Obstetrics

Question 1

Name 6 common nerve and subsequent peripheral palsies from labor and delivery.

Answer 1

1) Femoral: flexion, abduction, external rotation, decreased patellar reflex
2) Lumbrosacral plexus: foot drop, L5 sensory disturbance
3) Sciatica: lateral below knee sensory disturbance.
4) Myalgia paresthetica: lateral femoral cutaneous nerve. Paresthesia of anterolateral thigh.
5) Obturator: hip adduction, internal rotation, upper inner thigh decreased sensation
6) Peroneal: foot drop

Question 2

What are 6 common risk factors for postpartum neuropathy.

Answer 2

1) Abnormal presentation
2) Persistent posterior occiput
3) Macrosomia
4) Prolonged second stage of labor
5) Difficult Instrumental delivery
6) Prolonged lithotomy position

Question 3

What are 14 conditions associated with uterine atony?

Answer 3

1) Multiparity
2) previous hx postpartum hemorrhage
3) uterine leiomyomas/ fibroids
4) multiple gestation
5) macrosomia
6) chorioamnionitis
7) polyhydramnios
8) fetal demise
9) amniotic fluid embolism
10) General anesthesia
11) tocolytic use
12) prolonged labor
13) stimulated labor
14) precipitous labor

Question 4

List 9 risk factors for amniotic fluid embolism.

Answer 4

1) Older age
2) Race
3) Abnormal placentation
4) Placental abruption
5) Eclampsia
6) Multiple gestation
7) Induction of labor
8) Artificial or spontaneous rupture of membranes
9) Operative delivery

Question 5

What is the risk of placenta accreta in patients with current placenta previa, in relation to the number of prior cesarean sections?

Answer 5

No previous sections have a risk of 3 % accreta.
1 previous section have a risk of 11 %.
2 previous sections have a risk of 40 %.
3 previous sections have a risk of 61 %.
4 previous sections have a risk of 67 %.

Question 6

Name 4 pharmacological ways to treat uterine atony, along with its dose, contraindications and side effects.

Answer 6

1) Oxytocin. Dose is 20 to 60 units per liter of intravenous infusion. There are no contraindications. Side effects include decreased systemic vascular resistance and free water retention. There is a short duration of effect.
2) Methylergonovine. Dose is 250 micrograms IM. Contraindications include hypertension, pre eclampsia, and coronary artery disease. Side effects include thromboembolic sequelae, severe nausea and vomiting, and arteriolar constriction. There is a long duration of action. Methylergonovine may be repeated once after 1 hour.
3) 15 Methylprostaglandin F 2 alpha AKA heme abait AKA carboprost. Dose is 250 micrograms IM or intrauterine. Contraindications include reactive airway disease, pulmonary hypertension or hypoxemic patients. Side effects include bronchoconstriction, shivering, elevated temperature and diarrhea. Heme abait can be repeated every 15 minutes up to 2 milligrams total.
4) Prostaglandin E 1 AKA Misoprostol. Dose is 800 to 1000 micrograms per rectum. There are no contraindications. Side effects include shivering, temperature elevation, diarrhea, nausea and vomiting, depression of ventilation, bradycardia, flushing.

Question 7

Name 4 strategies to treat uterine atony and postpartum hemorrhage.

Answer 7

1) Directed therapy of uterine massage and uterotonic drugs.
2) Non surgical uterine compression which includes bimanual uterine compression, external aortic compression, uterine packing and balloon tamponade.
3) Compression sutures including B lynch, and uterine artery embolization.
4) Artery ligation such as uterine or hypogastric artery. Or hysterectomy (subtotal or total).

Question 8

Question: Name 7 coagulation factors that increase by at least 50% in pregnancy.

Answer 8

1) Factor 7
2) Factor 8
3) Factor 9
4) Factor ten
5) Factor twelve
6) Fibrinogen AKA factor 1
7) plasminogen

Question 9

Name 8 coagulation factors and parameters that decrease in pregnancy.

Answer 9

1) Factor eleven
2) Factor thirteen
3) Prothrombin time by 20%
4) PTT by 20%
5) Antithrombin three
6) Platelet count
7) Protein S
8) Protein C

Question 10

Name 5 hematological alterations in pregnancy.

Answer 10

1) Plasma volume increases 40 to 50 percent.
2) Total blood volume increases 25 to 40 percent.
3) Red blood cell volume increases 20 percent.
4) Hematocrit decreases by 35 percent. This relative anemia of preganancy plateaus at 32 to 34 weeks gestation.
5) Serum cholinesterase activity decreases by 25 percent.

Question 11

Name the 6 cardiovascular changes of pregnancy.

Answer 11

1) Cardiac output increases by 30 to 50 percent.
2) Stroke volume increases by 20 to 50 percent.
3) Systemic vascular resistance decreases by 50 percent.
4) Left axis deviation is seen in EKG due to upward displacement of the heart.
5) Heart rate increases slightly.
6) Systemic blood pressure decreases slightly.
7) LVEDV goes up
8) PCWP no change
9) PVR decreases 30%

Question 12

Describe cardiac output, with pre preganancy values as baseline, with respect to the following stages of pregnancy:

Answer 12

1) 1st trimester

Answer: Cardiac output begins to increase by 5 weeks’ gestation and is 35% to 40% above baseline by the end of the first trimester.

2) 2nd trimester

Answer: 50% above non pregnant values.

3) Third trimester

Answer: Same as second trimester, 50% above non pregnant values.

4) Labor

Answer: Cardiac output increases progressively with latent, active and 2nd stages, from 70 to 120% above non pregnant values.

Question 13

When is the highest cardiac output during pregnancy?

Answer 13

Immediately after birth.

Question 14

When does cardiac output return to pre labor values?

Answer 14

In 24 hours time.

Question 15

When does cardiac output return to pre pregnancy values?

Answer 15

Between 12 to 24 weeks time. Heart rate, in comparison, reaches pre pregnancy value by 2 weeks post partum.

Question 16

When do albumin and other protein levels return to pre pregnant levels?

Answer 16

6 weeks post partum.

Question 17

When do coagulation factors return to pre pregnant levels?

Answer 17

2 weeks post partum

Question 18

What are the twelve respiratory changes of pregnancy?

Answer 18

1) Functional residual capacity decreases by 20 to 30 percent.
2) Expiratory reserve volume decreases by 15 to 20 percent.
3) Residual volume decreases by 20 to 25 percent.
4) Inspiratory reserve volume is increased.
5) Minute ventilation increases by 50 percent.
6) Alveolar ventilation increases by 70 percent.
7) Tidal volume increases by 30 to 50 percent.
8) Oxygen consumption increases by 20 percent.
9) Carbon dioxide production increases by 35 percent.
10) Respiratory rate is slightly increased.
11) Alveolar dead space increases.
12) Minimum alveolar concentration decreases by 32 to 40 percent.

Question 19

Describe 2 characteristics of renal plasma flow during phases of pregnancy.

Answer 19

1) During second trimester, renal plasma flow is increased by 80%.
2) Renal plasma flow decreases to 50% above nonpregnant baseline by term.

Question 20

What happens to creatine and GFR during pregnancy?

Answer 20

GFR increases by 50%, while serum creatinine concentration is decreased.

Question 21

When is the earliest sign of IVC compression during pregnancy?

Answer 21

13 to 16 weeks.

Question 22

According to the SOGC 2014 pregnancy induced hypertension guidelines, name three partner related risk factors for pre eclampsia.

Answer 22

1) New partner
2) Previous early miscarriage with same partner
3) Little exposure to paternal sperm (IE reproductive technologies)

Question 23

Name 7 non partner related risk factors for pre eclampsia.

Answer 23

1) Advanced maternal age (more than 40 years).
2) Family history of preeclampsia.
3) History of preeclampsia in previous pregnancy
4) Multiple gestation.
5) Hydatidiform mole
6) Inter pregnancy interval of more than 10 years

Note: black, hispanic racial background is in Chestnut, as is History of placental abruption, intrauterine growth restriction, or fetal death.

Question 24

According to the SOGC 2014 pregnancy induced hypertension guidelines, name 5 second or third trimester risk factors for pre eclampsia.

Answer 24

1) Gestational hypertension
2) Abnormal AFP, HCG, uterine artery Dopplers
3) Excessive weight gain in pregnancy
4) Infection during pregnancy
5) Intra uterine growth restriction

Question 25

Name 7 maternal disease related risk factors for pre eclampsia.

Answer 25

1) Obesity.
2) Chronic hypertension.
3) Diabetes.
4) Renal disease.
5) Antiphospholipid antibody syndrome
6) Systemic lupus erythematosus
7) Cocaine and methamphetamine use

Paradoxically, cigarette smoking during pregnancy has been associated with a decreased risk for pre eclampsia.

Question 26

Name the 4 hypertensive disorders in pregnancy.

Answer 26

1) Gestational hypertension, which is defined as elevated blood pressure after 20 weeks gestation that resolves by 12 weeks post partum.
2) Pre eclampsia, which is defined as the new onset of hypertension and either proteinuria, adverse or severe complications after 20 weeks gestation.
3) Chronic hypertension, which is defined as pre pregnancy blood pressure levels more than one hundred and forty millimeters mercury systolic, or more than ninety millimeters mercury diastolic that fails to resolve after delivery.
4) Pre existing (chronic) hypertension with superimposed pre eclampsia, which is the new onset of proteinuria or sudden increase in hypertension, or the appearance of other manifestations of severe pre eclampsia.

Question 27

What are 4 physical symptoms of gestational hypertension?

Answer 27

1) dyspnea
2) right upper quadrant pain
3) cerebral disturbance, such as headache, hyperexcitability, coma
4) visual disturbance, such as blurred vision, scotoma, amaurosis

Question 28

What are 6 clinical signs of gestational hypertension?

Answer 28

1) Oliguria
2) Proteinuria
3) Papilledema
4) Edematous airway
5) Intrauterine growth restriction
6) Hyper reflexia

Question 29

According to ACOG in Chestnut 5, what are the 2 diagnostic criteria of pre eclampsia without severe features?

Answer 29

1) Blood pressure of more than one hundred and forty over ninety millimeters mercury after twenty weeks gestation.
2) Proteinuria of three hundred milligrams over twenty four hours or one plus on dipstick.

Question 30

According to ACOG in Chestnut 5, what are 6 diagnostic criteria for severe pre eclampsia?

Answer 30

1) Blood pressure of more than one hundred and sixty over one hundred and ten millimeters mercury, at bed rest.
2) Thrombocytopenia of less than 100
3) Elevated serum creatinine of 2 times the baseline
4) Pulmonary edema.
5) New onset cerebral or visual disturbances.
6) Impaired liver function, as indicated by elevated liver enzymes more than twice normal, and severe persistent epigastric or right upper quadrant pain.

The term eclampsia is used when CNS involvement results in the new onset of seizures in a woman with pre eclampsia.

Question 31

List 8 other manifestations or complications of pre eclampsia.

Answer 31

1) Congestive heart failure
2) Arterial hypoxemia
3) Laryngeal edema
4) Hypovolemia
5) Decreased uterine blood flow
6) Intrauterine growth retardation
7) Premature delivery and labor
8) Placental abruption.

Question 32

List 12 complications in patients with HELLP.

Answer 32

1) Disseminated intravascular coagulation
2) Subcapsular liver hematoma
3) Placental abruption
4) Acute renal failure
5) Acute respiratory distress syndrome
6) Severe ascites
7) Pulmonary edema
8) Pleural effusions
9) Cerebral edema
10) Retinal detachment
11) Laryngeal edema
12) Maternal death

Question 33

According to the SOGC 2014 pregnancy induced hypertension guidelines, when are platelet transfusion cutoffs for c sections and vaginal deliveries?

Answer 33

1) For c sections, the cutoff for platelet transfusion is less than 50 x 109 / liters
2) For vaginal delivery, the cutoff for platelet transfusion is less than 20 x 109 / liters
Note: Platelet transfusions can be considered at levels higher than cutoff in the presence of active bleeding, known platelet dysfunction, coagulopathy, or rapidly falling platelet count.

Question 34

According to the SOGC 2014 pregnancy induced hypertension guidelines, what are 14 adverse conditions of pre eclampsia that increase the risk of severe complications?

Answer 34

1) Headache or visual symptoms
2) Chest pain or dyspnea
3) Oxygen saturation of less than 97%
4) Elevated white blood cell count
5) Elevated INR of PTT
6) Low platelet count
7) Elevated creatinine
8) Nausea or vomiting
9) Right upper quadrant or epigastric pain
10) Elevated serum AST, ALT, LDH or bilirubin
11) Low plasma albumin
12) Abnormal fetal heart rate
13) Intrauterine growth restriction
14) Oligohydramnios

Question 35

According to the SOGC 2014 pregnancy induced hypertension guidelines, what are 14 severe complications of pre eclampsia that warrant delivery?

Answer 35

1) Eclampsia
2) Cortical blindness or retinal detachment
3) GCS of less than 13
4) TIA or stroke
5) Uncontrolled severe hypertension refractory to 3 antihypertensive agents over 12 hours
6) Oxygen saturation less than 90%, requiring more than 50% FIO2, or pulmonary edema
7) Positive inotropic support
8) MI
9) Platelet count less than 50
10) Blood product transfusion
11) Acute renal failure
12) Hepatic hematoma or rupture
13) Abruption
14) Stillbirth

Question 36

According to the SOGC 2014 pregnancy induced hypertension guidelines, list 6 indications for use of magnesium sulfate.

Answer 36

1) Eclampsia
2) severe hypertension
3) Right upper quadrant or epigastric pain
4) Progressive renal disease
5) Platelet count of less than 100
6) Fetal neuroprotection if less than 31 weeks and 6 days gestational age.

Question 37

According to the SOGC 2014 pregnancy induced hypertension guidelines, what are the first three treatments for blood pressure in mild pre eclampsia?

Answer 37

1) Labetalol 100 to 400 milligrams PO BID to TID, maximum 1200 milligrams per day.
2) Methyldopa 250 to 500 milligrams P BID to QID, maximum 2 grams per day
3) Calcium channel blocker

Question 38

According to the SOGC 2014 pregnancy induced hypertension guidelines, what is the first three treatments for blood pressure in severe pre eclampsia?

Answer 38

1) Nifedipine 5 to 10 milligrams every 30 minutes.
2) Hydralazine 5 milligrams IV then 5 to 10 milligrams every 30 minutes maximum 20 milligrams IV.
3) Labetalol IV 20 milligrams IV every 30 minutes repeat 20 to 80 milligrams every 30 minutes, maximum 300 milligrams.

Question 39

List 3 medications used to treat severe gestational hypertension refractory to the above medications.

Answer 39

1) Sodium nitroprusside
2) Nicardipine
3) Esmolol

Question 40

List 5 physiological causes for decreased fetal heart rate variability.

Answer 40

1) Premature fetus
2) Fetal sleep
3) Fetal hypoxia
4) Fetal acidosis
5) Fetal neurologic abnormality such as anencephaly.
6) Fetal arrhythmia

Question 41

List 11 drugs that can diminish fetal heart rate variability.

Answer 41

1) Atropine
2) Anticonvulsants (excluding phenytoin)
3) Beta adrenergic antagonists
4) Antenatal corticosteroids such as betamethasone or dexamethasone.
5) Ethanol
6) General anesthesia
7) Hypnotics including diazepam
8) Insulin, if associated with hypoglycemia
9) Magnesium sulfate
10) Local anesthestics
11) Systemic opioids analgesia
12) Promethazine

Note: Propanolol has little effect on variability.

Question 42

List 8 causes of sustained fetal tachycardia, of over 160 beats per minute.

Answer 42

1) Fetal hypoxia
2) Fetal anemia
3) Tachyarrhythmia
4) Maternal fever
5) Chorioamnionitis
6) Anticholinergic (such as atropine)
7) Beta adrenergic receptor agonist (such as ritodrine or terbutaline)
8) Epinephrine

Question 43

List 5 physiological causes of persistent fetal bradycardia.

Answer 43

Persistent fetal bradycardia is a fetal heart rate of less than 110 beats per minute, for longer than 10 minutes.

1) Congenital heart block
2) Hypothermia
3) Hypoglycemia
4) Initial fetal hypoxia
5) Beta blocker

Note: Systemic opioids analgesia can cause a sinusoidal fetal heart rate pattern.

Question 44

List 5 drugs that can cause fetal bradycardia.

Answer 44

1) Anti thyroid medications such as propylthiouracil.
2) Beta adrenergic antagonists such as propranolol.
3) Intrathecal or epidural analgesia
4) Methylergonovine, which is contraindicated prior to delivery.
5) Oxytocin.

Question 45

Describe the changes in gastrointestinal physiology during pregnancy with respect to each of the following physiological parameters for each trimester.

Answer 45

1) Gastric emptying: There is no change in any of the stages, with the exception of labor where it slows down.
2) Gastric acid secretion: This slows down or decreases in 1st and 2nd trimester. It has no effect on the third trimester.
3) Gastric volume: This is unchanged, except in labor, where it increases.
4) Gastric pH of 2.5: this is unchanged, except in labor, where it decreases.

Note: These parameters return to normal in the first 18 hours post partum. The risk of aspiration starts as early as 14 weeks of gestational age during pregnancy.

Question 46

Describe the course of the lower esophageal high pressure zone during pregnancy.

Answer 46

LEHPZ normally prevents the reflux of gastric contents. In the first trimester of pregnancy, basal LEHPZ pressure may not change, but the sphincter is less responsive to physiologic stimuli that usually increase pressure. In the second and third trimesters, LEHPZ pressure gradually decreases to approximately 50% of basal values, reaching a nadir at 36 weeks’ gestation and returning to pre pregnancy values at 1 to 4 weeks postpartum

Question 47

List 3 risk factors for gastroesophageal reflux disease during pregnancy.

Answer 47

1) Pre pregnancy heart burn
2) Multiparity
3) Gestational age

Note: Weight gain amount, weight gain rate, and BMI do not correlate. Maternal age has an inverse correlation.

Question 48

What happens to the following thyroid functions during pregnancy?

Answer 48

1) Thyroid gland

Answer: Thyroid gland enlarges by 50 to 70%.

2) T3 and T4

Answer: 50% increases in both T 3 and T 4.

3) TSH

Answer: Decreases during first trimester, than normal for rest of pregnancy.

Question 49

What are five causes of cirrhosis strictly related to pregnancy?

Answer 49

1) Hyperemesis gravidarum
2) Acute fatty liver of pregnancy
3) Intrahepatic cholestasis of pregnancy, due to bile stasis and greater secretion
4) HELLP syndrome
5) Pre-eclampsia or eclampsia

Question 50

List 13 conditions that simulate seizures in eclampsia.

Answer 50

1) Seizure disorder
2) Stroke
3) Hypertensive encephalopathy
4) Ischemia or hypoxia
5) Cerebral space occupying lesion
6) Endocrine disease such as systemic lupus erythematosus, sickle cell anemia.
7) Infection such as meningitis or encephalitis
8) Electrolyte and endocrine disturbances
9) Reversible posterior leukoencephalopathy syndrome, or posterior reversible encephalopathy syndrome.
10) Vasculitis or angiopathy
11) Amniotic fluid embolism
12) Medication withdrawal or drug use
13) Organ failure.

Question 51

List 6 conditions associated with an increased risk of umbilical cord prolapse.

Answer 51

1) Multiple gestation
2) Breech, with incomplete being the highest.
3) Prematurity
4) Unengaged presenting part
5) Polyhydramnios
6) Multiparity

Question 52

What are 8 fetal complications associated with multiple gestation?

Answer 52

1) Preterm delivery.
2) Congenital abnormalities.
3) Polyhydramnios.
4) Cord entanglement.
5) Umbilical cord prolapse.
6) Intrauterine growth restriction.
7) Twin to twin transfusion.
8) Malpresentation.

Question 53

What are 10 maternal complications associated with multiple gestation?

Answer 53

1) Preterm premature rupture of membranes.
2) Preterm labor.
3) Prolonged labor.
4) Placental abruption.
5) Operative delivery (forceps and cesarean).
6) Obstetric trauma.
7) Preeclampsia/ eclampsia.
8) Disseminated intravascular coagulation.
9) Uterine atony.
10) Antepartum and/ or postpartum hemorrhage.

Question 54

What are the top 4 causes, in descending order, of third trimester hemorrhage?

Answer 54

1) Placenta previa
2) Placental abruption
3) Uterine rupture
4) Vasa previa

Question 55

What is the incidence of antepartum vaginal bleeding?

Answer 55

20%

Question 56

Name 7 risk factors for placenta previa.

Answer 56

The classic sign of placenta previa is painless vaginal bleeding during the second or third trimester.

1) Multiparity
2) Multiple gestation
3) Advanced maternal age
4) Previous cesarean delivery or other uterine surgery such as pregnancy termination.
5) Previous placenta previa
6) Smoking
7) Cocaine abuse

Question 57

Name 11 risk factors for placental abruption.

Answer 57

1) Advanced maternal age
2) Multiparity
3) Pre eclampsia
4) Premature rupture of membranes
5) Chorioamnionitis
6) Hypertension
7) Acute or chronic respiratory illness
8) Substance abuse
9) Maternal and paternal tobacco use
10) Cocaine use
11) Direct or indirect trauma

Question 58

List 10 conditions associated with uterine rupture.

Answer 58

1) Induction of labor
2) High dose oxytocin induction
3) Prostaglandin induction
4) Grand multiparity of more than 5
5) Morbidly adherent placenta
6) Congenital uterine anomaly
7) Prior uterine surgery
8) Connective tissue disorder such as ehlers danlos syndrome
9) Trauma
10) Forceps or version

Question 59

List 6 major complications of placental abruption.

Answer 59

1) Hemorrhagic shock
2) Couvelaire uterus
3) Coagulopathy or disseminated intravascular coagulation.
4) Acute renal failure
5) Anterior pituitary necrosis AKA Sheehan syndrome
6) Fetal compromise or demise, rate of 50%

Question 60

What is the definition of postpartum hemorrhage for vaginal and cesarean section?

Answer 60

Postpartum hemorrhage is usually defined as blood loss of more than 500 milliliters after vaginal delivery and more than 1 liter after cesarean section.

Question 61

List the 7 most common causes of disseminated intravascular coagulation in the obstetrical population.

Answer 61

1) Pre eclampsia
2) Placental abruption
3) Sepsis
4) Retained dead fetus syndrome
5) Post partum hemorrhage
6) Acute fatty liver of pregnancy
7) Amniotic fluid embolism

Question 62

List 4 contraindications to vaginal delivery after previous c-section.

Answer 62

1) Previous classic or T-shaped incision or extensive transfundal uterine surgery
2) Previous uterine rupture
3) Medical or obstetric complication that precludes labor and vaginal delivery
4) Inability to perform emergency cesarean delivery because of unavailable surgeon, anesthesia provider, or operating room staff

Question 63

List 9 obstetrical complications associated with cocaine abuse during pregnancy.

Answer 63

1) Maternal hypertension
2) Preterm labor
3) Premature rupture of membranes
4) Placental abruption
5) Precipitous delivery
6) Meconium aspiration
7) Low Apgar scores at birth.
8) Decreased birth weight
9) Intrauterine growth restriction and microcephaly
10) Fetal anomalies.
11) Spontaneous abortion
12) Stillbirth

Question 64

List 6 risk factors for cardiomyopathy of pregnancy.

Answer 64

Cardiomyopathy of pregnancy is left ventricular failure occurring late in pregnancy or in the first 6 weeks postpartum.

1) Advanced maternal age
2) Obesity
3) Hypertension
4) Pre eclampsia
5) Multiparity
6) Multiple gestation

Question 65

List 4 actions of magnesium on the neuromuscular junction

Answer 65

1) Attenuates the release of acetylcholine at the neuromuscular junction
2) Reduces the sensitivity of the end plate to acetylcholine
3) Decreases the excitability of the muscle membrane.
4) Potentiates the action of both depolarizing and non depolarizing muscle relaxants.

Question 66

List 4 relative contraindications to fetal scalp pH monitoring.

Answer 66

The obstetrician cannot perform this procedure if there is minimal cervical dilation.

1) Presence of intact membranes and an unengaged vertex presentation.
2) Fetal coagulopathy (which entails the potential for fetal exsanguination).
3) Infection, such as chorioamnionitis, human immunodeficiency virus, or herpes simplex virus (disruption of the fetal scalp allows a portal of entry for infection).
4) Anticipated need for many samples, which might result in significant fetal trauma.

Question 67

List 12 drugs that cross the placenta.

Answer 67

1) Anticholinergic agents, atropine and scopolamine
2) Beta blockers
3) Nitroprusside
4) Nitroglycerin
5) Benzodiazepines
6) Propofol
7) Ketamine
8) Etomidate
9) Inhalational anesthestic agents, including nitrous oxide
10) Local anesthetics
11) Opioids
12) Ephedrine

Question 68

List 4 drugs that do not cross the placenta.

Answer 68

1) Glycopyrrolate
2) Heparin
3) Depolarizing and non depolarizing agents
4) Phenylephrine

Question 69

List 4 adverse fetal effects with maternal use of beta adrenergic antagonists.

Answer 69

1) Fetal growth restriction
2) Neonatal bradycardia
3) Hypoglycemia
4) Respiratory depression

Question 70

List 6 uses for nitroglycerin during obstetrical delivery.

Answer 70

1) Uterine inversion
2) Retained placenta
3) Head entrapment
4) Uterine hyperstimulation
5) Second twin
6) Intrapartum cephalic version

Question 71

List 2 options apart from nitroglycerin for uterine relaxation.

Answer 71

1) Nitroprusside

2) Volatile agents

Question 72

List 3 disadvantages of continuous spinal epidural use in obstetrics.

Answer 72

1) Higher risk of fetal bradycardia
2) Delayed verification of functional epidural catheter
3) Higher incidence of pruritus