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6-30-10 OB Mid Sum

6-30-10 OB Midterm Summary All Slides - Barry

QuestionAnswer
How old does pt need to be to consent to lubal 21
Can consent for tubal be given during labor No
Can consent for tubal be given while under going abortion No
Can consent for tubal be given while on drugs No
Can consent for tubal be given and surgery performed within 30 days No, 30 day waiting period
Can consent for tubal be given and surgery performed within 181 days No, consent only good for 180 days
What does Suxx last longer post-partum Lower cholinesterase levels
What med used for aspiration prevention causes prolonged Suxx time Reglan (metoclopramide)
Are most drugs given secreted in breast milk Yes
Is ESWL safe during pregnancy No, contraindicated
Does anesthesia cause fetal malformations No
Does anesthesia cause IUGR Possibly
What respiratory items decrease during pregnancy PaCO2(10 mmHg), Serum HCO3 (by 4 mEq/L), FRC (20%), ERV (by 20%), RV (by 20%)
MAC decreases by how much during pregnancy 40%
What decreases cardiovascular wise with pregnancy SVR, SBP, DBP
What decreases with regards to renal with pregnancy Serum creatinine and BUN
What increases hematologically during pregnancy Coagulation factors (II, V, VII, VIII, IX, X, XII), Plasma 50%, RBC 35%
What decreases hematologically with pregnancy Hg, platlets, lymphocytes
Most all anesthetics make their way to the fetus except Paralytic agents- they are quaternart ammonium salts
If a teratogen is given to effect organogenisis when would it be given between 15 days to 56 days gestation
A classification of "A" of teratogen risk means Controlled studies should no risk to humans
A classification of "C" of teratogen risk means Risk cannot be ruled out
A classification of "D" of teratogen risk means Positive human evidence of fetal risk
A classification of "X" of teratogen risk means It is contraindicated
Most anesthetic drug are classified as "B" or "C" teratogen risk except for Benzodiazepines - "D"
Thalidomide babies have malformed limbs due to ingestion of sedative (thalidomide) during early gestation
Cerebral Palsy is caused by Hypoxia or hypotension in late gestation
What is the highest incidence (65-70%) of cogenital abnormalities of fetus Its unknown (next highest-20% is genetic transmission)
What are some documented teratogens ACE inhibitors, alcohol, cocaine, coumadin, depakote
The most serious fetal risk during pregnant surgery Asphyxia (insufficient O2)
When does maternal positioning start to matter 20 weeks when uterous leaves the pelvis at umbilicus level
When does fetal monitoring become practical After 16 weeks
What is the best measurement of your skill when delivering anesthetic during pregnancy Fetal monitor (fetal heart rate)
Has any study shown one anesthetic to be more prone top cause preterm labor No
Which trimester has lowest risk for surgery producing preterm labor 2nd trimester
Name 4 drug classes that are used to stop labor Beta adrenergic agonist, Mg sulfate, Prostaglandin synthetase inhibitors, and Ca channel blockers
What fetal effects do Beta blockers cause Hyperglycemia, tachycardia, those related to mom's hypotention
What effects do MgS04 have on fetus hypotonia, drowsiness, decreased gastric motility, hypocalcemia
What effects do prostaglandin synthetase inhibitors have on fetus Premature closure of ductus arteriosus, and pulmonary HTN
What effects do CA blockers have on fetus Methemoblobinemia
Pneumoperitoneum pressures for pregnant laparoscopy should be between 12-15
What is EXIT procedure Fetus is removed from uterus while cord stays intact until airway (ett, trach) can be established, the cord cut (done for fetal high airway obstruction, pleural effusion)
What is the dose of fetal Fentanyl IM 5-20 mcg/kg
What is the dose of fetal Vecuronium 0.2 mg/kg
What is the dose of fetal epinephrine 1 mcg/kg
What is the dose of fetal atropine 0.02 mg/kg
Recurrent second trimester pregnancy losses could be the result of Incompetent Cervix
What is a treatment for incompetent cervix Cervical cerclage (increases fetal survival rate from 20% to 89%
Name 3 types of Cervical cerclage Shirodkar, McDonald (both transvaginally), and Transabdominal
When are cervical cerclages performed between 12 and 26 weeks
Contraindications to cervical cerclage (7 of them) Active bleeding, Active labor, ruptured membranes, dilation > 4 cm, infection, fetal abnormalities, and abruptio placenta
What level do you need for cervical cerclage T8-T10
The leading cause of maternal death Trauma
What is a main cause of Abruptio Placenta Trauma
Sodium nitroprusside may cause fetal ? cyanide toxicity
MAP with neurosurgery should be >70
The portion of the fetus closest to the cervical Os is the definition of Presentation
Name 3 cephalic presentations Vertex (back of head), Brow (head position 1/2 way between vertex and face presentation), and Face (extended sniffing)
Is a breech position transverse or longitudinal Longitudinal (in reference to moms spine)
Name 3 Breech positions Frank (looking at his frankfurter- legs up), Complete (Indian style), Incomplete (one leg more extended either up or down)
Name a tranverse presentations Shoulder
Transverse and longitudinal are types of Lie
What is the most common type of breech position Frank
What are main causes for abnormal presentations Aberrant uterine shape, decreased uterine constraint (IUGR, premature), increase uterine constaint, and previous Hx of same
Umbilical cord prolapse is most common with which breech position Incomplete
ECV stands for External Cephalic Version (trying to turn the fetus by pushing on the outside of moms abdomen
Fetal head entrapment greatest in what gestational age >32 weeks
Treatmens for fetal head entrapment (4 of them) C section, Duhrssen incision, GETA (2-3 MAC), Nitroglycerin (IV 50-500 mcg or 2 sublingual sprays)
Twins from one ovum are called Monozygotic Twins
Twins from two separate ova are called Dizygotic twins (more common in african american)
Twin gestation increases blood volume over regular pregnancy by 500 ml
Twin to twin tranfusion occurs in which situation - monozygotic or dizygotic Both if they have the same (or fused) placenta
The most common medical disorder of pregnancy Hypertension
What is the definition of perinatal The period starts at 28 weeks gestation and goes through 28 days after delivery
What percent of pregnancy have HTN 6%-8%
What is the percent of preclampsia all of pregnancies in U.S. 4%
What is the percent of Eclampsia in pregnancy up to 0.05% (0.5% of preeclampsia population)
Coma and convulsive seizures between the 20th week gestation and the end of the first week postpartum is the definition of Eclampsia
The most common cause of HTN during pregnancy Gestational HTN
What is the start and stop time of the HTN in gestational HTN Starts 20 th week gestation and end 12 weeks postpartum (most start at 37 weeks gestation)
Is there proteinurea in Gestational HTN NO (that would be preeclampsia)
What would HTN be called if it started prior to 20 weeks gestation and continued after 12 weeks postpartum Chronic HTN
Overall the most commonly essential HTN Chronic HTN
What can Chronic HTN develop into Superimposed preeclampsia
Onset of HTN and proteinurea after 20 weeks gestation is called Preeclampsia
75% of preeeclampsia are "Mild" defined as (2 things) BP >/= 140/90 mmHg after 20 wks and Proteinurea 300mg/24hr (or +1 on dipstick)
Severe Preeclampsia is defined as (10 things) BP >/= 160/110 mmHg (on 2 occasions at least 6 hours apart), proteinurea >/= 5 g/24hr, Oliguria (<500ml/24hr), Elevated Serum Creatinine, Cerebral or visual disturbances (Headache), Pulmonary edema with resp distress, Liver dx, RUQ pain, IUGR, and Thrombo
HELLP stands for Hemolysis, Elevated Liver Enzymes, and Lowered platlets
The "E" ion HELLP is specific for elevated hepatic transaminases
Why are platlets low in HELLP syndrome they are decreased secondary to an increase rate of consumption
How is hemolysis diagnosed in HELLP usually by the presents of schistocytes in a peripheral blood smear (microangiopathic - small vessels tear cells apart)
What physiologically happens in eclampsia Diffuse vasospasm of cerebral vessles leads to cerebral ischemia
Risk factors for preeclampsia Nulliparity, Hx of, > 35yr old, Non-Hispanic African American, Obesity, HTN, DM, Sickle cell Dz, Smoking, Multiple gestation, Hydatidform mole, Abnormal Placenta, and Materal Syndrome
Most current released theory of preeclampsia Antiangiogenic Protiens
The vasospasm that occur in preeclampsia are caused by an increase in circulating levels of renin, aldosterone, angiotensin, and catecholamines
What causes the edema in preeeclampsia Aldosterone by retaining Na and H2O
What happens to the plasma level in preeclampsia decreases by 30-40%
What increases (4 things) that imply hypercoagulation in preeclampsia Common pathway activity, Fibrin degradation products, Factor VIII and its activity, Platlet aggregability
What decreases (4 things) to imply hypercoagulation in preeclampsia Fibrinogen, Antithrombin III, Platlets, and Sensitivity to prostacyclin
What happens with Renal in preeclampsia Decrease in renal blood flow (20%), decrease GFR (30%), decrease uric acid clearance (elevated uric acid levels), proteinurea, and glomerular endotheliosis
60 % of pts with acute fatty liver disease have Preeclampsia/HELLP, hemorrhage, even Liver rupture
What happen with the brain in preeclampsia (4 things) Headache, eclampsia, visual disturbances (including cortical blindness), and seizures
What happens hematologically with preeclampsia Hemolysis, thrombocytopenia, platlet disfunction, and increased platlet consumption
What effects on the respiratory system does preeclampsia have (4 things) Edema (laryngeal, upper airway, and pulmonary), pulmonary capilary leak, increased sucretions and congestion
Why does pulmonary edema take place in preeclampsia Low colloid oncotic pressure, increased pulmonary capillary permeability, ventricular disfunction, and increased intravascular hydrostatic pressure
Does respiratory issues with preeclampsia happen more frequent antepartum or postpartum Postpartum 70% (Antepardum 30%)
What placenta effects does preeclampsia have (5 things) Intervillous blood flow decreases 2-3 fold, Hypoperfusion (premature labor), Chronic fetal hypoxemia, IUGR, Placenta abruption is more common
Management for preeclampsia includes (6 things) Antihypertensive Tx, Anticonvulsant Tx, Urteroplacental perfusion management, Analgesia for L&D, L&D management, and Surveillance of fetus and materal
What is used for longterm management of HTN in preeclampsia Aldomet and Labetalol
Name tx for htn in preeclampsia (5 of them) Hydralazine, Labetolol, Calcium channel blockers, Nitroglycerin, and Sodium Nitroprusside
What is the first line anticonvulsant treatment for preeclampsia Mag Sulfate
How does Mag sulfate prevent seizures Cerebral and peripheral vasodilator, NMDA antagonist, and NMJ effect
What is the MgSO4 dose 4-6 g over 20 min, then 1-2 gram/hr
What is the theraputic level of MgSO4 6-8mg/dl
MgSO4 causes ECG changes at what plasma level 5 meq/L
What plasma level does MgSO4 cause resp depression at 10 meq/L
What plasma level does MgSO4 cause resp arrest at 15 meq/L
What plasma level does MgSO4 cause cardiac arrest at 25 meq/L
What are the side effects of mag sulfate Thing get weak and floppy (NMB last longer also)
What is the etiology for neuromuscular effects from Mag sulfate Decreases acetylcholine release from nerve terminal, decreases sensitivity of acetylcholine at endplate, and depresses the excitability of skeletal muscle membrane
Five things preeclampsia can lead to CVA, Pulmonary edema, Renal failure, Placenta Abruption, and HELLP (Hemolysis, Elevated Liver enzymes and Low Platlets)
What is the level of bilirubin in HELLP > 1.2 mg/dl
What is the level of Lactic dehydrogenase in HELLP > 600 IU/L
What is the level of SGOT in HELLP >/= 70 IU/L
What is the platelet level associated with HELLP < 100,00/mm3
HELLP can lead to (9 things) Pulmonary edema, ARDS, Placenta abruption, DIC, Ruptured liver (hematoma), Acute renal failure, severe Ascites, Cerebral edema, and materal death
A women who is not now or never has been pregnant Nulligravida
Time frame after delivery Postpartum
A women who is or has been pregnantirrespective of the pregnancy outcome Gravida
Time frame before delivery of fetus Antepartum
Refers to a women's previous pregnancies of at least 20 weeks gestation Parity
A term delivery happen when Between 37 and 41 weeks
A women who is pregnant for the first time beyond the stage of abortion Primigravida
When is the third trimester begins at 27 weeks and ends at delivery
Delivery when infant delivers after 42 weeks gestation Postterm
A women who has completed two or more pregnancies beyond the stage of abortion Multigravida
Delivery that occurs prior to 37 weeks gestation Preterm
A women who has never completed a pregnancy beyong an abortion Nullpara
The period from 13 weeks to 26 weeks from the last menstrual period Second trimester
A women that has delivered a viable fetus past the stage of abortion Primipara
The period the begins at conception and ends at 13 weeks from last mentrual period First trimester
A women in labor Parturient
A women who had just given birth Puerpera
Most HELLP pts have what type of delivery C-section
What is an indicator for PA cath placement Evidence of CHF
Benefits of regional anesthetics in preeclamptic patients (9 of them) Pain relief and relaxation, decreased catecholamines, increased uteroplacenta blood flow, no parental narcotic systemic effects, control of BP, permits low outlet forcepts, njo pulm. edema, can use for c-section, and decr. aspiration
Eclampsia is highest risk at age < 20yrs
What is the clinical presentation of eclampsia Headache, blurred vision, photophobia, RUQ or epigastric pain, hyperreflex, and altered mental status
Facial twitching, tonic phase (persisting about 15-20 seconds) progresses to what in eclampsia Generalized clonic phase with 1 min apnea then postictal and coma
First line drug with eclampsia Mag Sulfate
2nd and third line drugs for eclampsia Antihypertension agents then thiopental, propofol, versed
Amniotic fluid emboli triad Dyspnea, Cyanosis, Carviovascular Collapse
Amniotic fluid embolism - % fatal 20-80% fatal
Amniotic fluid embolism account for what percent of maternal deaths 12% of materal deaths (5 in 100,000 births)
Name all the predisposing factors for Amniotic fluid embolism Just one - The fact of being pregnant
Three things that need to be present for Amniotic fluid embolism Amniotomy, laceration of endocervical or uterine vessel, and Pressure gradient to force fluid into materal circulation
What causes Amniotic fluid embolism to be deadly The Biochemical mediators it contains (prostaglandins, leukotrienes), they cause vasoconstrictions, vasodilation, and inotropic effects
How do you diagnose AFE By exclusion
Amniotic fluid embolism cause what to resp system Hypoxemia - pulmonary vasospasm
Amniotic fluid embolism causes what to cardiovascular system Hypotension, tachycardia leading to cardiac arrest
If one survives Amniotic fluid embolism, what happens hemodynamically Coagulopathy in 66% of pt (DIC 80% of the 66%)
The cascade of Amniotic fluid embolism Resp distress, cerebral hypoperfusion, Hemodynamic collapse, Hemorrage, then multi-organ failure and infection
Top 3 (seen more than 90 % of the time) S/S of Amniotic fluid embolism Hypotension (100%), Fetal distress (100%), and Pulmonary edema (93%)
Main priority for Amniotic fluid embolism recovery Get the BP up - pressers, fluids
Venous Air Embolism (VAE) occurred in 97% of pts receiving General anesthesia
Is VAE rare No, VAE is a common occurance
The lethal amount of air in VAE > 3 ml/kg
50% of VAE pts had these on the monitor ECG changes - ST depression
First action with VAE Flood the field
What often is the begining cause of Pulmonary thromboembolism (PTE) DVT
When is PTE most likely to occur Postpartum
Up to what percent of untreated pregnant DVT result in PTE 15-24 % end up with PTE
The etiology of PTE (3 things) Venous stasis, increased hypercoagulable r/t pregnancy), and vascular injury (r/t vaginal or c-section trauma)
Most pronounced finding in PTE (85% of the time) Tachypnea
When is it ok to start DVT therapy with Warfarin Postpartum (it crosses the placent easily - Heparin can be given antepartum)
How long after Low molecular weight heparin (LMWH) can a neuraxial be attempted 12-hrs (same time frame when removing epidural catheter
Created by: smorrissey1 on 2010-06-30



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