3. Pregnancy-OB Flashcards
(140 cards)
1
Q
gravida
A
number of times pregnant, including current pregnancy
2
Q
parity
A
number of deliveries that made it past 20 weeks gestation (completed pregnancies)
- not necessarily a live birth
3
Q
primigravida
A
1st pegnancy
4
Q
multigravida
A
2 or more pregnancies
5
Q
grand multigravida
A
4 or more pregnancies
6
Q
multiparous
A
delivered more than one baby
7
Q
nulliparous
A
has not give birth previously
8
Q
twins count as what parity
A
1
9
Q
miscarriage/abortion
A
loss of fetus prior to 20 weeks
10
Q
stillborn
A
loss of fetus after 20 weeks
11
Q
GTPAL
A
gravida
term births
pre-term births (prior to 37 weeks gestation)
abortions
living
12
Q
CV changes in pregnancy
A
decr SVR by 35%
incr BV
incr CO
13
Q
what decreases SVR
A
incr progesterone
incr NO
incr prostacyclin
decr NE
incr relaxin
14
Q
prostacyclin
A
prostaglandin produces by vascular smooth muscle and endothelium
- stimulates vasodilation
- inhibits platelet aggregation
15
Q
relaxin
A
reproductive hormone produced by ovaries and placenta
- loosens everything
16
Q
what compensates for decr SVR
A
incr HR
incr BV
17
Q
what incr plasma volume
A
incr renin
18
Q
Hct changes at end of first trimester
A
decreased due to dilutional anemia
19
Q
when is cardiac output the highest
A
3rd stage of labor (80% from pre-labor levels)
20
Q
structural changes of heart
A
ventricular hypertrophy (both LV/RV)
dilation
mild valvular insufficiency
21
Q
preg ECG changes
A
sinus tachycardia
left axis deviation
incr arrythmias
22
Q
supine hypotension syndrome
A
compression of IVC
- severe hypotension
- initial tachycardia then bradycardia
23
Q
treat supine hypotension
A
LUD
(wedge under right side)
24
Q
preg respiratory
A
decr FRC
incr TV
incr MV
incr PaO2
airway edema = incr difficult airway
25
do pregnant pts have change in desaturation rates during apnea
more rapid desturation
- incr BMR
- decr FRC
- right shift
26
coagulation state during pregnancy
hypercoagulable to prevent hemorrhage
27
what incr coagulation
incr factors
decr protein S
protein C resistance
decr fibrinolysis
28
LES tone in pregnancy
LES tone decreases
29
gastric emptying in preg
normal
slow in labor
30
bile secretions during preg
increased bile secretions
(decr GB motility)
31
fasting glucose should be ______ compared to pre-pregnancy levels
fasting glucose lower than pre-preg levels
32
E2 increases levels of
TBG
T3/T4
33
what happens to the pain threshold in pregnancy
elevated due to progesterone/endorphins
34
do you need a higher or lower MAC in pregnancy
lower MAC
35
CSF in pregnancy
decreased
36
renal BF in pregnancy
increased
37
BUN/Cr in pregnancy
decreased
38
LAST symptoms
mental status changes
anxiety
muscle twitches
seizures
bradycardia
arrythmias
hypotension
cardiac arrest
39
LAST management
100% Fio2
airway management
Intralipid
40
intralipid dosing
100mL bolus over 2-3 mins
200-250mL infusion over 15-20 min
41
intralipid max dose
12 mL/kg
42
common surgeries during pregnancy
ovarian cystectomy
appendectomy
cholecystectomy
breast-biopsy
trauma
43
cardiac sx during pregnancy mortality
maternal: 3-15%
fetal" 20-35%
44
pregnancy anesthesia induction changes
faster induction:
incr MV
decr FRC
45
local anesthetics during pregnancy
increased effect
higher risk of LAST at lower doses
46
critical organogenesis
first trimester
47
tetragenic drugs
high dose diazepam
nitrous oxide (extended dose)
volatile anesthetics
48
sugammadex and pregnancy
avoid routine sugammadex in pregnancy due to progesterone impacts
49
intrauterine asphyxia causes
inadequate blood flow
inadequate O2 offload
50
inadequate blood flow causes
maternal hypertension
uterine hypertension
51
pregnancy BP during surgery
SBP > 100 mmHg
MAP > 65 mmHg
> 80% of baseline
52
elective surgery
delay until 2-6 weeks postpartum
53
what trimester is best for surgery
2nd trimester
54
1st trimester has higher risk of
teratogenicity
55
3rd trimester has higher risk of
preterm labor
56
what type of anesthetic minimized fetal exposure
regional
57
when is LUD needed
2d and 3rd trimesters
58
what is required for all pregnant pts before surgery
aspiration prophylaxis
59
aspiration precautions
H2 blocker (pepcid)
nonparticulate antacid (sodium citrate)
metoclopramide
60
when do you use an RSI on pregnant pts
after 12 weeks
61
gestational hypertension
BP > 139/89 after first 19 weeks
no proteinuria
severe >159/109
62
preeclampsia
new onset hypertension
new onset proteinuria
20+ weeks
63
preeclampsia physiologi
abnormal implantation of placenta
64
preeclampsia risk factors
obesity
nulliparity
advanced maternal age
chronic HTN
CKD
diabetes
multiple gestation
65
preeclampsia symptoms
HTN
CHF
pulm edema
hypoxemia
hypovlemia
laryngeal edema
seizures
66
severe preeclampsia
BP > 159/109 (>6hr apart)
preoteinuria >5g in 24 hrs
67
preeclampsia treatment
delivery
mag sulfate
HTN medications (<160/110)
68
preeclampsia epidural
recommend early placement
facilitates safe BP managmeent in labor
69
preeclampsia general
incr risk of difficult intubation
incr risk of apsiration
incr sensitivity to NDMR
incr risk uterine atony
incr risk postpartum hemorrhage
70
eclampsia
preeclampsia that progresses to seizures or coma
71
what percentage of seizures occur at term
75%
72
does the magnitude of HTN correlate with risk of eclampsia
No
73
is eclampsia an indication for c section
no
74
seizure control
magnesium (2g every 15 mins)
max 6g
75
HELLP
hemolysis
elevated liver enzymes
low platelets
76
HELLP common symptoms
RUQ
proteinuria
malaise
77
HELLP labs
hemolysis
- incr bilitubin
- incr lactate dehydrogenase
elevated liver enzymes
low platelets
78
HELLP treatment
delivery
seizure prophylaxis (mag sulfate)
platelets
79
neuraxial anesthesia and HELLP
CI with thrombocytopenia
80
PPROM treatment
CCB
magnesium
beta agonists
81
placenta previa
placenta attached to lower area of uterus and cover maternal cervix
82
placenta previa symptoms
painless vaginal bleeding
32 weeks
83
placenta previa types
complete
partial
marginal
84
placenta previa treatment
deliver after fetal lung maturity (37 weeks)
deliver via c section
85
placenta previa prognosis
maternal mortality: rare
infant mortalioty: 12 in 1000
86
placenta previa anesthetic management
type and cross
regional preferred
large bore IV
87
placenta previa GETA induction
ketamine
88
vasa previa
fetal vessels near to inner cervical os at risk of rupture
89
vasa previa risk factors
low lying placenta
IVF
twins
90
vasa previa c section
elective c section at 35 weeks
maternal bedrest 30-32 weeks
91
placenta accreta
placenta abnormally adheres to myometrium
92
placenta accreta risk
massive hemorrhage
93
accreta
adherant placenta that has not invaded myometrium
94
increta
placenta that has invaded the myometrium
95
percreta
placenta that has invaded through the serosa/bladder
96
placenta accreta symptoms
no symptoms
97
when is placenta accreta diagnosed
at time of delivery
98
placenta accreta treatment
elective c section at 34 weeks
typically w/hysterectomy
99
placent accreta anesthetic management
hemorrhage expected
2 large bore IVs
consider art line
consider central line
4 units PRBC/FFP
100
most common anesthetic for placent accreta
GA
possibly continuous epidural
avoid spinal
101
placenta abruption
placenta partially or completely separates from uterine wall before birth
102
placental abruption fetal symptoms
fetal distress
decreased perfusion due to maternal hypotension
103
placental abruption symptoms
abdominal pain
vaginal bleeding
severe blood loss
104
placental abruption diagnosis
ultrasound
105
placental abruption prognosis
DIC (10%)
106
placental abruption anesthesia management
epidural if no fetal/maternal issues
emergency C section with GETA if hemorrhage
107
obstetrics hemorrhage
leading cause of all pregnancy-related deaths
3-5% of all vaginal deliveries
108
hemorrhage resuscitation
1:1:1
pRBC: FFP: Plts
TXA
Factor VII
109
uterine rupture
division of all 3 layers of uterus
110
uterine rupture risk factors
myometrial scar
connective tissue disorder
trauma
111
uterine ruprure symtpoms
severe abdominal pain w/shoulder referral
maternal hypotension
no fetal heart tones
112
uterine rupture treatment
immediate laparotomy
113
113
uterine rupture prognosis
maternal mortality: rare
fetal mortality: 35%
114
uterine dehiscence
incomplete division of uterus that does not penetrate all layers
115
DIC
overactive clotting followed by uncontrollable bleeding
116
triad of death
hypothermia
acidosis
coagulopathy
117
amniotic fluid embolism
disruption of barrier between the amniotic fluid and maternal circulation that results in CV collapse
118
AFE diagnosis
requires 4 features:
acute hypotension/cardiac arrest
acute hypoxia
coagulopathy/severe hemorrhage
within labor or 30 mins postpartum
119
AFE treatment
intubate/mechanical ventilation
100% FiO2
inotropic support
fluids
coagulopathy correction
ECMO
120
what presents similar to AFE
LAST
pulm embolism
high spinal
venous air embolism
121
peripartum cardiomyopathy
aquired cardiomyopathy during pregnancy
LV systolic
EF < 45%
122
peripartum cardiomyopathy treatment
optimize preload
decr afterload
incr contractility
possible anticoags
123
peripartum cardiomyopathy anesthetic management
art line
central line with PAC
124
should you place a spinal or epidural in peripartum cardiomyopathy
epidural early
not spinal (not tolerated)
not GA
125
multiple gestation
typically c section
- diamniotic w/breech
- monoamniotic
126
multiple gestation anesthetic
epidural
large bore IV
127
kidney disease
poor fetal outcomes
worse anemia
high risk preeclampsia
128
liver disease
cholestatis
HELLP
129
gestational diabetes
2% of pregnant women
insulin resistance
130
glycemic control range
60-120 mg/dL
131
maternal diabetes risk to neonate
late trimester stillbirth
resp distress
hyperglycemia
132
diabetes pregnancy anesthetic management
epidural encouraged
more prone to hypotension
133
what pts have a higher risk of epidural failure
obese patients
134
hyperemesis gravida
intractable vomiting during pregnancy
- weight loss
- dehydration
- ketonuira
135
chorioamnionitis
infection of placenta and amniotic fluid
136
hyperemesis gravidarum treatment
antihistamines
IV fluids
NG
metoclopramide
ondansetron
137
chorio symptoms
fever
maternal/fetal tachycardia
abdominal pain
138
chorio management
abx
urgent/emergent C section
139
