Obstetrics Flashcards by Andrew Skuta

What hastens the onset of hypoxemia in the parturient?

increased O2 consumption and decreased FRC

How well did you know this?

Not at all

Perfectly

What causes airway closure during tidal breathing?

FRC falling below CC

How well did you know this?

Not at all

Perfectly

______ increases Mv up to 50% and the mom develops….

Progesterone
mild compensated respiratory alkalosis

How well did you know this?

Not at all

Perfectly

What causes vascular engorgement and hyperemia?

increased progesterone, estrogen, and relaxin

How well did you know this?

Not at all

Perfectly

Blade handle for large breasted women?

Datta handle

How well did you know this?

Not at all

Perfectly

FRC is ?

reduced because of decreased ERV and RV

How well did you know this?

Not at all

Perfectly

CO increases by labor stage:

1st: 20%
2nd: 50%
3rd: 80%

How well did you know this?

Not at all

Perfectly

MAP and SBP remain stable. What decreases?

DBP, SVR, PVR

How well did you know this?

Not at all

Perfectly

What causes dilutional anemia?

plasma volume expansion outpacing RBC production

How well did you know this?

Not at all

Perfectly

Increases in what clotting factors?

1,7,8,9,10,12

hypercoagulable state

How well did you know this?

Not at all

Perfectly

What counteracts the state of hyper coagulability?
Bottom line?

increase in Fibrin breakdown

mom makes more clot but she breaks it down faster

How well did you know this?

Not at all

Perfectly

MAC? Locals? Why?

increased sensitivity to locals

MAC decreased 30-40%

d/t increased progesterone

How well did you know this?

Not at all

Perfectly

Increased _____ reduces gastric pH

gastrin

How well did you know this?

Not at all

Perfectly

Gastric emptying before labor and after it begins?

-unchanged before labor but slows after labor begins

How well did you know this?

Not at all

Perfectly

Uterine blood flow rate? CO %?

700-900 mL/min
10% of CO

How well did you know this?

Not at all

Perfectly

Albumin and effect on drugs?

low serum albumin which increases the free fraction of highly protein bound drugs

How well did you know this?

Not at all

Perfectly

Creatinine and BUN?

decreases
increase in creatinine clearance

How well did you know this?

Not at all

Perfectly

What characteristics favor the placental transfer of drugs?

Low molecular weight
high lipid solubility
non-ionized
non-polar

How well did you know this?

Not at all

Perfectly

What drugs DON’T cross the placenta?

NMBs
Glyopyrolate
Heparin
Insulin

How well did you know this?

Not at all

Perfectly

Why does Mag cross the placenta?

not lipophilic but it’s small

How well did you know this?

Not at all

Perfectly

Does atropine cross the placenta?
Beta-blockers?

YES and YES

How well did you know this?

Not at all

Perfectly

First stage of labor starts with _____ and ends with _____.

cervical dilation, regular uterine contractions and ends with full cevical dilation (10cm)

divided into latent and active phase

How well did you know this?

Not at all

Perfectly

2nd stage of labor starts with ___ and ends with ____.

full cervical dilation and ends with delivery of newborn

How well did you know this?

Not at all

Perfectly

3rd stage of labor starts with ____ and ends with ____.

delivery of newborn and ends with delivery of placenta

How well did you know this?

Not at all

Perfectly

ASA guidelines for food and liquids?

drink throughout labor and eat solid food up until neuraxial block is placed

Latent phase =

2-3 cm dilated and lasts up to 8 hour

First stage of labor pain originates from__-__ and the second stage is __-__.

T10-L1 T10-S4

Analgesia for 1st stage? 2nd?

1st: neuraxial block, paravertebral lumbar sympathetic block, paracervical block 2nd: neuraxial or pudendal nerve block

Common nitrous administration?

50% O2 50% N2O self administered via face mask

Consequences of uncontrolled pain?

-increased maternal catecholamines --> HTN and reduced uterine blood flow -Maternal hyperventilation --> leftward shift of oxyhgb curve --> redcued O2 delivery to baby

Describe the "epidural volume extension technique"

saline/volume is added to the epidural space which compresses the subarachrnoid space which enhances rostral spread of local anesthetic -acheives a higher level and a smaller dose may be used

What local reduces the efficacy of epidural morphine? How?

2-Chlroroprocaine antagonizes mu and kappa receptors in the spinal cord no other locals do this

____ is contraindicted via epidural d/t risk of toxicity of IV injection

0.75% Bupivicaine

____ has local anesthetic properties

Meperidine

Most common side effect of neuraxial opioids?

pruririts

Spinal doses : Bupi- Ropi- Levobupi-

Bupi- 1.25 - 2.5 mg Ropi- 2 - 3.5 mg Levobupi- 2- 3.5 mg

Opioid Spinal doses: Fentanyl: Sufentanil: Morphine: Meperidine:

Fentanyl: 15-25 mcg Sufentanil: 1.5-5 mcg Morphine: 125 - 250 mcg Meperidine: 10-20 mg

Epidural bolus doses for Fentanyl?

50-100 mcg

3 ways a patient can develop a total spinal?

-epidural dose injected into subarachnoid space -epidural dose into the subdural space (s/sx delayed) -single-shot spinal after failed epidural block

Tx total spinal?

airway management IVF vasopressors LUD leg elevation

Normal FHR: Brady? Tachy?

110-160 < 110 > 160

How does the fetus respond to stress?

-peripheral vasoconstriction -HTN -Baroreceptor-mediated reduction in HR

A healthy variablity in HR for the baby is___-___ bpm

6-25 Variability indicates an intact CNS and normal oxygenation and norma acid-base

Three types of fetal deceleration phenomena: most likely cause and risk of retus? Early: Late: Variable:

Early: Head compression No risk to fetus Late: Placental insufficiency Fetus AT RISK Variable: Cord Compression Fetus AT RISK VEAL CHOP

Mg: < 1.2 mg/dL

tetany seizures dysrhythmias

Mg: 5-7 mg/dL

diminished deep tendon reflexes lethargy, drowsy flushing N/V

Mg: 7-12 mg/dL

Loss of deep tendon reflexes hypotension EKG changes somnolence

Mg: > 12 mg/dL

Respiratory depression --> apnea complete heart block cardiac arrest coma paralysis

___ causes reduced effectiveness to ephedrine and phenylephrine

Hypermagnesemia

Treatment for Hypermagnesemia:

diuretics IV calcium gluconate 1g over 10 mins (to antagonize Mg+)

Methergine drug class and dose:

uterotonic IM 0.2mg

Side effects of oxytocin:

-Water retention (similar to vasopressin) - hyponatremiia -hypotension -reflex tachycardia -coronary vasoconstriction -Rapid IV administration can cause CV collapse

What is prostaglandin F2?

Hemabate or Carboprost

Hemabate/Carboprost dose and side effects

250mcg IM or diret into uterus N/V, diarrhea, hypotension, HTN, BRONCHOSPASM

Methergine half life =

2 hours

Aspiration prophylaxis for emergency c-section (general)

sodium citrate, H2 receptor antagonist, and gastrokinetic agent

The risk of neonatal acidosis increases when time between uterine incision and delivery exceeds __ mins

is a defasciculating dose needed for succs in pregnancy?

No, pregnancy reduces myalgia

Volatile agent combo for c-section:

0.8 MAC + 50% nitrous oxide

Normal amniotic fluid volume ~ ___ mL

700 mL

Most significant risk in non-obstetric surgery

difficult intubation and aspiration

What surgeries are the highest incidence of preterm labor?

intraabdominal and pelvic surgery

Iatrogenic hyperventilation does what?

reduces placental blood flow (risk of fetal asphyxia)

Why should the parturient avoid NSAIDs after the first trimester

potentially closes the ductus arteriosus

Surgery is delaeyed __-__ weeks afterf delivery

2-6 weeks

Normal maternal PaCO2

30 mmHg

Chronic vs Gestational HTN timeframe

Chronic occurs before 20 weeks Gestational develops after 20 weeks

Preeclampsia is more common is mothers < __ and > __ years

< 20 years > 35 years

Who has the highest risk for developing preeclampsia?

-chronic renal disease and those that are homozygous for the angiotensinogen T235 allele

Preeclampsia: thromboxane vs prostacyclin

7 times more thromboxane produced vs prostacyclin

Key complications of preeclampsia:

HF, pulmonary edema, intacranial hemorrhage, cerebral edema, DIC, proteinuria

Definitive treatment for preeclampsia:

delivery of the baby

When should you treatg BP in preeclampsia?

160/110

Treatment for Preeclampsia and doses:

Labetalol 20mg IV followed by 40-80 mg q10 up to 220mg Hydralazine 5 mg IV q20 up to 20 mg max Nifedipine 10mg PO q20 up to max of 50 mg Nicardipine infusion started at 5 mg/hr up to 15mg/hr

Risk of stroke and pulmonary htn are highest when?

postpartum period (preeclampsia)

Mg infusion for the eclamptic patient:

Load: 4g over 10 mins Infusion: 1-2 g/hr

Treatment for Mg+2 toxicity

10mL of 10% calcium gluconate IV

What is HELLP syndrome?

Hemolysis, Elevated Liver enzymes, and Low Platelet count 5-10% of preeclamptic patients epigastric pain and upper abdominal tenderness

Placenta covers the cervical os

Placenta Previa causes painless vaginal bleeding

Placenta attaches to the surface of the myometrium

Placenta Accreta Accreta Attaches

Placenta invades the myometrium

Placenta increta Increta Invades

Placenta extends beyond the uterus

Placenta percreta Percreta Penetrates

Most common cause of postpartum hemorrhage?

Utrine atony

What provides uterin relaxation for placental extraction?

IV nitroglycerin

APGAR scoring

HR: Absent 0, < 100bpm 1, > 100 bpm 2 Respiratory effort: Abesnt 0, slow, irregular 1, normal, crying 2 Muscle Tone: limp 0, flexion 1, active motion 2 Reflex irritability: abesnt 0, grimace 1, cough, sneeze, cry 2 Color: pale, blue 0, body pink extemities blue 1, completely pink 2

Normal baby SpO2

60% rise o 90% after 10 mins

_____ increases the risk of an inflammatory response. Use what instead?

supplemental oxygen use room air instead of 100% FiO2

What is the best indicator of adequate ventilation in the newborn?

resolution of bradycardia

IV epi dose for newborn reuscitation Intratracheal?

10-30 mcg/kg 0.05 - 0.1 mg/kg

Volume expansion for newborn resuscitation

10mL/kg PRBCs NS LR

Obstetrics Flashcards

(90 cards)