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Principles B - Summer '25 > Complicated OB - Pt 2 > Flashcards

Complicated OB - Pt 2 Flashcards

(90 cards)

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1
Q

Define umbilical cord prolapse and its two forms.

A

Cord descends through cervix with/ before presenting part—occult (not visible, sensed as bradycardia) or overt (visible/palpable).

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2
Q

Classic fetal heart tracing change in cord prolapse.

A

Sudden prolonged fetal bradycardia or recurrent variable decelerations.

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3
Q

Name two immediate manual maneuvers to relieve cord compression.

A

Elevate presenting part with gloved hand and place mother in knee‑chest or Trendelenburg position.

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4
Q

Describe retrograde bladder filling maneuver.

A

Fill bladder with 500–600 mL warm saline via Foley to lift presenting part off cord.

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5
Q

Drug doses to relax uterus during cord prolapse management.

A

Terbutaline 0.25 mg SQ or IV nitroglycerin 50–100 µg bolus.

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6
Q

Definitive delivery method for persistent cord prolapse with distress.

A

Emergent cesarean delivery.

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7
Q

Anesthetic plan if epidural in situ for emergent cord prolapse CS.

A

Top up epidural rapidly with 3% chloroprocaine; if inadequate, proceed to GA.

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8
Q

Two types of twin zygosity.

A

Monozygotic (identical) and dizygotic (fraternal).

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9
Q

Differentiate dichorionic diamniotic vs monochorionic monoamniotic.

A

Dichorionic diamniotic: two placentas & sacs; Monochorionic monoamniotic: one placenta, shared amniotic sac.

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10
Q

Primary maternal physiologic change in twin pregnancy CV system.

A

Cardiac output rises ~20 % above singleton, mainly via increased stroke volume.

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11
Q

Pulmonary change increasing hypoxemia risk near term twins.

A

Further reduction of FRC and TLC due to larger uterus.

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12
Q

Maternal blood volume increase in twins vs singleton.

A

~105 mL kg⁻¹; plasma volume expands additional ~750 mL, predisposing to anemia.

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13
Q

Typical extra EBL anticipated with twin vaginal delivery.

A

Approximately 500 mL greater than singleton.

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14
Q

Twin‑to‑twin transfusion syndrome occurs in which placentation?

A

Monochorionic diamniotic twins with vascular anastomoses.

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15
Q

Preterm delivery incidence in twins.

A

>  50 % deliver before 37 weeks; planned at 38 weeks (twins) or 35 weeks (triplets).

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16
Q

Drug and dose to relax uterus for internal podalic version of twin B.

A

Terbutaline 0.25 mg IV/SQ or nitroglycerin 100–250 µg IV (400 µg SL).

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17
Q

Double‑setup definition in twin labor anesthesia.

A

Prepare OR for immediate cesarean while allowing vaginal attempt.

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18
Q

Preferred neuraxial technique when vaginal twin attempt.

A

CSE or epidural for analgesia, convertible to surgical level if twin B requires CS.

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19
Q

General anesthesia downsides in twin cesarean.

A

Higher difficult airway risk, ↑EBL, acidosis and depression worse in twin B.

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20
Q

Define gestational hypertension.

A

New BP ≥ 140/90 mm Hg after 20 weeks without proteinuria, resolves by 12 weeks postpartum.

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21
Q

Define preeclampsia without severe features.

A

BP ≥ 140/90 and proteinuria ≥ 300 mg/24 h or P:C ≥ 0.3.

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22
Q

List severe features of preeclampsia.

A

BP ≥ 160/110, thrombocytopenia < 100 k, serum creatinine > 1.1 mg/dL, pulmonary edema, new cerebral/visual symptoms, elevated AST/ALT.

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23
Q

Define chronic hypertension in pregnancy.

A

SBP ≥ 140 or DBP ≥ 90 existing pre‑pregnancy or persisting > 12 weeks postpartum.

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24
Q

Percentage of chronic HTN patients that develop superimposed preeclampsia.

A

20–25 %.

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25
Hallmark vascular pathology of preeclampsia.
Diffuse endothelial dysfunction from anti‑angiogenic placental factors causing vasoconstriction & capillary leak.
26
CNS warning signs of severe preeclampsia.
Severe headache, visual scotoma, hyperreflexia, PRES on imaging.
27
Respiratory complication rate of pulmonary edema in preeclampsia.
~3 %.
28
Airway consideration in severe preeclampsia.
Upper airway edema leading to decreased subglottic diameter; anticipate difficult intubation.
29
Low‑dose aspirin prophylaxis timing.
Start ≤ 16 weeks gestation for high‑risk women.
30
Magnesium sulfate loading and infusion doses for seizure prophylaxis.
Load 4–6 g IV over 20 min, then 1–2 g h⁻¹ maintenance.
31
Therapeutic serum magnesium level.
4–7 mEq L⁻¹ (or 2–3.5 mmol L⁻¹).
32
Antidote for magnesium toxicity and dose.
Calcium gluconate 1 g IV over 5 min.
33
First‑line IV antihypertensive and starting dose.
Labetalol 20 mg IV, repeat 40–80 mg q10 min up to 220 mg.
34
Hydralazine alternative dosing.
5–10 mg IV q20 min up to 30 mg.
35
Define eclampsia.
New tonic‑clonic seizure in woman with preeclampsia that cannot be attributed to other cause.
36
Immediate seizure management drug.
Magnesium sulfate 4–6 g IV bolus (additional) or 2 g if already on infusion.
37
Airway management priority during eclamptic seizure.
Prevent aspiration with left lateral tilt, suction, and prepare for RSI after seizure.
38
Definitive treatment of eclampsia.
Prompt delivery once mother stabilized.
39
Classic presentation triad of AFE.
Sudden hypoxia, hypotension, and coagulopathy/DIC during labor or soon postpartum.
40
First three steps in suspected AFE.
100 % O₂, intubate & ventilate, initiate CPR/A‑OK drugs if arrest.
41
A‑OK regimen components.
Atropine 0.2–1 mg, Ondansetron 8 mg, Ketorolac 30 mg IV.
42
Role of CPR timing in AFE with maternal arrest.
Deliver fetus within 4–5 min to improve maternal resuscitation.
43
Ideal vasopressor for treating spinal hypotension in preeclampsia.
Phenylephrine preferred; maintains uteroplacental perfusion.
44
Epidural advantages in hypertensive parturient.
Blunts stress response, lowers BP, provides surgical anesthesia if CS needed.
45
Platelet count threshold for neuraxial in preeclampsia.
≥ 70 000 /µL generally considered safe if stable and no coagulopathy.
46
Occult cord prolapse definition.
Cord compressed alongside presenting part; detected by fetal bradycardia without visible cord.
47
Twin delivery sequence risk for acidosis in twin B under GA.
Longer uterine relaxation & surgical time leads to lower pH in second twin.
48
Percentage of twin placentas with vascular anastomoses.
Most monochorionic twins; rare in dichorionic.
49
Main maternal aspiration risk factor exacerbated in twins.
Cephalad stomach displacement and lower LES tone.
50
Drug choice for uterine atony in twin delivery and dosing.
Methylergonovine 0.2 mg IM; carboprost 250 µg IM if hypertensive contra.
51
Risk factors for umbilical cord prolapse.
Malpresentation (breech, transverse), preterm rupture of membranes, polyhydramnios, long cord, multiple gestation, high parity
52
Cord prolapse maternal positioning maneuver besides knee‑chest.
Extreme Trendelenburg or Sims (left lateral) to relieve pressure on cord
53
Maximum time goal from decision to incision for emergent CS due to cord prolapse.
Ideally within 30 minutes, sooner if severe bradycardia persists
54
Monoamniotic twin unique delivery concern.
High risk of cord entanglement—planned cesarean around 32–34 weeks with continuous inpatient monitoring
55
Twin pregnancy risk for uterine atony postpartum.
Uterine over‑distention increases atony and PPH incidence; methylergonovine or carboprost often needed
56
Percentage increase in cardiac output in twin vs singleton pregnancy.
~20 % above the singleton pregnancy increase
57
First‑line uterotonic if hypertensive twin parturient develops atony.
Carboprost 250 µg IM (avoiding methylergonovine due to HTN)
58
Maternal aspiration prophylaxis drugs for twin cesarean.
Sodium citrate 30 mL PO, famotidine 20 mg IV, metoclopramide 10 mg IV
59
Definition of superimposed preeclampsia.
Preeclampsia that develops in a woman with pre‑existing chronic hypertension
60
Recommended seizure prophylaxis duration postpartum in severe preeclampsia.
Continue magnesium sulfate for 24 hours after delivery
61
Signs of magnesium toxicity to monitor.
Loss of patellar reflexes (>10 mEq L⁻¹), respiratory depression (>12 mEq L⁻¹), cardiac arrest (>15 mEq L⁻¹)
62
Magnesium excretion organ impairment that raises toxicity risk.
Renal insufficiency—monitor urine output <30 mL h⁻¹
63
Target systolic/diastolic BP after antihypertensive treatment (severe range).
Maintain SBP 140–160 mm Hg and DBP 90–100 mm Hg
64
Pulmonary edema management steps in preeclampsia.
Stop IV fluids, give diuretics (furosemide 10–20 mg IV), apply supplemental O₂, consider CPAP
65
AFE mortality rate range as cited.
11–43 % despite advances in care
66
Lab hallmark pointing toward DIC in suspected AFE.
Low fibrinogen <200 mg dL⁻¹ with elevated PT/PTT and thrombocytopenia
67
Preferred vasopressor in AFE‑related hypotension.
Norepinephrine infusion titrated to MAP ≥65 mm Hg
68
Eclampsia seizure drug if magnesium fails.
Second‑line benzodiazepine such as diazepam 5–10 mg IV
69
Optimal FHR monitoring requirement during twin labor for vaginal attempt.
Continuous electronic monitoring for both fetuses throughout labor and delivery
70
Cord prolapse prophylactic measure in footling breech before ROM.
Perform cesarean delivery prior to spontaneous membrane rupture
71
Differentiate early‑onset vs late‑onset preeclampsia.
Early = before 34 weeks (worse outcomes); Late = ≥ 34 weeks, often metabolic predisposition
72
Postpartum‑onset preeclampsia timing.
Occurs within 7 days postpartum; may include proteinuria and seizures
73
Key predictors of unfavorable preeclampsia outcome listed on slide.
Chest pain/dyspnea, low SpO₂, thrombocytopenia, elevated creatinine, high AST
74
HELLP syndrome acronym components.
H = Hemolysis, EL = Elevated Liver enzymes, LP = Low Platelets
75
Diagnostic lab thresholds for HELLP.
AST ≥ 70 IU L⁻¹, LDH > 600 IU L⁻¹, platelets < 100 000 µL⁻¹
76
Platelet transfusion triggers in HELLP.
Transfuse if platelets < 20 000 µL⁻¹, or < 40 000 µL⁻¹ before cesarean
77
Recommended anesthesia for C‑section if platelets < 50 000 µL⁻¹.
General anesthesia—neuraxial contraindicated
78
Labetalol IV algorithm for acute severe HTN.
20 mg → 40 mg → 80 mg q10 min; if ineffective, give 10 mg hydralazine IV and call specialist
79
Hydralazine dosing per checklist.
5–10 mg IV over 2 min; may repeat every 20 min up to 30 mg
80
Oral nifedipine alternative dose.
10 mg capsule orally; repeat in 20 min if BP still ≥ 160/110
81
Therapeutic magnesium range and toxicity signs.
Therapeutic 4–7 mEq L⁻¹; loss of reflexes > 10, respiratory arrest > 12, cardiac arrest > 15 mEq L⁻¹
82
Fetal heart effect of maternal magnesium.
Decreases variability but HR remains > 110 bpm
83
Magnesium interaction with neuromuscular blockers.
Potentiates both depolarizing and non‑depolarizing NMB; use smaller doses and monitor with PNS
84
Postpartum pulmonary edema risk window in severe preeclampsia.
Greatest after mobilization of extracellular fluid; monitor closely first 5 days
85
Late eclampsia definition.
Seizure onset 48 h to 4 weeks postpartum
86
AFE newer pathophysiology term.
Considered an anaphylactoid syndrome of pregnancy—systemic inflammatory response rather than mechanical obstruction
87
DIC lab hallmark in AFE.
Low fibrinogen with elevated PT/PTT and thrombocytopenia
88
PRES relationship to eclampsia/preeclampsia.
Loss of autoregulation leads to posterior vasogenic edema visible as PRES
89
Twin pregnancy increased risk of aortocaval compression.
Larger uterine size elevates risk; consider lateral tilt during neuraxial placement
90
Twin-to‑twin transfusion donor vs recipient findings.
Donor twin smaller with anemia/IUGR; recipient plethoric with volume overload/heart failure

Principles B - Summer '25 (6 decks)

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