Obstetrics 3

Question 1

Fifteen minutes after a patient’s epidural as dosed, the patient becomes hypotensive and experiences respiratory arrest. What is the MOST likely etiology?
a. epidural catheter migration
b. loss of accessory respiratory muscle strength
c. subdural injection
d. eclampsia

Answer 1

C. subdural injection
this patient has experienced a total spinal

Question 2

Describe the ways that a patient can develop a total spinal.

Answer 2

an epidural dose injected into the subarachnoid space
an epidural dose injected into the subdural space (s/sx may be delayed)
a single-shot spinal after a failed epidural block

Question 3

Describe the treatment for a total spinal.

Answer 3

treatment is supportive and includes airway management, IVF, vasopressors, left uterine displacement, and leg elevation

Question 4

___________________ will rule out subdural placement.

Answer 4

Neither catheter aspiration nor a test dose

Question 5

Symptoms of a total spinal will include

Answer 5

dyspnea, difficulty phonating, and hypotension; loss of consciousness occurs as a result of cerebral hypoperfusion secondary to severe hypotension

Question 6

Differential diagnosis for high spinal includes

Answer 6

anaphylactic shock, eclampsia, and amniotic fluid embolism

Question 7

________ are causes of late decelerations.

Answer 7

maternal acidosis and preeclampsia

Question 8

______ is consistent with early decelerations.

Answer 8

Fetal head compression

Question 9

______ is a surrogate measure of fetal wellbeing.

Answer 9

Fetal heart rate

Question 10

Fetal heart rate provides an indirect method to asess

Answer 10

fetal hypoxia and acidosis

Question 11

_________ is a function of uterine and placental blood flow

Answer 11

Fetal oxygenation

Question 12

The fetus responds to stress with

Answer 12

peripheral vasoconstriction, hypertension, and a baroreceptor-mediated reduction in heart rate

Question 13

Normal fetal heart rate is

Answer 13

110-160

Question 14

Bradycardic fetal heart rate is

Answer 14

<110

Question 15

Tachycardic fetal heart rate is

Answer 15

> 160

Question 16

What are the three types of fetal decelerations

Answer 16

early
late
variable

Question 17

Which fetal decelerations put the fetus at risk?

Answer 17

late and variable

Question 18

An absence of variability may indicate

Answer 18

fetal distress

Question 19

Causes of lack of variability include

Answer 19

CNS depressants, hypoxemia, and acidosis

Question 20

Variability is an indicator of

Answer 20

oxygenation, normal acid-base status
intact central nervous system
& SNS & PNS are functioning in a healthy way

Question 21

Fetal causes of bradycardia include

Answer 21

asphyxia and acidosis

Question 22

Maternal causes that lead to fetal bradycardia include

Answer 22

hypoxemia
drugs that decrease uteroplacental perfusion

Question 23

Fetal causes of tachycardia include

Answer 23

hypoxemia
arrhythmias

Question 24

Maternal causes that can lead to fetal tachycardia include

Answer 24

fever
choriomnionitis
atropine
ephedrine
terbutaline

Question 25

What is normal variability?

Answer 25

6-25 bpm

Question 26

What is the mnemonic VEAL CHOP?

Answer 26

Variable decels: Cord compression Early decels: Head compression Accelerations: Ok or give oxygen Late decels: Placental insufficiency

Question 27

According to the American College of Obstetrics and Gynecologists, which findings are predictive of poor fetal status? a. sinusoidal pattern b. no late or variable decelerations c. bradycardia without absence of baseline variability d. absent baseline variability

Answer 27

A & D.

Question 28

Someone trained in fetal monitoring must monitor and document fetal status

Answer 28

before and after any anesthetic procedure

Question 29

Describe Category 1 for evaluation of fetal heart rate.

Answer 29

suggest normal acid-base status with no threat to fetal oxygenation

Question 30

Describe Category 2 for evaluation of fetal heart rate.

Answer 30

Is not 1 or 3 and cannot predict a normal or abnormal acid-base status

Question 31

Describe Category 3 for evaluation of fetal heart rate.

Answer 31

suggest abnormal acid-base status with a significant threat to fetal oxygenation

Question 32

Describe Category 1 findings.

Answer 32

Baseline heart rate between 110-160 moderate variability accelerations absent or present early decelerations absent or present No late or variable decelerations

Question 33

Describe category 2 findings.

Answer 33

Bradycardia without the absence of baseline FHR variability tachycardia variable variability absent or minimal acceleration with fetal stimulation recurrent variable decelerations

Question 34

Describe category 3 findings.

Answer 34

bradycardia absent baseline variability recurrent late deceleration recurrent variable deceleration sinusoidal pattern

Question 35

The first sign of magnesium toxicity is

Answer 35

diminished deep tendon reflexes

Question 36

Premature delivery is defined as delivery before

Answer 36

37 weeks gestation

Question 37

The leading cause of perinatal morbidity and mortality is

Answer 37

premature delivery

Question 38

The incidence of prematurity rises with

Answer 38

multiple gestations and premature rupture of membranes

Question 39

Select fetal complications of prematurity include

Answer 39

respiratory distress syndrome, intraventricular hemorrhage, and NEC

Question 40

_______ may be used to delay labor by suppressing uterine contractions (up to 24-48 hours).

Answer 40

Tocolytic agents

Question 41

Examples of tocolytic agents include

Answer 41

beta-agonists magnesium sulfate calcium channel blockers nitric oxide donors

Question 42

In the setting of preterm labor, ________ are given to hasten fetal lung maturity.

Answer 42

corticosteroids (betamethasone)

Question 43

Tocolytic agents or corticosteroids are seldom given after

Answer 43

33 weeks of gestation

Question 44

Side effects of beta agonists include

Answer 44

hyperglycemia resulting from glycogenolysis in the liver hypokalemia from intracellular potassium shift cross the placenta and may increase FHR newborn of a hyperglycemic mother is at risk of post-delivery hypoglycemia

Question 45

What are examples of beta agonist tocolytics?

Answer 45

ritodrine and terbutaline

Question 46

How do beta agonists prevent uterine contraction?

Answer 46

beta-2 stimulation increases intracellular cAMP--> turns on protein kinase, turns of MLCK--> relaxes the uterus also increases progesterone release which contributes to additional myometrial relaxation

Question 47

How to calcium channel blockers work to prevent uterine contraction?

Answer 47

Blocks the influx of Ca+2 into the uterine muscle--> reduces Ca2+ release from the SR--> turns off myosin light-chain kinases--> relaxes uterine muscle

Question 48

_______ is the first-line calcium channel blocker agent.

Answer 48

PO Nifedipine

Question 49

Co-administration of calcium channel blockers with ______ can contribute to skeletal muscle weakness.

Answer 49

Magnesium

Question 50

How do nitric oxide donors work?

Answer 50

nitric oxide is a vasodilator that is essential in maintaining smooth muscle tone increases cGMP--> turns off myosin light-chain kinases--> relaxes uterine muscle

Question 51

_______ are rarely used due to hypotension.

Answer 51

Nitric oxide donors

Question 52

How does magnesium sulfate work?

Answer 52

calcium antagonist--> relaxes smooth muscle by turning off MLCK in the vasuclature, airway, and uterus also hyperpolarizes excitable tissues

Question 53

The ______ eliminate Mg2+, so mothers with ______ should be closely monitored

Answer 53

kidneys; renal insufficiency

Question 54

What is the normal range of magnesium?

Answer 54

1.8-2.5 mg/dL

Question 55

Hypomagnesemia can lead to

Answer 55

tetany, seizures, and dysrhythmias

Question 56

We start to see diminished deep tendon reflexes at a magnesium level of

Answer 56

5-7 mg/dL

Question 57

We see a loss of deep tendon reflexes, hypotension, EKG changes, and somnolence, at a magnesium of

Answer 57

7-12 mg/dL

Question 58

We see respiratory depression, complete heart block, cardiac arrest, coma, and paralysis at a magnesium level of

Answer 58

>12 mg/dL

Question 59

Additional side effects of hypermagnesemia include

Answer 59

skeletal muscle weakness (potentiates NMBD) pulmonary edema reduced responsiveness to ephedrine and phenylephrine

Question 60

Treatment for hypermagnesemia includes

Answer 60

supportive measures diuretics (to facilitate excretion of Mg2+) IV calcium gluconate 1 g over 10 minutes (to antagonize Mg2+)

Question 61

List 6 complications of premature delivery

Answer 61

NEC intraventricular hemorrhage respiratory insufficiency hypocalcemia hypoglycemia hyperbilirubinemia

Question 62

Anesthetic considerations for the use of methergine include: a. IV administration is safe b. tocolysis c. administration of 0.2 mg d. risk of water intoxication

Answer 62

c. - should always be given IM