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APEX: Flashcards > OB > Flashcards

OB Flashcards

1
Q

Most likely cause for rapid arterial O2 desaturation during the intubation of a pregnant patient

A

decreased FRC

FRC = RV + ERV

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2
Q

OB upper airway

A
  • increased risk for difficult mask, difficult laryngoscopy, difficult intubation (failed intubation 8x higher)
  • hormones cause vascular engorgement & upper airway swelling
  • increased MP score
  • narrow glottic opening = 6.0-7.0 ETT
  • short handle laryngoscope (Datta handle)
  • tissue friable- avoid nasal airway
  • edema worse w/ preeclampsia, tocolytics, Tburg
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3
Q

Lung physiology

A
  • relaxin relaxes ribcage, more horizontal
  • uterus pushes diaphragm cephalad
  • FRC decreases (ERV + RV)
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4
Q

ABG

A
  • progesterone = resp stimulant
  • resp alkalosis
  • pH normal
  • PaCO2 decreases
  • HCO3 decreases (to normalize pH)
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5
Q

OxyHgb curve shifts

A
  • right
  • facilitates O2 transfer to fetus
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6
Q

Ve, Vt, & RR

A

all increased d/t increased O2 consumption & CO2 production

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7
Q

Lung volumes

A
  • Decrease = TLC, FRC, ERV, RV
  • No change = VC, CC
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8
Q

O2 consumption

A
  • Term = 20 % increase
  • 1st stage labor = 45 % increase
  • 2nd stable labor = 75% increase
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9
Q

CO

A
  • increases 40%
  • during labor:
    1. 1st stage = 20% increase
    2. 2nd stage = 50% increase
    3. 3rd stage = 80% increase
  • returns to pre-labor in 24-48 hours
  • HR = 15% increase
  • SV = 30% increase
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10
Q

BP

A
  • no change MAP or SBP
  • DBP decreases
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11
Q

Vascular resistance

A
  • SVR & PVR decrease
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12
Q

CVP & PAOP

A

no change

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13
Q

cardiac axis deviation

A
  • left deviation
  • uterus pushes diaphragm cephalad which pushes heart up & left
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14
Q

aortocaval compression

A
  • “supine hypotension”
  • uterus compresses aorta & vena cava
  • decreased venous return
  • place mother in LUD (2nd/3rd trimester)
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15
Q

IV volume

A
  • increases 35%
  • plasma volume increases 45%
  • erythrocyte volume increases 20%

dilutional anemia

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16
Q

hematologic changes

A
  • clotting factors 1, 7, 8, 9, 10, 12 = increase
  • anticoagulants
    1. antithrombin = decrease
    2. protein S = decrease
  • fibrin breakdown = increase
  • antifibrinolytic = decrease (11 & 13)
  • PT/PTT= decrease
  • PLT count same or decreases
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17
Q

MAC

A

30-40% decrease

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18
Q

sensitivity to LA

A

increase

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19
Q

gastric volume & gastric pH

A
  • gastric volume increases
  • gastric pH decreases
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20
Q

LES sphincter tone

A

decreases

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21
Q

Renal

A
  • increase = GFR, CrCl, glucose in urine
  • decrease = creatinine & BUN (d/t inc CrCl)
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22
Q

Uterine blood flow

A
  • increases up to 700-900 ml/min
  • 10% of CO
  • not autoregulated

UBF = (Uterine a. pressure - Uterine v. pressure) / uterine vascular resistance

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23
Q

Most important variables that increase drugs across placenta

A
  1. diffusion coefficient (drug characteristics)
  2. concentration gradient b/t mom & fetus
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24
Q

Drug characteristics that favor placental tranfer

A
  • LMW < 500 daltons
  • lipid soluble
  • non-ionized
  • non-polar
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25
Q

Drugs that cross placenta

A
  • LA (except chloroprocaine
  • IV anesthetics
  • VA
  • opioids
  • benzos
  • atropine
  • BB
  • Mg+
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26
Q

Drugs that do NOT cross placenta

A

H - Heparin
I - Insulin
G (h)- Glycopyrrolate
Noon- NMBs

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27
Q

Stage 1 of labor

A
  • regular contractions to full dilation (10 cm)
  • latent = 2-3 cm
  • active = 3-10 cm
  • dull/diffuse/cramping pain in lower uterine segment & cervix (T10-L1)
    1. neuraxial
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28
Q

Stage 2 of labor

A
  • full dilation to delivery of fetus
  • sharp/localized perineal pain begins (T10-L2 + S2-S4)
    1. neuraxial
    2. pudendal n. block
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29
Q

Stage 3 of labor

A
  • delivery of placenta
30
Q

NPO guidelines

A

laboring mothers may drink a moderate amount of clear liquids through labor & eat solid food up to the point a neuraxial block is placed

31
Q

Timing of epidural placement

A

ACOG recommend timing of epidural placement should be individualized and patient should not have to wait until she achieves certain dilation

32
Q

Consequences of uncontrolled pain

A
  • increase catecholamines = HTN, decrease UBF
  • hyperventilation = left OxyHgb shift = decrease O2 to fetus
33
Q

early decelerations

A

VEAL CHOP
- Early = Head compression
- occur w/ contraction

34
Q

late decelerations

A

VEAL CHOP
-Late = placental insufficiency
- FH falls after peak of contraction
- occur w/ each contraction
- Causes = hypotension, hypovolemia, acidosis, preeclampsia

35
Q

variable decelerations

A

VEAL CHOP
- Variable = Cord compression
- no pattern b/t FHR & uterine contraction

36
Q

Prematurity

A
  • < 37 weeks gestation
  • tocolytics to suppress contractions
  • betamethasone to hasten fetal lung maturity
37
Q

B2 agonists

A
  • ritodrine, terbutaline
  • relax uterus
  • SE: hyperglycemia, hypokalemia
38
Q

Mg+ sulfate

A
  • Ca+ antagonist
  • relaxes uterus
  • hyperpolarizes membranes in excitable tissue (SZ prophylaxis for preeclampsia)
39
Q

Mg+ toxicity

A
  • 1st sign = loss of deep tendon reflexes
  • diminish at 5-7 , loss of reflexes at 7-12 mg/dL
  • other side effects: skeletal muscle weakness (potentiates NMBs), pulmonary edema, reduced response to ephedrine & neo
  • Tx: diuretics, IV calcium gluconate 1 gram
40
Q

Oxytocin

A
  • uterotonic
  • administered after delivery of placenta
  • SE: water retention, hyponatremia, hypotension, reflex tachycardia, coronary vasoconstriction
  • CV collapse if given too quickly
41
Q

Methergine (Ergot Alkaloid)

A
  • uterotonic
  • 0.2 mg IM
  • IV admin cause cause HTN & cerebral hemorrhage
42
Q

Prostaglandin F2 (hemabate, carboprost)

A
  • uterotonic
  • 250 mcg IM
  • SE: N/V, diarrhea, hypotension, HTN, bronchospasm
43
Q

Which trimester is best for non-OB surgery?

A

2nd trimester

44
Q

When is RSI indicated in the pregnant patient?

A
  • 18-20 weeks
  • immediate postpartum period
45
Q

Safe drugs for non-OB surgery

A
  • opioids
  • VA
  • NMBs
  • thiopental
46
Q

Why are NSAIDs avoided after the 1st trimester?

A

potentially close ductus arteriosus

47
Q

Chronic HTN

A
  • before 20 weeks gestation
  • does not return to normal after delivery
48
Q

Gestational HTN

A
  • occurs after 20 weeks gestation
49
Q

Preeclampsia

A
  • mild = BP > 140/90
  • severe = BP > 160/110
  • develops after 20 weeks gestation
  • proteinuria usually present
  • Also RUQ/epigastric pain HA, FGR, thrombocytopenia, elevated serum liver enzymea
50
Q

Preeclampsia patho

A
  • abnormal placental implantation creates an environment characterized by elevated vascular resistance & reduction in placental blood flow.
  • 7:1 thromboxane : prostacyclin ratio
  • thromboxane = vasoconstriction, PLT aggregation
51
Q

Preeclampsia treatment

A
  • definitive treatment = delivery
  • treat BP > 160/110
  • labetalol, hydralazine, nifedipine, nicardipine
52
Q

Eclampsia

A

preeclamptic patient develops seizures

53
Q

SZ prophylaxis magnesium

A
  • loading dose = 4 grams over 10 min
  • then 1-2 g/hr
54
Q

HELLP Syndrome

A

H -Hemolysis
EL- Eelvated Liver enzymes
L- Low
P- Platetes

  • 5-10% of preeclamptic patients
  • RUQ/epigastric pain
  • assess for thrombocytopenia before placing a block
  • Tx: delivery
55
Q

Maternal cocaine abuse

A
  • cocaine = ester LA
  • inhibits NE reuptake in presynaptic SNS neuron
  • CV = tachycardia, dysrhythmias, coronary vasoconstriction, MI
  • CNS = CVA, SZ, ischemia
  • Acute intoxication = increased MAC
  • Chronic use = decreased MAC
  • OB risks = spont abortion, premature labor, placental abruption, low APGAR, thrombocytopenia
  • Tx: labetalol, tx hypotension w/ phenylephrine (may not response to ephedrine d/t catecholamine depletion)
56
Q

Placenta accreta

A

attaches to surface of myometrium

57
Q

Placenta increta

A

invades myometrium

58
Q

Placenta percreta

A

extends beyond uterus

59
Q

Placenta accreta/increta/percreta

A
  • potential for large blood loss
  • GA preferred
  • associated w/ placenta previa & previous c/s
60
Q

Placenta previa

A
  • placenta attaches to lower uterine segment & partially/completely covers cervical os
  • **PAINLESS vaginal bleeding
  • risk factors: hx c/s, multiple births
61
Q

Placental abruption

A
  • partial or complete separation of placenta from uterine wall
  • risk factors: PIH, preeclampsia, HTN, cocaine use, smoking, excessive alcohol use
  • **PAINFUL vaginal bleeding
  • risk of AFE & DIC
  • blood products ready, prep c/s
62
Q

Most common cause of postpartum hemorrhage

A

uterine atony

63
Q

DIC is associated with:

A
  • AFE
  • placental abruption
  • intrauterine fetal demise
64
Q

normal APGAR

A

8-10

65
Q

moderate distress APGAR

A

4-7

66
Q

impending demise APGAR

A

0-3

67
Q

APGAR HR

A

0 = absent
1 = < 100
2 = > 100

68
Q

APGAR RR

A

0 = absent
1 = slow, irregular respirations
2 = normal, crying

69
Q

Muscle tone APGAR

A

0 = limp
1= some flexion of extremities
2 = active motion

70
Q

Reflex irritability APGAR

A

0 = absent
1 = grimace
2 = cough, sneeze, cry

71
Q

APGAR color

A

0 = pale, blue
1 = body pink, extremities blue
2 = completely pink

72
Q

neonatal resuscitation

A

APEX: Flashcards (13 decks)

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