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Apex Review > Obstetrics 5 > Flashcards

Obstetrics 5 Flashcards

1
Q

Which signs are consistent with a diagnosis of preeclampsia?
a. seizures
b. increased thromboxane
c. increased prostacyclin
d. proteinuria
e. vasoconstriction
f. impaired platelet aggregation

A

b. increased thromboxane
d. proteinuria
e. vasoconstriction

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2
Q

We can classify obstetric hypertensive disorders as

A

Chronic hypertension
gestational hypertension
preeclampsia
eclampsia

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3
Q

Describe chronic hypertension in the setting of obstetric hypertensive disorders.

A

occurs before 20 weeks of gestation
does not return to normal after delivery

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4
Q

______ is a risk factor for developing preeclampsia

A

Chronic HTN

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5
Q

Eclampsia occurs when the mother

A

with preeclampsia develops seizures

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6
Q

Severe preeclampsia occurs when

A

the BP exceeds 160/110

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7
Q

Gestational hypertension develops after

A

20 weeks of gestation
- proteinuria does not occur

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8
Q

The only way to truly diagnose gestation HTN is

A

after delivery when a return to a normotensive state rules out chronic hypertension

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9
Q

Preeclampsia includes

A

HTN that develops after 20 weeks gestation
proteinuria is typically present

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10
Q

Describe mild vs. severe preeclampsia

A

mild= BP >140/90
severe= BP >160-110

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11
Q

The definitive treatment for preeclampsia and eclampsia is

A

delivery of the fetus and placenta

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12
Q

The presence of _____ differentiates eclampsia from prreclampsia

A

seizures

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13
Q

_______ is the drug of choice for seizure prophylaxis.

A

Magnesium sulfate

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14
Q

________ is the treatment for magnesium toxicity

A

Calcium chloride

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15
Q

Chronic cocaine abuse is associated with

A

thrombocytopenia (check platelet count before neuraxial anesthesia

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16
Q

Cocaine abuse increases the risk of

A

spontaneous abortion, premature labor, placental abruption, and low Apgar scores

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17
Q

HELLP syndrome stands for

A

hemolysis, elevated liver enzymes, and low platelet count

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18
Q

Don’t place a neuraxial block in a patient with a platelet count below

A

100,000 per microliter of blood

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19
Q

_____________ is a reasonable option for cocaine overdose because of its

A

labetalol; mixed beta 1 and beta 2 effects

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20
Q

Selectively blocking the beta-1 receptor can cause

A

heart failure if the SVR is significantly elevated
(causes myocardial depression)

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21
Q

Selectively blocking the beta-2 receptor (impaired vasodilation in muscular beds) can cause

A

heart failure if the SVR is significantly elevated (it causes SVR to increase further)

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22
Q

In some cases, preeclampsia can exist in the absence of proteinuria if the patient has any of these conditions:

A

persistent RUQ or epigastric pain
fetal growth restriction
thrombocytopenia
elevated serum liver enzymes
persistent CNS or visual symptoms (headache, hyperreflexia, hyperexcitability and coma)

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23
Q

Preeclampsia is more common in these age groups

A

<20 years old
>35 years old

24
Q

Patients with these conditions have the highest rate of developing preeclampsia

A

chronic renal disease
homozygous for the the angiotensinogen T235 allele

25
Q

The patient with preeclampsia produces up to 7x more thromboxane than prostacyclin, increased thromboxane favors

A

vasoconstriction
platelet aggregation
reduced placental blood flow

26
Q

Key complications of preeclampsia include

A

heart failure
pulmonary edema
intracranial hemorrhage
cerebral edema
DIC
proteinuria

27
Q

If symptoms of preeclampsia and eclampsia are mild and the fetus is young, the mother may be managed with

A

observation and bed rest

28
Q

The primary reason why we medicate beyond 160/110 for severe preeclampsia is

A

to prevent a CVA, MI, and placenta abruption

29
Q

Treatment for acute hypertension includes:

A

labetalol 20 mg IV
hydralazine 5 mg IV
Nifedipine 10 mg PO
Nicardipine infusion

30
Q

Describe the seizure prophylaxis with magnesium sulfate.

A

load: 4 g loading dose over 10 minutes
infusion: 1-2 g/hr

31
Q

For patients with preeclampsia, neuraxial anesthesia assists with

A

blood pressure control & provides better uteroplacental perfusion

32
Q

Patients with preeclampsia have an exaggerated response to

A

sympathomimetics and methergine

33
Q

The hemodynamic response to laryngoscopy for patients with preeclampsia can b blunted with

A

labetalol, esmolol, remifentanil, or magnesium

34
Q

_________ relaxes the uterus and increases the risk of postpartum hemorrhage

A

Magnesium

35
Q

Patients with HELLP are at higher risk for

A

DIC & Intra-abdominal bleeding from the liver

36
Q

The definitive treatment for HELLP syndrome is

A

delivery of the fetus; HELLP syndrome can present though for the first time in the postpartum period

37
Q

CV risks of cocaine abuse include

A

tachycardia, dysrhtymias, coronary vasoconstriction, and myocardial ischemia

38
Q

CNS risks of cocaine abuse include

A

cerebral vasoconstriction, ischemia, seizures, and stroke

39
Q

Acute cocaine intoxication and chronic cocaine intoxication affect MAC in the following ways:

A

chronic- decreases MAC
acute- increases MAC

40
Q

Labetalol is a reasonable choice for cocaine overdose because it blocks _________

A

alpha-mediated peripheral vasoconstriction

41
Q

Hypotension may not respond to ______ in chronic cocaine abusers.

A

ephedrine (d/t catecholamine depletion)
Neo is the best option for hypotension

42
Q

What is the antidote for magnesium toxicity?

A

10 mL of 10% calcium gluconate IV

43
Q

This is when the placenta attaches to the lower uterine segment

A

placenta previa
-associated with painless vaginal bleeding

44
Q

______ occurs when there’s partial or complete separation of the placenta from the uterine wall before delivery.

A

placental abruption (abruptio placentae)

45
Q

Placental abruption is associated with

A

pain and vaginal hemorrhage along with fetal hypoxia

46
Q

_______ is when the placenta attaches to the surface of the myometrium

A

placenta Accreta

47
Q

_____ is when the placenta invades the myometrium

A

placenta Increta

48
Q

______ is when the placenta extends beyond (penetrates) the uterus

A

placenta Percreta

49
Q

The placenta normally implants into the

A

decidua of the endometrium

50
Q

With abnormal placental implantation, uterine contractility is

A

impaired, and there is a potential for tremendous blood loss

51
Q

Describe the preferred anesthetic for patients with abnormal placental implantation

A

although neuraxial anesthesia is safe
GA is preferred

52
Q

Abnormal placental implantation is associated with

A

placenta previa & previous C-sections

53
Q

Risk factors for placenta previa include

A

previous C-sections
history of multiple births

54
Q

Placenta previa often requires

A

C-section

55
Q

Risk factors for placental abruption include

A

PIC
preeclampsia
chronic HTn
cocaine use
smoking
excessive alcohol use

Apex Review (224 decks)

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