OB Complications- Test 2 Flashcards
(180 cards)
1
Q
preterm infant
A
prior to 37 weeks gestation
between 20 0/7 and 36 6/7
2
Q
low birth weight
A
<2500 gm
3
Q
very low birth weight
A
<1500 gm at birth
4
Q
extremely low birth weight
A
<1000 gm at birth
5
Q
threshold of viability
A
22-24 weeks
6
Q
demographic characteristics of preterm
A
non caucasian race extremes in ages (<17 or >35 yrs) low socioeconomic status lowe prepregnancy BMI history or preterm delivery interpregnancy interval <6 months abnormal uterine anatomy truma abd surgery during pregnancy
7
Q
behavioral factors
A
tobacco use
substance abuse
8
Q
obstetric factors
A
vaginal bleeding infection short cervical length multiple gestations assisted reproductive technologies preterm premature rupture of membranes polyhydramnios
9
Q
process of parturition
A
0-quiescence
1-activation
2-stimulation
3- involution
10
Q
causes of preterm labor
A
systemic and uterine infections (most common)
uteroplacental thrombosis
intrauterine vascular lesions (fetal stress or decidual hemorrhage)
uterine overdistension
cervical insufficiency
11
Q
preterm delivery due to
A
preterm premature rupture of membranes
spontaneous preterm labor
maternal fetal indications
12
Q
preterm anestheic management
A
neuroaxial
csection
tocolytic therapy (CCB, Indomethacin (cycooxygenase inhibitor), terbutaline (beta adrenergic receptor agonist), magnesium sulfate
13
Q
side effects of terbutaline
A
hypotension, tachycardia, pulmonary edema, hyperglycemia, hypokalemia
14
Q
presentation
A
portion of fetus over pelvic inlet
15
Q
lie
A
alignment of fetal spine with maternal spine
16
Q
position
A
relationship of specific fetal bony point to maternal pelvis
17
Q
occiput
A
position for vertex presentation
18
Q
sacrum
A
postion for a breech presentation
19
Q
mentum
A
position for face presentation
20
Q
acromion
A
position for shoulder presenation
21
Q
uterine distension or relaxation factors associated with breech presentation
A
multiparity
multiple gestation
hydramnios
macrosomia
22
Q
abnormalities of the uterus or pelvis factors associated with breech presentaiton
A
pelvic tumors
uterine anomalies
pelvic contracture
23
Q
abnormalities of the fetus factors associated with breech presentation
A
hydrocephalus
anencephaly
24
Q
obstetric conditions factors associated with breech presentation
A
previous breech delivery preterm gestation oligohydramnios cornual-fundal placenta placenta previa
25
anesthesia for breech delivery
should be in OR and prepped for emergency GA
may need more dense anesthesia
increase GA halogenated agents for uterine relaxation
26
what is the worst fear for breech delivery
fetal head entrapment
27
what agent could be used to produce uterine relaxation for breech presentation if using NA
NTG
28
what is the LA of choice for a dense block while delivering breech baby
3% chloroprocaine or 2% lidocaine with epi and bicarb
29
monoxygotic twins
single fertilized ovum divides
30
disygotic twins
2 ova fertilized
31
placentation
dichorionic diamniotic
monochorionic diamniotic
monochorionic amniotic
32
multiple gestation
cardiovascular and respiratory changes intensified
20% greater CO
15% great SV
3.5% increase in HR
33
what are the two causes of hypoxemia occuring more rapidly?
decrease in FRC and increase in maternal metabolic rate
34
maternal weight is greater rate at what time for multiple gestation parturients?
30 weeks
35
plasma volume is increased with multple gestation parturients by what value
750mL
36
fetal complications associated with multiple gestation
```
preterm delivery
congenital anomalies
polyhydramnios
cord entanglement
cord prolapse
fetal growth restriction
twin to twin transfusion
malpresentation
```
37
maternal complications associated with multiple gestation
```
preterm rupture of membranes
preterm labor
prolonged labor
preeclapsia or eclampsia
placental abruption
DIC
operative delivery
uterine atony
obstetric trauma
antepartum or postpartum hemorrhage
```
38
what is the optimal management of multiple gestation labor?
epidural
39
true or false multiple gestation pregnancies require full lateral position
yes increased risk for aortocaval compression
40
true or false multpile gestations require large bore IVs
true, increased risk of hemorrhage
41
when should epidurals be augmented for delivery of multiple gestations?
for delivery of twin A; augment with more concentrated local
42
what should sensory level for delivery of twin A be?
T6-T8
43
where should the sensory level be extended to for delivery of baby B?
T4-T8
44
If cesarean required for twin B, what med should be added?
nonparticulate antacid
45
gestational hypertension
HTN after 20 wks WITHOUT proteinuria
46
when does gestational HTN resolve?
12 wks postpartum
47
preeclampsia
new onset HTN and proteinuria after 20 wks gestation
48
if no proteinuria preeclampsia should be considered with new onset HTN after 20 weeks and the addition of?
```
persistent epigastric or RUQ pain
persistent cerebral symptoms
fetal growth restriction
thrombocytopenia
elevated liver enzymes
```
49
eclampsia is signaled with the onset of what?
seizures
50
HELLP syndrome stands for what?
homolysis, elevated liver enzymes, low platelet count in woman with preeclampsia
51
chronic hypertension
prepregnancy systolic BP >140 and or diastolic >90 or elevated unresolved BP after delivery
52
chronic HTN with superimposed preeclampsia
presence of HTN prior to pregnancy
| new onset proteinuria or sudden increaes in proteinuria or hypertension or both
53
diagnostic criteria for preeclampsia without severe features
BP >140/90 after 20 wks
proteinuria (>300mg/24hrs)
protein-creatnine ration >0.3 or 1 on dipstick
54
preeclapsia with severe symptoms
BP >160/110
thrombocytopenia (platelets <100,000/mm3)
serum cr concentration >1.1mg/dl or >2 from baseline
pulmonary edema
new onset cerebral or visual disturbances
impaired liver function
55
maternal syndrome
HTN and proteinuria with or without other systemic abnormalities
56
fetal syndrome
fetal growth restriction
oligohydramnios
abnormal oxygen exchange
57
preeclampsia presents more frequently in this pooulation
nulliparous usually 3rd trimester
58
when does preeclampsia usually resolve?
within 48 hrs of delivery
59
what CNS symptoms accompany preeclampsia
```
severe HA
hyperexcitability
hyperreflexia
coma
visual disturbances (scotoma, amaurosis, blurred vision)
```
60
true or false; eclampsia is outward manifestation of disease progression in the brain
true
61
airway changes in preeclampsia
pharyngolaryngeal edema
| subglottic edema
62
pulmonary changes in preeclampsia
DECREASED colloid osmotic pressure
INCREASED vascular permeability
loss of intravascular fluid and protein into interstitium
--> pulmonary edema
63
cardiovascular effects of preeclampsia
```
hypertension
vasospams
end organ ischemia
hyperdynamic state
increase CO
hyperdynamic LV function
increased SVR
exaggerated response to catecholamines
```
64
hematologic changes in preeclampsia
thrombocytopenia (most common) platelets <100,000
| DIC (in liver involvement, intrauterine fetal demise, placental abruption, postpartum hemorrhage)
65
liver presentation in preeclampsia
periportal hemorrhage and fibrin deposits
66
renal presentation in preeclampsia
proteinuria,
decreased GFR
hyperuricemia
oliguria (late but severe symptom)
67
labetolol dose
20mg IV then 40-80mg q 10mins
| max 220mg
68
hydralazine dose
5mg q 20mins
| max 20mg
69
nifedipine dose
10mg PO q 20mins up to 50mg
70
nicardipine dose
initial infusion of 5mg/h, increase by 2.5mg/h every 5min to max of 15
71
sodium nitroprusside dose
0.25-5 mcg/kg/min IV infusion
72
nifedipine dose
10mg PO q 20mins up to 50mg
73
nicardipine dose
initial infusion of 5mg/h, increase by 2.5mg/h every 5min to max of 15
74
sodium nitroprusside dose
0.25-5 mcg/kg/min IV infusion
75
seizure prophylaxis in severe preeclampsia
mag sulfate
76
loading dose of mag
4-6gm over 20-30 minutes
77
maintenance dose of mag
1-3 g/hr
78
duration of maintenance mag
2hrs preop
during surgery
12-24 hrs postop
79
therapeutic range of mag
5-9mg/dL *chestnut*
| 4-6 mEq/L *M&M*
80
symptoms of hypermagnesemia
patellar reflexes lost at 12 mg/dL
respiratory arrest at 15-20 mg/dL
asystole at 25 mg/dL
81
treatment of hypermagnesemia
stop infusion and start calcium gluconate
82
how long is delivery deferred for HELLP?
24-48 hrs for corticosteroids to enhance fetal lungs
83
thrombocytopenia of HELLP
platelets <100,000mm3
84
hemolysis of HELLP
abnormal peripheral blood smear
increased bilirubin >1.2 mg/dL
increased LDH >600 IU/L
85
elevated liver enzyme levels for HELLP
increased AST >70 IU/L
| increased LDH >600 IU/L
86
thrombocytopenia of HELLP
platelets <100,000mm3
87
anesthesia plan for hypertensive disorders
expect difficult airway
may need a line or cvp
preferred continuous lumbar epidural or CSE
88
when should neuroaxial be initiated with hypertensive disorders
early; avoids GA, optimizes placement before platelets decrease, beneficial effects on uteroplacental perfusion
89
advantages of cont. epidural or CSE
analgesia
reduced catecholamines
improved intervillous blood flow
means for csection
90
disadvantage of cont. epidural or CSE
cant evaluate function of epidural until spinal gone
91
what signifies preeclampsia has progressed to eclampsia?
new onset seizures or unexplained coma
92
when does fetal bradycardia occur with seizure associated with eclampsia?
during or immeditely after; persistant requires immediate delivery
93
which drugs are appropriate to adminster during or after sz associated with eclampsia?
magnesium 4-6g over 20min
1-2 g for maint
2g for recurrence
antihypertensives
labetalol or hydralazine
94
fluid balance required for managment of eclampsia
75-100mL/hr to prevent cerebral edema
95
is continuous FHR monitoring required for eclampsia?
yes
96
do you need coag studies regardless of platelet count?
yes
97
total placenta previa
covers entire cervical os
98
partial placenta previa
covers only part of the cervical os
99
marginal placenta previa
lies within 2cm of the cervical os
100
what is the classic sign of placenta previa?
painless vaginal bleeding in the 2nd and 3rd trimester
101
when will placenta previa require csection?
for total previa or placental edge to os distance <1cm = significant bleeding
102
what does the anesthetic plan for placenta previa depend on?
indication and urgency for delivery
severity of maternal hypovolemia
obstetric history
103
what is the anesthetic plan of choice for placenta previa?
neuroaxial
104
what is required for delivery of placenta previa?
2 large bore IVs
| RSI if GA
105
what drugs should be considered for GA of placenta previa?
low dose propofol
ketamine 0.5-1mg/kg
etomidate 0.3mg/kg
106
placental abruption
complete or partial separation of placenta from decidua basalis before delivery of the fetus
107
what are some of the complications associated with placental abruption?
hemorrhagic shock
coagulopathy
fetal compromise or death
108
what ist the preferred technique for labor and vaginal delivery of placental abruption?
NA
109
what is the preferred technique for CS of placental abruption?
NA if volume and coags ok
110
what are the best agents for GA in urgent delivery of placental abruption?
ketamine and etomidate
111
what is a potential risk associated with placental abruption?
trapped blood under placenta
112
what are obstetric condiotions associated with placental abruption?
```
advanced maternal age
multiparity
preeclampsia
premature rupture of membranes
chorioamnionitis
```
113
maternal comorbitites associated with placental abruption?
```
hypertension
acute or chronic resp illness
substance abuse
cocaine use
tobacco use (maternal or paternal)
```
114
trauma associatd with placental abruption
direct (blunt abdominal)
| indirect (acceleration/deceleration)
115
obstetric conditions associated with uterine rupture?
```
prior uterine surgery
induction of labor
high dose oxytocin induction
prostaglandin induction
morbidly adherent placenta
grand multiparity (>5)
congenital uterine anomaly (bicorniculate uterus)
```
116
maternal comobidities associated with uterine rupture
connective tissue disorder (ehlers-danlos)
117
obstetric characteristics of uterine rupture
corceps delivery
internal podalic version
excessive fundal pressure
118
nonobstetric conditions associated with uterine rupture
blunt
penetrating
trauma
119
presenting signs of uterine rupture
abdominal pain and abnormal FHR pattern
120
what anesthesia method is necessary for uterine rupture
GA unless epidural is already established
121
what should be part of the anesthetic plan for uterine rupture
agressive volume replacement
monitor UOP
invasive monitoring?
122
vasa previa
fetal vessels cross fental membranes before presenting part
123
what usually occurs to fetal membranes in vasa previa
rupture of fetal membranes usually tears vessels leads to fetal exsanguination
124
what is generally the plan for vasa previa?
immediate delivery- GA
125
primary postpartum hemorrhage occurs when?
first 24 hrs
126
secondary postpartum hemorrhage occurs when?
between 24hrs and 6wks
127
uterine atony accounts for what?
80% of hemorrhage
128
treatment of uterine atony includes
IV crystalloids colloids, vasopressors
H&H, coags
blood products
129
obstetric management associated with uterine atony
CS
induction of labor
augmented labor
130
obstetric conditions associated with uterine atony
```
multiple gestations
macrosomia
polyhydramnios
high parity
prolonged labor
precipitous labor
chorioamnionitis
```
131
maternal comorbidities associated with uterine atony
advanced maternal age
hypertensive disease
diabetes
132
other conditions associated with uterine atony
tocolytic drugs
| high concentrations of halogenated volatiles
133
oxytocin dose for postpartum hemorrhage
0.3-0.6 IU/min IV
| short duration of effect
134
side effects of oxytocin
tachycardia
hypotension
MI
free water retention
135
ergonovine or methylergonovine dose for postpartum hemorrhage
0.2 mg IM
| long DOA- may be repeated once after 1 hr
136
side effects of ergonovine or methylergonovine
N/V
arteriolar constriction
HTN
137
relative contraindications to ergonovine or methylergonovine
HTN
preeclampsia
CAD
138
dose fo 15-methylprostaglandin
0.25 mg IM
| may be repeated q15mins up to 2mg
139
relative contraindications for 15-methylprostaglandin
reactive airway disease
pulm. HTN
hypoxemia
140
side effects of 15-methylprostaglandin
```
fever
chills
N/V
diarrhea
bronchoconstriction
```
141
dose for misoprostol
600-1000ug per rectum, sublingual, or buccal
| this is an off label use for this drug
142
contraindications for misoprostol
none
143
side effects of misoprostol
fever
chills
N/V
diarrhea
144
placenta accreta
part or all of the placenta invades the uterine wall and is inseperable
145
placenta accreta vera
adherance of basal plate of placenta to uterine myometrium without decidual later
146
placenta increta
chorionic villi invade the myometrium
147
placenta percreta
invasion through myometrium into serosa adn adjacent organs
148
anesthesia management of placenta accreta
similar to other cases of postpartum hemorrhage
149
peripartum hysterectomy
requires GA
150
exact trigger of amniotic fluid embolism
unknown
151
amniotic fluid embolism
systemic inflammatory response associated with inappropriate release of endogenous inflammatory mediators.
152
clinical presentation of amniotic fluid embolism
acute resp distress
cardiovascular collapse
coagulopathy near delivery
*OCCURS MOST OFTEN IN LABOR*
153
2 most important risk factros in developing DVT or PE in pregnancy
history of thromboembolism
| diagnosis of thrombophilia
154
3 factors that increase risk of DVT or PE
venous stais
vascular damage
hypercoagulability
155
how many major risk factors must be present for increased risk of venous thromboembolism postpartum?
minor?
one for major, two for minor
156
major risk factors for venous thromboembolism in the postpartum period
```
immobility (>1week)
prevous VTE
preeclampsia with fetal grown restriction
thrombophilia (antithrombin III def, factor V leiden, prothrombin G20210A)
SLE
heart disease
sickle cell
postpartum hemorrhage + surgery
blood transfusion
postpartum infection
```
157
minor risk factors for VTE in postpartum
```
BMI >30
emergency c section
mult. pregnancy
postpartum hemorrhage
smoking >10/day
fetal growth restriction
thrombophilia (protein C or S deficiency)
preeclampsia
```
158
DVT symptoms
nonspecific lower leg pain and edema
erythema
tenderness
palpable cord
159
PTE symptoms
```
palpitations
anxiety
chest pain
cyanosis
diaphoresis
cough with or without hemoptysis
SOB
```
160
signs of RV failure with PTE
split S2
JVD
parasternal heave
hepatic enlargement
161
ECG changes in PTE
```
RV strain=
RAD
p pulmonale
ST abnomalities
T wave inversion
supraventricular arrhythmias
```
162
hemodynamic monitoring for embolic disorders
| PAOP
normal to low (<15)
163
hemodynamic monitoring for embolic disorders
| MEAN PAP
increased (usually <35)
164
hemodynamic monitoring for embolic disorders
| CVP
increased (>8)
165
management for embolic disoders
anticoagulation
166
potential anesthetic complications for embolic disorder treatments
spinal/epidural hematoma-NA
| airway bleeding- GA
167
warfarin should be held for
4-5 days for INR to normalize
168
avoid neuroaxial catheter with which drug
fondaparinux
169
neuroaxial not recommended with which class of drugs
direct thrombin inhibitors
170
which class is an ABSOLUTE contraindication for NA
thrombolytics
171
when should you switch oral anticoagulants to LMWH or UFH?
36wk gestation
172
when should LMWH be discontinued?
36hrs prior to delivery
173
when should IV UFH be discontinued?
4-6 hours prior to delivery
174
when is VAE likely to occur?
after placental separation, potential for air entrapment
175
what are the clinical symptoms of VAE?
mostly without symptoms
| massive: hypoTN, hypoexemia, potential cardiac arrest
176
pathophysiology course of VAE
```
small amount of air ->
pulmonary vasospasm ->
VQ mismatch->
hypoxemia->
right sided heart failure->
arrhythmias->
hypoTN
```
177
what volume of air can lead to an RV outflow tract obstruction leading to cardiovascular collapse?
>3mL/kg
178
suspect VAE if
complaints of intraop chest pain, dyspnea
| sudden hypoxemia, hypoTN, arrhythmias
179
how do you prevent further air entrapment during VAE
flood surgical field with saline solution
| lower the surgical field lower than the heart if tolerated
180
what should be evaluated in the postrescuscitation period after VAE
intracerebral air and potentially hyperbaric O2 therapy
