6-30-10 OB Sess 3 Mid term Barry Class 2012
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| Why is the term C section proven not to be linked to Julius Caesar | Because a Cesarean section would have been fatal to his mother at such a primative time and there if evidence she was alive after his birth (plus cesarean means to cut - so cesarean section is repetative...should be cesarean delivery)
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| Name 3 Horizonal skin incisions for c section (starting at lowest) | Rfannenstiel, then Maylard, then Supraumbilical (the vertical incision is called Midline)
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| T/F: Has the incidence of c sections increased to date | Yes
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| What are the indications for having a c-section over a vaginal delivery | Problems or just preference
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| Which ligament may cause a complication of c section hematoma | Broad ligament
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| Premedications for C-section (3 classes) | Benzodiazepines (which are considered a "D" by the FDA), Opioids, and Aspiration prophylaxis
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| What are 5 possible materal complications of Anesthesia for parturients | Aspiration (r/t delayed gastric emptying and decreased esophagus sphincter tone), Hypotension (r/t decreased SVR and placenta hypotensive arena), Difficult intubation (swelling r/t progesterone), high spinal (r/t venous engourgement), Local CNS toxicity
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| Benefits of spinal over epidural (8 things) | Spinal has quicker onset, reaches Sacrum better, denser block, cheaper, easier to perform, less painful, lower dose needed, and rare Shivering
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| Negatives of Colloid prehydration for spinal/Epidural | Anaphylaxis, alter coagulation, and expensive
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| Bupivicaine dose for 5'9" 172 lb pt for Spinal | 11.25 mg (1.5 dextrose)
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| A high spinal causes severe hypotension because of | decreased CO2 secondary to decreased preload
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| If Moms systolic BP stays below (?) for 4-5 minutes it will cause irreversable fetal damage | < 80 mm Hg
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| Brain stem hypoxia may trigger | vomiting center
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| Shivering more common in Epidural or Spinal | Epidural
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| What is better, treating hypotension or preventing it | Prevention (although studies state prehydration doesn't prevent)
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| What is epinephrine role with epidural (4 things) | Prolonged duration, reduced peak plasma concentration of local, increased density of block, and marker for intravascular injection
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| Where should the heart be to decrease the incidence of Venous air embolism | Above the uterous
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| A hormone that stimulates gastric emptying | Motilin (it is inhibited by progesterone)
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| What is the starting dose of Pitocin | 20-40 units per liter (slide 69) - have methergine, hemabate, and misoprostol availible as back up for uterine atony
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| Uterine to delivery should be less than (minutes) | 3 minutes
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| S/S of Classical scar ruture (6 of them) | Sudden severe pain, Contractions, Palpable fetus, no heart tones, sudden colapse, and diffuse tenderness
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| VBAC stand for | Vaginal birth after cesarian section
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| TOLAC stand for | Trial of labor after c section
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