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NUNA 693 Obs/Regional > OB: Non-Obstetric Sx During Pregnancy > Flashcards

OB: Non-Obstetric Sx During Pregnancy Flashcards

1
Q

Up to 1 in ___ parturients will require surgery during their pregnancy
_____/year in the US

A

50
80,000

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2
Q

Most are urgent or emergent surgeries

A

Trauma
Ovarian cysts
Appendicectomy
Cholecystectomy
Breast
Cervical incompetence
Craniotomy
CPB
Liver transplantation

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3
Q

Anesthetic Management

Maternal Physiology (4)

A

Respiratory
Cardiovascular
Gastrointestinal
CNS

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4
Q

Anesthetic Management

Maintenance of ____ _____

A

Fetal Oxygenation

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5
Q

Anesthetic Management

Prevention of _____ Labor

A

Preterm

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6
Q

Teratogenicity - what not to give

The usual suspects (2)

A

Nitrous Oxide
Benzodiazepines

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7
Q

Teratogenicity - what not to give

New issues

A

Neurotoxicity?
Apoptic neurodegeneration?

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8
Q

Anesthetic Management less than 24 wks gestation

A

Postpone if possible
Post op assessment by OB
Counsel preoperatively
Nonparticulate antacid
Maintain normal O2, CO2, BP, & Glucose
Regional when appropriate
Document FHT before & after

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9
Q

Anesthetic Management greater than 24 weeks

A

Postpone if possible
Counsel preoperatively
OB consult, prophylactic tocolytics?
Aspiration prophylaxis
Uterine displacement
Maintain normal O2, CO2, BP, & Glucose
Document FHT before & after, or continuous if feasible
Regional when possible

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10
Q

Tocolysis - PO/PR _____ few anesthesia implications

A

Indomethacin

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11
Q

Tocolysis - PO _____ contribute to hypotension

A

Nifidepine

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12
Q

Tocolysis - IV Mag Sulfate potentiates ______ and attenuates ______ responsiveness

A

nondepolarizers
vascular

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13
Q

Preoperative Pregnancy Testing

Minimum: date of ____

A

LMP

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14
Q

Preoperative Pregnancy Testing

_____ testing is controversial

A

mandatory

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15
Q

Intraoperative Management

No preference as to type of anesthesia maintenance, assuming maintenance of _______

A

normotension

One small study suggested general better than regional of ovarian mass, but not replicated in larger studies

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16
Q

Intraoperative Management

_____ monitoring

A

standard

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17
Q

Intraoperative Management

____ pre and post at minimum, intraoperatively either continuous or intermittent if it won’t interfere with surgery

A

FHT

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18
Q

Intraoperative Management

Loss of beat-to-beat is _____ (General or MAC), but not fetal ______

A

expected
bradycardia

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19
Q

Intraoperative Management

Decelerations: increase maternal _____, increase maternal ___, increase uterine _____, adjust surgical ______, begin tocolysis

A

oxygenation
BP
displacement
retraction

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20
Q

Intraoperative Management

Monitoring ____ ____ to improve fetal outcomes

A

hasn’t shown

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21
Q

General Anesthesia implications (7)

A

Full preoxygenation/denitrogenation
RSI
Avoid hypoxia
Difficult airway??
First trimester – high dose ketamine (>2mg/kg) can cause uterine hypertonus
MAC is decreased 20-40% in pregnancy
Muscle relaxants should be given slowly to prevent acute increases in acetylcholine

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22
Q

Regional Anesthesia implications (4)

A

Minimize drug exposure
No change in FHT variability
Adequate volume and ephedrine or phenylephrine to prevent hypotension
Decrease neuraxial dose by 1/3

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23
Q

Postoperative Care

Continue monitoring ____ & _____ activity

A

FHT & uterine

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24
Q

Postoperative Care

Treat preterm labor ____ & ____

A

early and aggressively

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25
Q

Postoperative Care

L&D unit or L&D RN in ____ area

A

recovery

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26
Q

Postoperative Care

Pain meds will _____ beat-to-beat variability

A

decrease

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27
Q

Postoperative Care

High risk for embolus, should ____ as early as possible

A

ambulate

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28
Q

Postoperative Care

Maintain oxygenation and ____ ____

A

uterine displacement

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29
Q

Postoperative Care

_____ consult if greater than 23 weeks

A

Neonatology

30
Q

Trauma

Leading cause of ____ ____

A

maternal death

31
Q

Trauma

Fetal loss due to (3)

A

hemodynamic instability, abruption or maternal death

32
Q

Trauma

Continuous fetal monitoring ____ weeks

A

> 23

33
Q

Trauma

Do not avoid diagnostic tests, but ____ ____ if possible

A

shield fetus

34
Q

Trauma

___ & ____ do not use ionizing radiation, Head CT is of ___ risk to fetus

A

U/S & MRI
no

35
Q

Trauma

Cesarean delivery indication (4)

A

Stable mom, fetus in distress
Uterine rupture
Gravid uterus interfering with maternal abdominal repairs
Viable fetus, nonviable mom

36
Q

ECT

_____ disease is a significant cause of maternal morbidity and mortality

A

Psychiatric

37
Q

ECT

Withholding treatment for any disease is ____ ____

A

rarely justified

38
Q

Cardioversion

Direct current cardioversion is ____ in all stages of pregnancy

A

safe

39
Q

Cardioversion

Careful ___ monitoring is required
___ ____ displacement

A

FHT
Left uterine

40
Q

Cardioversion

Aspiration risk: sedation vs. GETA precuations (2)

A

Non-particulate antacid
Consider H2 antagonist

41
Q

Maternal Cardiac Arrest

____ Uterine displacement, Hands __-____ ____ on sternum for compressions

A

Left
1-2 cm higher

42
Q

Maternal Cardiac Arrest

Perimortem cesarean delivery within __ _____

A

5 minutes

43
Q

Maternal Cardiac Arrest

Similar causes for arrest as non-pregnant, with addition of (4)

A

AFE
Eclampsia
Placental abruption
Hemorrhage

44
Q

Laparoscopic - Fetal outcomes are ____ with laparotomy or laparoscopy

A

similar

45
Q

Laparoscopic - CO2 insufflation does cause fetal ___ ____

A

respiratory acidosis

46
Q

Laparoscopic - Keep intraabdominal pressures as ___ as possible and as ___ as possible

A

low
short

47
Q

Laparoscopic - Fetal shielding during ____ (cholangiograms)

A

x-ray

48
Q

Laparoscopic - Maintain ___ ____ displacement

A

left uterine

49
Q

Laparoscopic - ____ _____ to prevent DVT

A

Compression stockings

50
Q

Cardiopulmonary Bypass - Maternal decompensation can occur 28-30 weeks with increase of blood volume and cardiac output with _____ _____ ______ or ____

A

stenotic valvular lesions or PHTN

51
Q

Cardiopulmonary Bypass - Immediate _____ is another time of concern

A

postpartum

52
Q

Cardiopulmonary Bypass - If possible, delay to ____ trimester

A

second

53
Q

Cardiopulmonary Bypass - In patients close to term combined ____ and ____ replacement has been successful

A

cesarean and valve

54
Q

Cardiopulmonary Bypass - Beyond ___ weeks, monitor fetus & maintain uterine displacement

A

24

55
Q

Cardiopulmonary Bypass - Higher pump flows may be ______ per animal studies

A

beneficial

56
Q

Cardiopulmonary Bypass - Fetal ____ is common when going on pump, but returns to normal without beat-to-beat

A

bradycardia

57
Q

Cardiopulmonary Bypass - Hypo____? Normo____?

A

Hypothermia? Normothermia?

58
Q

Fetal Interventions

Rapidly _____
Ethical issue: maternal safety vs. risks to the mother & fetus vs. benefits to the fetus

A

evolving

59
Q

Fetal Interventions

Performed at few highly ____ centers

A

specialized

60
Q

Fetal Interventions

_____, ultrasound guided trocars into amniotic cavity

A

Fetoscope

61
Q

Fetal Interventions

Work around placenta _____

A

implantation

62
Q

Fetal Interventions

Can be with ____ or ____ with sedation depending on case and surgical technique

A

local or neuraxial

63
Q

EXIT Procedures

__-__ MAC for uterine relaxation

A

2-3

64
Q

EXIT Procedures

Partial ____, then ___ _____ for fetal analgesia & immobilization

A

delivery
IM injection

65
Q

EXIT Procedures

Step one is secure ___ ____

A

fetal airway

66
Q

EXIT Procedures

After procedure, ___ decreased to increase uterine tone, then ____ _____ baby delivered. Now uterine tone = good

A

MAC
cord clamped

67
Q

Open Mid-Gestation Fetal Surgery

Myelomeningocele
Intrathoracic ____ with _____ (severe fetal edema)
Similar to EXIT, but fetus is returned to uterus prior to ____ ____
Aggressive _____

A

lesions with hydrops
uterine closure
tocolysis

68
Q

___ ____ increase risk of uterine rupture

A

Fetal surgeries

69
Q

____ ____ is necessary for this (uterine rupture) and all future deliveries prior to onset of labor

A

Cesarean delivery

70
Q
A

NUNA 693 Obs/Regional (13 decks)

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