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EDRA > 6.1 Obstretrics > Flashcards

6.1 Obstretrics Flashcards

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1
Q

Physiological changes seen in pregnancy,

Cardiovascular system

Increase

A

Increase

Blood volume

Plasma volume

Cardiac output

Heart rate

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2
Q

Physiological changes seen in pregnancy,

Cardiovascular system

Decrease

A

Decrease

Systemic vascular resistance

Pulmonary vascular resistance

Pulmonary artery pressure

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3
Q

Physiological changes seen in pregnancy,

Cardiovascular system

Unchanged

A

Unchanged

Central venous pressure

Pulmonary capillary

wedge pressure

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4
Q

Physiological changes seen in pregnancy,

Respiratory system

Increase

A

Increase

Respiratory
system

Minute ventilation

Alveolar ventilation

Tidal volume

Inspiratory capacity

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5
Q

Physiological changes seen in pregnancy,

Respiratory system

Decrease

A

Decrease

Functional residual capacity

Minimum alveolar concentration
of volatile anaesthetics

Residual volume

Total lung capacity

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6
Q

Physiological changes seen in pregnancy,

Respiratory system

Unchanged

A

Unchanged

Respiratory rate

Forced vital capacity

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7
Q

Physiological changes seen in pregnancy

Gastric emptying time

A

Delayed gastric emptying

Consider patients as non-fasting

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8
Q

Physiological changes seen in pregnancy

Change in composition of blood

A

Higher increase in
plasma volume
than in red blood cell mass

Physiological anaemia

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9
Q

Physiological changes seen in pregnancy

Change of serum enzymes

A

Decrease in serum cholinesterase activity

Prolonged action of suxamethonium

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10
Q

Physiological changes seen in pregnancy

Albumin conc

A

Fall in albumin concentration
Higher free fraction of most
protein-bound drugs,

leading to toxicity

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11
Q

Physiological changes seen in pregnancy

Hormonal affect on LA

A

Progesterone-mediated
increased
sensitivity to
local anaesthetics

Use lower doses

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12
Q

Physiological changes seen in pregnancy

Change in MAC?

A

Decrease in minimum alveolar
concentration of
volatile anaesthetics

Use lower
minimum alveolar concentration values

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13
Q

Physiological changes seen in pregnancy

Fibronogen

A

fibrinogen levels are raised

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14
Q

Protein binding in foetus vs mother

A

protein binding in the foetus
is less than that in the mother.

This results in higher ionised
fraction of local anaesthetics
in the foetus.

This
free fraction further increases
with foetal acidosis,
resulting in ion trapping

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15
Q

Explain ion trapping.

A

The protein binding in the foetus is
less than that in the mother.

This results in higher ionised
fraction of local anaesthetics in the foetus.

This free fraction further increases
with foetal acidosis,
resulting in ion trapping.

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16
Q

Ion trapping how does this affect highly protein bound drugs like bupiv

A

Drugs like bupivacaine which are highly protein-bound may accumulate in this way

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17
Q

Does 2 Chloroprocaine accumulate in acidosis

A

2-Chloroprocaine is an

ester local anaesthetic.

It does not accumulate in foetus during acidosis,

as it undergoes
rapid hydrolysis by
pseudocholinesterease.

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18
Q

Does RA change newborn behaviour?

A

Transient neurobehavioural changes
may be seen in
newborn after regional anaesthesia

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19
Q

Pain during First stage of labour

Stage of labour Cause of pain Dermatomes

A

First stage

Cervical dilatation
Lower uterine segment distension

T10–L1
(Pain afferents via superior hypogastric plexus)

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20
Q

Pain during 2nd stage of labour

Stage of labour Cause of pain Dermatomes

A

Second stage

Vaginal vault and perineum

S2–S4 (pudendal nerves)

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21
Q

Epidural and labour

Can it Normalise a dysfxn labour?

How?

A

Epidural analgesia relieves pain.

This decreases the
catecholamine levels in
the mother and

may change dysfunctional
labour to normal labour.

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22
Q

Epidural and labour

Effect on Resp system

A

It also decreases the

maternal hyperventilation
and prevents left shift in oxygen–
haemoglobin dissociation curve.

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23
Q

Epidural and labour affects on stages

A

Epidural analgesia
may delay the second
stage of labour.

It may not affect the first stage of labour

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24
Q

pain relief during labour

Combined spinal epidural

affect on baby?

Study These Flashcards
A

Due to instantaneous pain relief,

it results in fall in maternal catecholamine

and transient changes
in foetal heart rate (bradycardia)

25
Combined spinal epidural PDPH
The incidence of post-dural puncture headache is similar to epidural block
26
Paracervical block: Involves use?
Paracervical block: involves injection of local anaesthetic at vaginal fornix. It was mainly used to reduce pain of first stage of labour.
27
Paracervical block: Current use? why
It is not commonly used, due to its association with constriction of uterine artery and foetal asphyxia.
28
Paracervical block: second stage
It is not effective for second stage of labour, as it does not block the sensory fibres arising from the perineum.
29
Paravertebral lumbar sympathetic block Use? Common?
Paravertebral lumbar sympathetic block: can be used for pain relief during first stage of labour. However, it is not popular, as it is technically difficult and there is higher risk of intravascular injection
30
Pudendal nerve block: Where performed Use?
Pudendal nerve block: pudendal nerves are blocked around ischial spines (and not ischial tuberosity.) It can be used for analgesia during 1 repair of episiotomy 2 as well as delivery of foetus with forceps
31
2-Chloroprocaine, Use? Preparation days gone by -issue? Changed to? Issue?
2-Chloroprocaine, which is used intrathecally, is a preservative-free solution. In the past, it was formulated with a preservative sodium bisulphite which was shown to be neurotoxic. Later it was replaced with EDTA, which caused severe back pain.
32
Is there any change to morphine that can be used for section
``` A new morphine formulation (lipid-encapsulated) for epidural use has been approved for analgesia after lower-segment Caesarean section. ```
33
Aspiration of epidural catheter CSF / Blood
Positive aspiration of blood or cerebrospinal fluid from an epidural catheter identifies intravascular or intrathecal location. A negative aspiration still does not rule out a partial intravascular or intrathecal placement. Hence it may not be able to identify the correct location of the catheter
34
Other tests that may be used to identify catheter location are:
1 test dose with lignocaine 45 mg with epinephrine 15 mcg 2 epidural hanging drop technique 3 meniscus fall sign 4 injection of air through the epidural catheter and precordial Doppler monitoring.
35
Maternal mortality RA v GA
The maternal mortality with general anaesthesia is 16.7 times more than regional anaesthesia, according to studies between 1979 and 1990 in the United States.
36
Hypertensive disorders in pregnancy are classified as
Gestational hypertension: Pre-eclampsia Mild / Severe Eclampsia Chronic hypertension
37
Gestational hypertension
Gestational hypertension: a rise in blood pressure (> 140/90 mmHg) after 20 weeks of gestation without proteinuria
38
Pre-eclampsia
Pre-eclampsia: a rise in blood pressure after 20 weeks of gestation with proteinuria. Oedema may or may not be present in preeclampsia.
39
Eclampsia
Eclampsia: pre-eclampsia associated with convulsions
40
Chronic hypertension
Chronic hypertension: hypertension detected before 20 weeks of gestation. It can be primary or secondary.
41
Pre eclamptic change in IV volume? affect on spinal?
In pre-eclamptic patients, intravascular volume is depleted. Hence spinal anaesthesia is associated with severe hypotension in such patients.
42
Pre eclamptic Epidural and BP
Epidural anaesthesia results in gradual fall in blood pressure and is easy to titrate by small boluses of local anaesthetic.
43
Vasopressors and pre eclampsia
Lower doses of vasopressors are required in patients with pre-eclampsia, as they have increased sensitivity to them
44
The nerve supply to the perineum is as follows.
1. Genitofemoral nerve 2. Ilioinguinal nerve 3. Pudendal nerve 4. Perineal branch of the posterior femoral nerve
45
Genitofemoral nerve
Genitofemoral nerve (L1, L2) – innervates the anterior part of perineum.
46
Ilioinguinal nerve
Ilioinguinal nerve – | innervates the anterior part of perineum
47
Pudendal nerve arises then
Pudendal nerve arises from the anterior rami of S2–S4. These form a trunk before leaving the pelvis via the greater sciatic foramen.
48
Pudendal nerve passage terminates
It passes immediately behind the ischial spine and swings forward to enter the perineum via the lesser sciatic foramen. The nerve passes through the ischiorectal fossa, where it gives off its terminal branches, which are
49
Pudendal nerve branches
Inferior rectal nerve Perineal nerve Superficial branch Dorsal nerve of the clitoris
50
Inferior rectal nerve
branch of pudendal – innervates the external anal sphincter and the perineal skin
51
Perineal nerve
Perineal nerve – branch of pudendal deep branch innervates the sphincter urethrae and other muscles of the anterior compartment
52
Superficial branch pudendal
Superficial branch – and the skin of the perineum posterior to the clitoris branch of pudendal
53
Dorsal nerve of the clitoris
Dorsal nerve of the clitoris – branch of pudendal supplies the skin surrounding this structure
54
Perineal branch of the posterior femoral nerve innervates?
Perineal branch of the posterior femoral nerve – innervates the lateral part of perineum. nerve supply to perineum nerve
55
Analgesics in pregnancy safe
paracetamol | opioids
56
Analgesics in pregnancy Unsafe
Unsafe ``` 1 non-steroidal anti-inflammatory drugs foetus: renal dysfunction and patent ductus arteriosus mother: haemorrhage ```
57
Analgesics Breastfeeding Safe
Breastfeeding Safe non-steroidal anti-inflammatory drugs and paracetamol opioids antiepileptics (neuropathic pain) tricyclic antidepressants: amitriptyline, imipramine selective serotonin reuptake inhibitors
58
Analgesics Breastfeeding Unsafe (caution advised)
ketorolac | aspirin up to 100 mg/day

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