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AP III > OB (4/10) > Flashcards

OB (4/10) Flashcards

1
Q

oxygen uptake in fetus is ________x that of the adult, but decreases significantly with hypoxemia

A

2

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2
Q

fetal circulation directs oxygenated blood to the _______________ & ___________ and deoxygenated blood to the ____________ & ________

A

Brain; heart; umbilical circulation; placenta

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3
Q

describe the flow of fetal circulation starting at the placenta

A

(oxygenated) placenta –> liver –> portal sinus and ductus sinus –> IVC –> right atrium –> foramen ovale –> L. atrium –> L ventricle –> aorta –> brain and myocardium (ensuring they get the highest concentration of O2 blood)

(deoxygenated blood) coming in from lower extremities and SVC –> R. ventricle –> pulmonary trunk –> ductus arteriosus –> descending Ao –> lower extremities and hypogastric arteries –> returns to placenta via umbilical arteries

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4
Q

the fetal oxyhgb dissociation curve is shifted to the ______________ with respect to the adult (non-pregnant) form and the pregnant womans oxyhgb curve lies to the ____________ of the nonpregnant

A

left; right

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5
Q

what would you expect to happen to the pregnant mothers oxy-hgb dissociation curve with hyperventilation

A

move left

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6
Q

why does fetal blood have higher affinity for O2 than the mothers

A

fetal hgb has no B-chain so has higher affinity

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7
Q

what are the 3 major shunts of fetal circulation

A
  1. ductus venosus
  2. foramen ovale
  3. ductus arteriosus
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8
Q

the fetal circulatory shunt bypasses the liver via the ________________

A

ductus venosus

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9
Q

_________________ is the shunt in fetal circulation which bypasses pulmonary circulation

A

ductus arteriosus

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10
Q

what is the purpose of oxytocin (“pitocin”)

A
  1. induce or augment labor
  2. induce uterine contractions
  3. maintains uterine tone
  4. given postpartum to increase uterine tone and stop bleeding
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11
Q

dose of oxytocin when used to augment/induce labor

A

3-40 miliunits/min titrated to achieve normal contraction pattern

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12
Q

dose of oxytocin postpartum to decrease hemorrhage

A

10-40 units per IVF bag or 10 units IM

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13
Q

common s/e of pitocin

A
  1. uterine hypertonicity
  2. N/V
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14
Q

_______________ are what change the size of the cervix

A

contractions

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15
Q

what is the black box warning for oxytocin

A

not indicated for elective labor

(but this is what we primarily use it for…)

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16
Q

serious side effects of pitocin

A
  1. anaphylaxis
  2. SIADH
  3. HTN
  4. arrhythmias
  5. postpartum hemorrhage
  6. pelvic hematoma
  7. vaginal or cervical laceration
  8. abruption
  9. uterine rupture
  10. uterine tetany
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17
Q

what is the laboring dose of oxytocin

A

0.5-1 mU/min

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18
Q

what dose of pitocin is equivalent to spontaneous labor

A

6 mU/min

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19
Q

what are the different drugs used for uterine atony

A
  1. oxytocin
  2. methylergonovine (methergine)
  3. hemabate
  4. misoprostol (cytotec)
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20
Q

if you have given pitocin for uterine atony after delivery, but the uterus is still boggy what drug should you give

A

methergine

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21
Q

dose of methergine

A

0.2 mg IM

can be repeated x1 after 1 hour

22
Q

contraindications to using methergine for uterine atony

A
  1. htn
  2. preeclampsia
  3. CAD
23
Q

________________ is a drug used for uterine atony, has a long duration of action and may be repeated 1x after 1 hour

A

methergine

if pt has htn you would not give methergine you would instead give hemabate

24
Q

s/e of methergine

A
  1. thromboembolic sequelae
  2. severe N/V
  3. arteriolar constriction
25
Q

dose of hemabate

A

250 mcg IM or IU for uterine atony

can be repeated q15min up to 2 mg

26
Q

c/i to using hemabate

A
  1. reactive airway dz
  2. pulmonary htn
  3. hypoxic pts
27
Q

s/e of hemabate

A
  1. bronchoconstriction
  2. shivering
  3. Temp increase
  4. diarrhea
28
Q

dose of misoprostol (cytotec) for uterine atony

A

800-1000 mcg PR

29
Q

s/e of misoprostol (cytotec)

A
  1. shivering
  2. temp increase
  3. N/V/D
30
Q

what is the rule of 3’s to guide pitocin administration

A
  1. 3 units of pitocin given IVP
  2. assesment of uterine tone at 3 minute intervals, redosing if needed with 3 unit boluses up to a total of 3
31
Q

what are the different ways to administer pitocin

A
  1. 200 mU/min for several minutes until uterus remains fimr then 1-2 mL/min until discharge
  2. 20 units in 1 L LR wide open then add 20 U to next IV bag
  3. 30 units in 500 mL of LR wide open
  4. 10 units IVP then 20 units in > 500 mL, add 20 more units per surgeon request
  5. 30 u/500 mL on pump at 333 mL/hr x 1 hour then 42 mL/hr after that til bag is complete
32
Q

what is the third line drug for uterine atony?

A

hemabate

33
Q

_____________ is a synthetic prostaglandin that stimulates uterine contraction

A

hemabate

34
Q

what is the common on label use of misoprostol (cytotec)

A

cervical ripening

35
Q

cytotec is administered via what route for cervical ripening? what route for post partum uterine atony?

A
  1. ripening = oral or vaginally
  2. postpartum atony = rectal
36
Q

_______________ is a synthetic analogue of lysine

A

TXA

37
Q

MOA of TXA

A

prevents fibrin degradation

38
Q

use of TXA

A
  1. postpartum bleeding
  2. trauma
  3. surgery
  4. tooth removal
  5. nose bleeds
  6. being used in prophylaxis for high risk pregnant moms before C-section
39
Q

dose of TXA

A

1000 mg IV over 30 minutes, can be repeated once

40
Q

T/F: if mom has covid 19, you should avoid TXA

A

true - increased risk of clot

41
Q

use of cervidil

A

cervical ripening

42
Q

dose/administration of cervidil

A

10 mg via vaginal suppository - leave in x12 hours

43
Q

under what circumstance would you remove the vaginal suppository cervidil from the pt before 12 hours

A
  1. if pt cervix dilates > 4 cm
  2. rupture of membrane
  3. non reassuring fetal heart tones.
44
Q

after placing cervidil, what positioning instructions should you give the pt

A

must lie flat for 2 hours

45
Q

what are the s/e of cervidil

A

cramping

46
Q

_______________ is a stick poked in the cervix for cervical ripening, mother is sent home and then next morning comes to the hospital for induction of labor

A

dilapan-S

47
Q

______________ initates endogenous prostaglandin release causing collagen degradation –> cervical softening

A

dilapan-S

48
Q

______________ is a catheter with 2 large ballons inserted into cervix, every few hours nurse tugs on catheter, once comes out pt is dilated to _________ cm

A

cook catheter; 4-5 cm

49
Q

______________ is a beta adrenergic agonist that is used a tocolytic

A

terbutaline

50
Q

dose of terbutaline for tocolysis

A

0.25 mg SQ

AP III (20 decks)

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