Test #2 OB review Flashcards
Esmolol was initially thought to hold promise for attenuating the HTN and Tachycardia of laryngoscopy in preeclampsia pts b/c
I dunno we need to find the answer!!
the answer she gave is
both A and B
CO increaes ______% by the 3rd trimester of pregnancy, due mainly to an increase in SV and to a lesser extent in resting HR
40%
General anesthestic considerations require a basic understanding of the physiologic changes in the parturient? True or False
True
with regard to systemic decline in B/P related to aortocaval compression, supine hypotension syndrome results in what?
a significant decline of venous return to the heart for which the CV system cannot compensate
in regards to natural physiologic compensation r/t aortocaval compression: compensation occurs as venousreturn is routed to the SVC via the paravertebral venous plexuses and azygos vein
true or false
true
a decrease in Systolic B/P with a value of _____mmhg is considered a problem and requires intervention when r/t uncompensated or untreated hypotension in the parturient
100mmhg
One of the most effective means for treatment of supine hypotension syndrome is placing the patient in the lateral decubitis position; right uterine displacement via left hip elevation
True or False
false
When considering laboring epidural for the parturient , these patients can develop profound decreases in systolic bp as result of the sympathectomy r/t regional anestesa? True or false
True
Parturiets pulmonary physiological changes are a RR increase of 3%? true false
False
exception question
Increases in minute ventilation and decreases in FRC result higher concentrations of inhaled anesthectics. true or false
True
Which of the following hey points regarding physiologic changes in the parturient are true:
A) plasma volume increases to a greated extent than RBC, resulting in dilutional anemia
B) CO increases are mostly due to the increase in SV but are also due to an increase in HR
C) Blood volume is markedly increased and prepares the parturient for blood loss associated with delivery
D) the greatest demand of HR is immediately after delivery when cardiac output increases
all
Should you use Nasal Trumpets as standard practice in the parturient
nope unless your an AA
What factors contribute to a decrease in dose requirement for LA by 30-50%
(all of the above)
Labor pain asoociated with the first stage of labor is what?
Visceral
caused by uterine contractions and dilation of the cervix (t-10-L1)
EBL for C-section
750-1000ml
Late decels are normal during labor and usually not associated with fetal distress
True or False
False
Early decels are abnormal during labor and are indicative of fetal distress? true or false
false
Normal fetal HR
120-160 BPM
You are called to the prop area to evaluate a patient for elective c-section. Your assessment results 30y/o female healthy no PMH, No PSHx, prenatal vitamins throughout pregnancy, 62 inches, 141 lbs, G1P0000, good physical condition, Airway MP I, TM >3fb, MO > 3fb, FROM, No GERD during pregnancy. VSS , no fetal distress, C-section planned due to pts small pelvic girth and est large fetal head. which anesthesia course would you chose as MOST appropriate?
meds
anesthesia
backup
Meds: zantac 50 mg/ reglan 10 mg/ nonparticulate antacid
Anesthesia: SAB using bupivicaine
Backup: convert to general if SAB unsuccessful
What % (fuck you and the%) of OB pts annually require nonOB surgical intervention
2%
From the list below which are the most commonly performed surgical procedures on the OBpts A) Neurosugical B) Trauma C) Appendectomy d) cholecystectomy E) Ovarian
B,C,D,E
It is safe for the OB to undergo extracorporal shock wave lithotripsy! true or false
False
Trauma is the leading cause of maternal death; fetal death is secondary two:
Both A and B!!!
we need to look this up
The OB undergoing an Appy has an 18% incidence of postoperative pulmonary edema or ARDS; risk factors include all the following except.
Preop temp <99.0F
Benefits of laparscopic sx in prego 1st trimester
all of the above ????
Why is cervacal cerclage performed
incompetent cervix resulting in weakness of the cervical OS related to trauma, congenital abnormalities or multiple pregnancies
All of the following are true EXCEPT what one regarding Thalidomide babies
thought to be safe treatment for severe nausea in 1960, Thalidomise was initially over the counter to pregnant mothers in the US
distinguishing drug exposure VS natural occuring incidence of congenital anomalies has NO bearing on teratogenicity! true or false
False
Is lasix a known teratogen
NOPE
The anesthetic management objectives of the OB pt can be summerized into what 4 main components which should be maintained during the course of surgery?
Maternal O2
CO
O2 delivery
Uterine blood flow
Virtually all anesthestic agents given to the mother are rapidly shared with the unborn child. The exception to this statement is?
Paralytic agents with QUATERNARY ammonium salts- have difficulty crossing the placenta
You can postpone elective sx until after delivery, immediately following delivery all the risk are resolved. True of false
False
Loss of beat to beat varibility is normal after anesthesia true or false
True
Decels r/t anesthesia may indicate a need for what?
All of the above
True or False: you should position the OB pt for NON OB sx RUD, left hip elevated
False
Is increased gastric empying a risk factor for aspiration
nope
Can you give opiods to the OB pt for NON OB sx
yes
which of the following agents is contraindicated for epidural analgesia in the OB pt
0.75% bupivacaine
Which local is highly protein bound , limiting transplacental transfer
Bupivacaine
Antepartum hemorrhage occurs in approximately ___% of pregnancies and includes what complications
4%
placenta previa, placental abruption and uterine rupture
True or false
Preterm labor is a common element for placenta previa
False
G3P2002 presents woth painless vaginal bleeding, she has a hx of uterine trauma form a MVA 2 years ago where she underwent sx for repair of her uterus, she is currently in her 3nd trimester, what diagnosis would you expect
Placenta Previa
you are paged overhead to evaluate a 44y/o G3P2002 @ 34 weeks, she admits to ETOH and smoking, med hx of HTN and GERD, past admitance for domestic abuse. she had cocaine yesterday. Now has bright red vag bleed what diagnosis does she have? and does it require attention now?
Placenta abruption
yes immediate attention
Your pt presents with placental abruption. you enter in the room and note VS HR128, RR 28, SAT 94 on FM 8Lpm, BP 89/42 FHR 90. what is you next logical step
Obtain consent and prepare the OR for C-section under General
With the last scenario. the FHR of 90 bpm. what would you say the FHR is an indication of?
Fetal distress, most likely due to loss of maternal fetal gas exchange
Pt is in OR for c-section and actively bleeding, platelet count is LOW, regional not an option. 1000 ml LR has been given with no improvement FHR is now 85 bpm, which sequence in the most appropriate
place monitors suport bp with symoathomimetics place 2 large bore PIV while OR preps Induce with Ketamine or etomidate Intubate with succs give ok to start prepare for volume transfer have blood ready
your pt had c-section with no complications, baby and placenta delivered. EBL approximately 3000cc surgeon states he is having difficulty with hemostasis. bp remain in 80s what should you do?
call for help start oxytocin PRBCs and crystalloids FFP/ platelets recheck H/H coags prepare for hysterectomy
Placental abruption is the most common cause of DIC in pregnancy, coagupathies occur in 10% of all cases and predisposec the fetus to hypoxia; 15-25% perinatal deaths are associated with abruption. true or false
true
Primary postpartum hemmorrhange is defined as what?
> 300 mL after delivery and or a 10% decrease in HCT from admissio to postpartum period or need to administer PRBCs, occurs during 1st 24 hrs after delivery
The preterm infant is defined as?
Need to look up
answer is both A and C
is nimesulide a tocolytic in use?
no
true false? After 26 weeks there is less risk to developmental abnormalities
false
neonates delivered from pregnant women in hemmorragic shock are likely to be acidodic and hypervolemic? true or false
false
which of the following areserious risk under GA in the parturient?
All the above
uterine rupture can be caused by what?
all the above
Absolute contraindications of general anesthesia in the parturient include ( choose all the apply
C) patient refusal
D) skin infection at placement site
E) coagulopathy
F) significant fetal distress
True or False: “Despite decreases in cholinesterase activity, clinically relevent prolongation of the duration of action of drugs that depend of cholinesterase for elimination (suxs) is uncommon in women with genotypically normal cholinesterase enzymes
true
When performing a SAB the Right lateral decubitis position can be advantageous to achieving optimal anesthesia b/c?
igt ensures that all nerves are bathed in hyperbaric LA when the parturient is placed in LUD prior to C-section
Undesirable SE of intrathecal morphine includes what?
A) pruritis
B) Urinary retention
C) N/V
As a general rule of thumb when placing a lumbar epidural in the parturient for labor, you should not place more than _____ cm of catheter into the epidural space
5
You have placed an epidural and gibven a test dose of 3cc 1.5% lidocaine with 1:200,000 epinephrine. less than 1 min later the parturient states “wow my pain is gone” you are a miracale worker there is a strong liklihood that you catheter is where?
SA space
Indications for GA for C-section include what?
A) significant coagulopathy
B) maternal Hemmorhage
C) Acute fetal Distress without epidural placement
Dermatomal spread of LA injected epidurally is dependent on ____ more than any other factor
Volume
Glucosuria and proteinuria in the absence of disease in the 3rd trimester can be attributed to?
Increased GFR with decreased absorption
You just relieved Tammy carrol at the completion of a c-section, but you are unable to see the suction canister to estimate blood loss. on a quick scan you note the pt is Tachycardic HR 114, with narrowing PP 94/74, moderate tachypnea, 28 bpm, and UOP of 30mL. you can assume what
pt has had moderate bleeding (20-25% of volume or 1200-1500mL) you open IVF, send a stat H/H and check for blood product availability, and notify attending of your concerns
A key point regarding physiologic changes in pregnancy is that platelets, factor VII, and Fibrinogen levels are normally _______
increased
In regard to physiologocical changes in pregnancy, which of the following statements are true?
- pregnant women have and increased sensitivity to LA
- Blood volume is increased to prepare the parturient for blood loss associated with delivery
Pain in the 1st stage of labor is caused by?
Cervical dilation and uterine muscle ischemia
before performing a regional anesthesia it is important to ask?
All of the above
Given a reasonable maternal O2 sat, Fetal O2 is limited primarily by uteroplacental blood flow, not maternial O2. True or False?
true
Fetal bradycardia is:
usually tolerated if it last < 2 minutes
i put the answer “defined as and was wrong
Dermatomes that cover the perineum are
S2, S3, S4
Which of the following statements are true
A) Increased ICP, patient refusal and Frank coagulopathy are absolute contraindications to epidural
B) mean age of women having children for the first time has increased from 20.7 in 1970 to 25.2 in 2004
E) always administer 30mL of a nonparticulate antacid by mouth before initiating labor epidural for c-section
F) ketamine is useful in partial or spotty blocks during c-section. dose of 10-20 mg IV produces profound anesthesia without impact on maternal respiration or fetal obtundance
G) Butorphanol (stadol) has fallon out of favor in labor analgesia due to a 75% incidence of transient sinusoidal fetal heart pattern
You must ensure that your NS is PF if using it for loss of resistance epidural placement technique True or False
True
is glucosuria of 5g per 100mL or urine in 24hrs a diagnoses for preeclampsia
nope
select all predisposinf factors for preeclampsia
A) primagravida B) obesity D) Renal disease F) Chronic preexisting HTN G) insulin dependent DM
