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OB final chp 23-25
OB chp 23, 24, 25
| Question | Answer |
|---|---|
| which c-section incision is the modern type | low vertical with curve |
| which c-section incision has a high incidence of rupture | classic |
| uterine rupture will cause disruption of labor, fetal distress, vag. bleeding, hypoTN, shock, pain (10%):which one is a tool to help dx rupture | fetal distress |
| T or F previous c-section for dystocia or cephalopelvic disporp. contradicts a trail of labor | false, doesn't contradict |
| does a previous classic or Tshaped uterine incision contradict a trail of labor | yes |
| implement of VBAC could avoid __,000 c-sections annually | 200,000 |
| after thorough counseling that wts the individual benefits and risks of VBAC, the ultimate decision to attempt this procedure or undergo a repeat c-section should be made by the ___ and ___ | pt and physician |
| risk of VBAC incidence of uterine rupture __% | 0.8 |
| the essential first sign of trouble is _____ and is the most reliable sign of uterine rupture | decreased FHR |
| T or F intrauterine pressure monitoring is ideal to dx uterine rupture | false, difficult to |
| this type of augmentation is controversial and studies show it may increase rupture incidence | oxytocin augmentation |
| what is the most common indication for c-section | previous c-section |
| T or F c-section is the most freq. performed operation in the Us | T |
| a trial of labor is successful in _% to _% of women who had a low-transverse incision: 40%-50%, 20%-40%, 60% to 80% | 60% to 80% |
| continuous electronic FHR monitoring represents the best means of detecting | uterine rupture |
| what age must the pt be at least to perform a tubal ligation | 21 |
| consent for tubal ligation is only valid for __ days | 180 |
| a total of __ days must pass b/n the date the consent is signed and the date the procedure is performed | 30 |
| if pt is not hemodynamically stable for a tubal you should delay for _ to _ wks | 6 to 8 |
| T or F you should evaluate neonate prior to tubal | T |
| what is a major risk assoc. with anesthesia for postpartum tubal | aspiration |
| T or F opioids given prior to can decrease delay of gastric emptying | F; can increase, so avoid prior to tubal procedure |
| metoclopramide may accelerate gastric emptying in pts who have recieved an opioid | F; may not |
| when does gastroesphageal reflux return to normal postpartum | 2nd postpartum day |
| an hour after 4th stage of labor pt is at risk for | bleeding; therfore there is a 8 hr wait period prior to tubal |
| __% tubal sterilizations worldwide | 75 |
| MAC greater than _ may inhibit oxytocin | 1; and cause uterine atony |
| metoclopriamide increase NMB duration with sCh | false, prolongs |
| most NDMB actions are prolonged except | atracurium and cisatracurium |
| T or F sCh action is prolonged during preg. | T |
| this type of anesthesia provides excellent operation conditions for postpartum tubals | regional |
| what level should the regional be at for tubal | T4 |
| it is advised to wait _ hrs postpartum for a tubal | 8 |
| regional may require more anesthesia secondary to decreased levels of | progesterone |
| lg volumes required of regionals can possible cause | cardiotoxicity |
| this medicine is contradicted with nursing mothers b/c of possible adverse effects of prostaglandin sysnthetase inhibitors on neonates | ketorolac |
| c-section rate exceeds __% | 24 |
| _ to _% of all maternal deaths due to anesthesia (general), failed airway common etilogy | 3 to 12% |
| versed is recommended as part of anesthesia | false |
| anxiolysis are rarely given b/c mother wants to remeber birth | T |
| before regional _to_cc/kg given _mins prior reduces hypoTN and improves uteroplacental circulation | 15 to 20; 30 |
| what type of IVF should be avoided | glucose containing solutions |
| avoid hyperventilation it can cause | uterine artery vasoconstriction |
| should you be concerned if mother has ST segment changes | No!(can be common) but rule out possible causes(hypervolemia, tachy, VAE, coronay vasospasm, anmiotic emboli) |
| use of doppler u/s should be routinely used for VAE | false |
| what triad should be rely on for VAE and txment | CP, desat., arrthy, right-sided strain; IVF and 5 to 10 degree reverse trendelenburg |
| all pregnant pt should receive what med before GA | aspiration prophylaxis (H2 blockers) |
| prevention of aspiration includes | avoid GA; awake intubation with diff. airway; cricoid, RSI, untubation with cuffed tube |
| goal pharmacotherapy of gastric secretions is to __ gastric vol, and __ pH | decrease, increase |
| these drugs don't alter pH of existing gastric contents | H2 receptor antagonist |
| this drug increases gastric emptying and increases LES tone and antiemetic | metoclopramide |
| what is the most common complication of regional anesthesia | hypotension |
| hypotension results from increased venous capacitance and decreased SVR from | sympathectomy from the blockade (avoid by IVF) |
| what things can be done to prevent hypotension | IVF, left uterine placement, prophylactic vasopressors |
| routinely administer prohylactic vasopressors is advised | false |
| which prophylactic vasopressors is preferred | ephedrine; give phenylephrine instead for tachy pt with low BP |
| what are some s/s of a high spinal | complete motor and sensory block, hypotn, brady, unconsciousness, loss of protective reflexes and respiratory arrest |
| if pt goes into cardiac collapse what should you do and should avoid | should intubate and paralysis, shouldn't sedate |
| how often does a high spinal occur out of 50,000 | 1 in 50,000 |
| prevention of a high spinal | administer test dose, aspirate before injecting, and give 5cc increments and wait/watch |
| convulsions, unconsciousness, arrhythmias, cardiovascular collapse are s/s of | local toxicity |
| bupivicaine has a 4 hr 1/2 life and can cause ___ heart ___ | complete heart block |
| what is the recommendation for txment of bupivacaine toxicity | 20% intralipids; 1cc/kg bolus than 0.25cc/kg/min infusion with CPR |
| persistent neurologic deficit is common and occurs after administration of spinal or epidural | rare |
| transient neurologic syndrome (TNS) occured after intrathecal injection of | hyperbaric 5% lidocaine |
| s/s of TNS | burning pain and dysethesthia in the L5- S1 dermatones usually start after spinal and can last for an hr to 4 days |
| TNS is more common in what position, type of pt, and outpt surgeries | lithotomy and obese |
| TNS occurs most in all locals | false, greater with 5% lidocaine |
| what dermatones are effected in TNs | L5-S1 |
| what is the recommended therapy for TNS with severe pain | NSAID or oral opioids |
| how long can TNS last | hour to 4 days |
| what can help reduce maternal nausea | supplemental o2 |
| support person can have a significant contribution to the delivery process | true |
| there is a increase risk of VAE with | exteriorizing the uterus |
| only general when truly ___ conditions exists | stat |
| considerations of choice of anesthetic technique are | urgency of procedure, choice of mother, health of mother and fetus |
| this type of needle decrease PDPH (postdural puncture H/A) | non-cutting needles |
| what type of drug is commonly used for spinals | 0.75% bupivacaine |
| what is 0.75% bupivacaine duration and dosage range | 60-125mins and 7.5mg-15mg |
| does 5% lido or 0.75% bupicacaine have a longer duration | bupivacaine |
| epidural absolute dose is _ to _ times greater than spinal | 5 to 10 |
| an epidural high spinal may be caused from | SA injection subarachnoid |
| should aspiration propylaxtis still be give for regional | yes; still at risk for aspiration |
| signficant coagulation is an indication for GA | true |
| inadequate regional anesthesia is an indication for GA | true |
| what is the most popular induction agent | thiopental |
| does thiopental cross the placenta | yes |
| thiopenthal has what kind of hemodynamic effects | negative inotrope and vasodilator |
| propofol is often used as an induction agent | false; never used in practice |
| the use of ketamine can increase BP by __% | 14 |
| lg does of ketamine can __ uterine tone | increse |
| what are ketamines hemodynamic effects | indirect sympathomimetic |
| ketamine should be used in severe hypotn | false, can cause myocardial depression, decreased CO, hypotn |
| induction of asthmatic, modest hypovolemic pts should give | ketamine |
| this induction agent can cause dysphoria and hallucinations; | ketamine (give versed suggested) |
| this induction agent is excellent choice in hemodynamically compromised pt | etomidate |
| pain and myoclonus may occur with this induction agent | etomidate |
| midazolam only indication may be contraindication to | other agents |
| versed is commonly used | false |
| Sch crossed placenta and paralyzes fetus | false; ionized |
| homozygous atypical pseudocholinesterase may result in __ infant | apneic |
| high does volatile may induce | uterine relaxation and post partum bleeding |
| when should volatile be discontinued | uterine atony occurs |
| maternal hypotension may cause fetal | hypoxia and acidosis |
| longer I-D time with GA doesn't effect fetus | false |
| infants have a lower 1 min apgar score with what type of anesthesia | GA |
| 5 min apgar scores differ greater with GA or regional | false; when proper resuscitation is given |
| U-D time of greater than _ mins:bad apgar, low pH score, regardles of anesthetic tech. | 3 min. |
Created by:
melbacs