiliac, pubic joints.

25
Q

insertion and removal of epidural should only occur when

A

coagulation function is normal

26
Q

For patients with PIH a platelet count of over ______ and normal PT, PTT is required for Neuraxial block

A

100K

27
Q

Look at slide 8 OB5

A

.

28
Q

S/S epidural hematoma

A
  • Bilateral leg weakness
  • Incontinence
  • Absent rectal sphincter tone
  • Back pain
  • If hematoma suspected pt must get a stat CT or MRI
  • Surgical decompression must occur w/in 6 hrs for full neurological recovery to occur
29
Q

S/S epidural abscess

A
  • Severe back pain
  • Worse with flexion; sometimes with radiation
  • Exquisite local tenderness
  • Fever, malaise, meningitis-like headache with neck stiffness
  • Laboratory changes - Inc. WBC, inc. ESR, positive blood culture
  • Progression over hours-days to neuro deficit or osteomyelitis
30
Q

compression injuries in lithotomy stirrups (3)

A
  • Common peroneal
  • Obturator
  • Femoral
31
Q

Postpartum foot drop from?

A

common peroneal nerve from stirrups or brow compression of lumbosacral trunk

32
Q

dec. sensation over upper inner thigh, weak hip adduction

A

obturator injury

33
Q

difficulty climbing stairs

A

femoral injury

34
Q

PDPH Risk Factors (5)

A
  • Younger age
  • Larger needle gauge
  • Cutting-edge Quincke spinal needle
  • Cephalad or caudal orientation of Quincke needle
  • History of PDPH or migraines.
35
Q

Gauge and chance of PDPH (5)

A 
16-18 ga epidural – 75-80% chance of PDPH
22 ga Quincke – 30-50% chance of PDPH 
25 ga Quincke – 8-10% chance of PDPH
24 ga Sprotte – 3-5% chance of PDPH
25 ga Whitacre – 1-2% chance of PDPH
36
Q

The hallmark of a PDPH is

A

continuous head pain when patient sitting or standing that is completely or almost completely relieved by recumbence

37
Q

Most common cause of perioperative headache

A

caffeine withdrawal

38
Q

look at slide 26 OB5

A

.

39
Q

look at slide 29-31 OB5

A

.

40
Q

Management of Total Spinal

A
  • Place patient in LUD and Trendelenberg
  • Early resuscitation, ventilation, and circulatory support.
  • Epinephrine may be needed
41
Q

Look at slide 40 OB5

A

.

42
Q

Tx of aspiration

A

Intubation and positive pressure ventilation w/ PEEP. Use only enough O2 to maintain O2 saturation in the 90s (high FiO2 may exacerbate lung injury)

My OB (4 decks)

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