OB

Question 1

1 maternal death in US

Answer 1

cardiovascular disease

Question 2

Coagulation factors that increase

Answer 2

1 = fibrinogen (doubles)

VII, VIII, IX, X, XII, vWF
D-dimer

Question 3

Cardiac changes in pregnancy

Answer 3

Inc SV, HR, CO

Progesterone –> dec SVR, MAP, afterload

Question 4

Time CO is greatest in pregnancy

Answer 4

immediately after delivery (75%)

Question 5

Resp changes in pregnancy

Answer 5

MV inc 50% due to inc TV
Resp alkalosis 7.44/30/104/20

Dec RV, ERV = FRC
Faster inhalation induction d/t dec FRC and inc MV

Question 6

Tx of AFE

Answer 6

Inflammatory mediators is cause

Intubate, 100% O2
Fluids
Phenylephrine +/- milrinone –> Norepi and epi if LV fails
Early administration of blood products

Question 7

What hemodynamic parameter is NOT likely to change during pregnancy?

Answer 7

CVP

Question 8

Lab changes in pregnancy:

1. Cr
2. Uric acid
3. Bicarb
4. Prothrombin time (PT)
5. D-dimer
6. Albumin

Answer 8

1. Dec
2. Dec
3. Dec (18-22)
4. Dec
5. Inc
6. Dec

Question 9

Oxy hemoglobin dissociation curve in pregnancy?

Answer 9

RIGHT shift - P50 is 30mmHg

Facilitates unloading to fetus + in CO to compensate for dilutional anemia

Question 10

LA most likely to undergo ion-trapping in fetal acidemia

Answer 10

Lidocaine

Bupi and Ropi highly protein bound and cross placenta less freely

Question 11

Risk factors for placenta accreta

Answer 11

AMA
Multiparity
Placenta previa
Previous uterine surgery
Smoking

Question 12

Electrolyte abnormality with oxytocin

Answer 12

hypoNa

Question 13

Coagulation factor that DECREASES in pregnancy?

Answer 13

Protein S

Question 14

Indications for uterine relaxation

Answer 14

VD of twin in transverse position
Breech position to deliver head
C/S for fetal anomaly (hydrocephalus)
Inverted uterus
Retained placenta