32. Pregnancy Flashcards
(170 cards)
1
Q
gravida
A
number of times pregnant including current pregnancy
2
Q
primigravida
A
1st pregnancy
3
Q
multigravida
A
2nd pregnancy
4
Q
grand multigravida
A
4+ pregnancies
5
Q
parity
A
number of deliveries that made it past 20 weeks gestation
6
Q
miscarriage
A
loss of fetus prior to 20 weeks
7
Q
stillbirth
A
loss of fetus after 20 weeks
8
Q
GTPAL
A
Gravida
Term births
Preterm births
Abortions
Living
9
Q
Factors that decrease O2 transfer to fetus: changeable
A
Environmental Po2
Maternal Cardiopulm function
10
Q
Factors that decreases O2 transfer to fetus: cannot change
A
O2 transport by maternal blood
placental blood flow
placental O2 transfer
umbilical blood floow
fetal circulation
O2 transport by fetal blood
11
Q
environmental Po2
A
high altitude
12
Q
maternal cardiopulm function
A
cyanotic heart disease
13
Q
O2 transport by maternal blood
A
anemia
cigarrette smoking
14
Q
placental blood flow
A
HTN
diabetes
placental abruption
uterine contractions
15
Q
placental O2 transfer
A
placental abruption
placental infarcts
16
Q
umbilical blood flow/fetal circulation
A
umbilical cord occlusion
maternal heart disease
17
Q
O2 transport by fetal blood
A
anemia
hemorrhage
18
Q
decreases in maternal blood flow can
A
reduce placental blood flow
19
Q
uterine blood flow is_____
A
cyclical
20
Q
as contraction occurs, blood flow
A
decreases
21
Q
as contraction subsides, blood flow
A
increases
22
Q
historically, vasopressor of choice in OB
A
ephedrine
23
Q
ephedrine DOA
A
longer
24
Q
ephedrine activity
A
alpha
beta
25
does ephedrine cross the placenta
yes
26
phenylephrine benefitsm in OB
lower risk of fetal acidosis
higher decr in IONV
preserves SBP and UBF
27
neuraxial anesthesia: increases UBF
pain relief
decr sympa
decr maternal hypervenilation
28
neuraxial anesthesia: decr UBF
hypotension
LA or Epi injection
absorbed LA
29
primary cause of decreased UBF due to neuraxial anesthesia
hypotension
30
what crosses the placenta
small
uncharged
lipophillic
unionized
albumin bound
high unbound fraction
31
32
what molecular weight has increased placenta transfer
<1000 Da
33
what protein binding has decreased placenta transfer
A1-acid glycoprotein (AAG)
34
what drugs do not cross the placenta
heparin
glyco
nondepolarizers
sux
sugammadex
phenylephrine
35
36
what drugs cross the placenta
atropine
scopolamine
BB
nipride
NTG
bezos
IA
VA
N2O
Ephedrine
LA
opioids
neostigmine
37
what do you need to use for OB reversal
neostigmine and atropine
38
dilation
cervical opening
39
effacement
% of cervical thinning
40
station
amount of fetal decent in relation to ischial spine
41
X/X/X
dilated/effeced/station
42
which station is higher in the pelvis
-3 is high
+3 is low
43
AROM
artificial rupture of membranes
44
BTL
bilaterla tubal ligation
45
IUFD
intrauterine fetal demise
46
PPROM
preterm premature rupture of membranes
47
PROM
premature rupture of membranes
48
TOLAC
trial of labor after CS
49
1st stage: latent
cervical dilation
50
1st stage: latent dermatome
T11-12
51
1st stage: latent - nervous pathway
uterovaginal plexus
52
1st stage: active
uterine compression
53
1st stage: active dermatome
T11-L1
54
1st stage: nervous pathway
hypogastric plexus
55
what stage of labor is covered by epidural
stage 1
56
stage 2
perineal pain
fetal decent
57
stage 2 pain dermatome
T10-S4
58
stage 3
placenta expulsion
59
opioid SE
loss of beat to beat variability in FHR
decr fetal movement
60
meperidine: sedation dose
10-25 mg IV
25-50 mg IM
61
fentanyl: sedation dose
25-100mcg/hr
62
butorphanol: sedation doese
1-2 mg
63
nalbuphine: sedation dose
10-20 mg IV or IM
64
which drug has mixed mu activity
butorphanol
nalbuphine
65
promethazine: sedation dose
25-50 mg IM
66
hydroxyzine: sedation dose
50-100mg IM
67
midazolam: sedation dose
2mg
68
ketamine: sedation dose
10-15 mg IV
69
larger doses of ketamine can cause
incr uterine contraction
70
most common drug for sedation
nitrous
71
spinal dosing
0.75% bupi: 1.6 mL
fentanyl (50mcg/mL): 0.4mL
morphine (0.5mg/mL): 0.3 mL
72
spinal tetracaine
3-4 mg
73
spinal bupivacaine
2.5-5mg
74
spinal lidocaine
20-40mg
75
which spinal drug can cause TNS
lidocaine
76
spinal morphine
0.1-0.5mg
77
spinal meperidine
10-15 mg
78
spinal fentanyl
10-25mcg
79
spinal sufentanil
3-10mcg
80
when would you consider epidural for c section
adhesions (multiple cs hx)
extreme morbid obesity
increta/percreta
81
do epidural incr deliver rate
no
82
do epidurals impede labor progress
no
83
walking epidural
0.0625% bupivacaine
84
epidural pump mix
0.0625-0.125% bupivacaine with 1-5 mcg/mL fentanyl
85
initial bolus
1 or 2 5mL-boluses of pump mix
86
what should you do if respiratory depression/hypotension happens during epidural
stop epidural
support as necessary
87
start infusion
5-15mL/hr
5 mL bolus
10 min lock out
total 15-25 mL /hr
88
what should you do if pt describes new pain during epidrual
incr basal rate dose
bolus 5mL of 0.25% bupi, 100mcg fentanyl, 3 mL saline
89
emergent C/S with epidural
give 20 mL 2% lido w/ 1:200,000 epi
4 ML bicarb
2 mL fentanyl
after delivery:
1.5-2mg morphine diluted to 10Ml with saline
90
CSE indication
pt in stage 2 labor and need immediate relief
potential for prolonged labor
91
what block alleviates stg 2 labor pain
pudendal
92
regional advantages vs GA
decr fetus drug exposure
decr maternal aspiration
mother awake
neuraxial opio0ds
93
intrauterine resuscitations during non-OB sx
incr LUD
incr O2 concentration
treat hypotension
decr retraction, insufflation
good EtCo2
good acid/base status
check Hb
consider uterine relaxation
94
meds for uterine relaxation
VA
NTG
95
when can you do FHT monitoring
>24 weeks
96
cervical cerclage
suture to secure incompetent cervix
97
cervical cerclage: primary anesthetic
spinal
alts:
epidural
GETA
98
what period has high stem cell differentiation
teratogenic period
31-71 dayswh
99
what drugs are taratogenic
benzos
nitrous
sugammadex
100
what should you avoid to mx uterine blood flow
avoid:
hypercapnia
hypocapnia
hypoxia
101
what drugs should you avoid in pregnant pts
VA
NSAIDS (PDA)
benzos (cleft palate)
keppra
amiodarone
102
when are pregnant pts full stomach
>18 weeks
103
apiration prophylaxis
nonparticulate antacid (sodium citrate)
H2 agonist (famotidine)
metoclopramide
104
LUD should be done after
18 weeks
105
suction D& C primary anesthetic
LMA
Alts:
MAC
Spinal
Epidrual
GETA
106
what should you have on standby for duction D and C
anxiolytic
oxytocin
107
most likely ectopic pregnancy olocation
fallopian tube
108
ectopic anesthetic consideration
Type and screen
large bore IV
GETA
109
what could happen during a pUBS
emergent C/S
110
external cephalic version anesthetic
CSE w/catheter
50 mg of 1% chloroprocaine
111
intrauterine procedure concerns
maternal hemorrhage
(type and screen at least)
112
intrauterine procedure prep
type and screen
art line
lg guage IV
warming
fetal monitopring
113
open hysterotomy MAC for uterine relaxation
2-3 MAC
114
open hysterotomy uterine relaxation
VA
NTG bolus
115
NTG bolus for uterine relaxation
50-100 mg
116
open hysterotomy maternal fluid restrictions
<2L
117
when do you start magnesium bolus and infusion during open hysterotomy
after fetal sx completed
118
open hysterotomy mgnesiuum
4-6g over 20 min
1-2 g/hr
119
C/S complications
hemorrhage
infection
120
should you push abx slow or fast during c section
slow
fast can cause N/V
121
1st line uterotonic
massage
pitocin
122
2nd line utertonic
methergine
hemabate
cytotec
123
pitocin dosing
30 units in 500 ml saline
3 units every 3 mins for 3 doses
3 unites/hr mx
124
methergine dose
0.2mg IM
125
why dont you give methergine iV
severe hyptension
126
methergine onset
10 min
127
methergine duraton
3-6 hrs
128
methergine SE
N/V
129
hemabate dosing
0.25mg IM
130
hemabarte max dose
2 mg
131
hemabate SE
bronchospasm
diarrhea
HTN
vomiting
tachycardia
132
when can you repeat hemabate
15-90 min intervals
133
cytotec dose
800-1000mcg rectal
134
TOLAC CI
t shape uterine incision
previous uterine rupture
other labor complication
facility unable to provide emergent C/S
135
blood saving measures
iron supplements
EPO
autologous donation
normovolemic hemodilution
cell salvage
balloon catheters
136
do you need to have pts pump and dump?
no
137
Preeclampsia
BP: > 140/90
20+ weeks gestation
proteinuria: >300 mg/day
138
ecclampsia
seizures
HTN
proteinuria
139
HELLP
hemolysis
elevated liver enzymes
low platelets
140
magnesium potentiaties
NMDRs
(need to give less Roc)
141
what treats mag toxicity
Calcium gluconate
1 g over 10 mins
142
mag loading dose
4g
143
mag infusion dose
1-3 g/hr
144
mag optimal range
4-6 mEq/L
145
preeclampsia definitive treatment
deliver placenta
146
neuraxial low limit PLTs
50,000 w/normal TEG
147
placenta previa
adherance of placenta over cervical os
148
placenta accreta
implantion onto myometrium
149
placenta increta
implantation into myometrium
150
placenta percreta
implantation through entire myometrium into bladder/bowel
151
accreta median blood loss
2-5L
152
abruptio placentae
dehiscence of placenta from uterus
153
what can cause uterine rupture
previous C/S scar
eversion
excessive utertonics
154
uterin rupture suymptoms
abrupt abdominal pain
hypotension
155
leading cause of maternal death
postpartum hemorrhage
156
postpartum hemorrhage
EBL after delivery > 500mL
157
hemorrhage causes
uterine atony
retained placenta
obstetric lacerations
158
atony correction
0.3-1 IU oxytocin bolus
5-10 IU/hr infusion
plus:
methergine
hemabate
TXA
159
which artery may need to be ligated in severe postpartum hemorrhage
internal iliac hypogastric artery
160
heart dz with reduced SVR
mitral regurge
aortic regurge
CHF
left to right shunt
161
heart dz with normal to incr SVR
aortic stenosis
congenital lesions
right to left shunt
PHTN
162
heart dz with reduced SVR neuraxial
normal neuraxial sympathectomy is helpful
163
heart dz with normal to incr SVR neuraxial
use neuraxial with sole opiods
pudendal nerve block
GETA
164
AFE mortality
86%
165
what causes AFE
placental abruption
placenta previa
uterine rupture
166
AFE symptoms
techycardia
cyanosis
shock
general bleeding
167
AFE presents similar to
PE
DIC
uterine atony
168
AFE treatment
CPR
supine
left tilt
baby out ASAP
169
AFE monitoring
central line
170
