Term
| Explain the respiratory changes in the OB patient |
|
Definition
| The OB patient's body makes multiple changes in order to adequately adjust and meet the metabolic needs of the fetus while conditioning the mother's own system for the duration of the pregnancy and trauma of surgery. Pregnant patients have increase O2 consumption by 20%. This is from Baby's needs and the increase CO. To get more O2 to the baby and into circulation the mother's respiratory system must compensate by increasing its minute ventilation by 50%. To do this it increases its RR by 15% and its tidal volumes by 40%. To get larger tidal volumes and more air they lungs physically change as a result of progesterone which increase AP diameter, relaxes airways and pulmonary vasculature. The goal being O2 delivery. Now once the O2 rich blood gets to the fetus it has to get off the RBCs and cross the placental membrane. To enchance this process the mother's 2,3 DPG content is increased as well. This promotes more O2 disassociation from the RBC. Mothers RBC favor a right shift. The fetus on the otherhand, has RBC that favor a left shift, so they suck up all the O2 they can get and hold onto it so that it stays with them and doesn't go back to mom. |
|
|
Term
| What respiratory volume decreases the most in the OB patient |
|
Definition
| The FRC, ERV, and RV all decrease. But the largest decrease is in the Expiratory reserve volume due to the abdominal distension from the gravid uterus. Which pushes the diaphragm cephalad |
|
|
Term
| how does progesterone increase the OB patient's drive to breath |
|
Definition
| increases the brain's sensitivity to CO2. So the brain thinks normal levels of CO2 are abnormal. Then the brain compensates by making the patient breath faster. Hence why their RR increases by 15% and their baseline CO2 is around 30. |
|
|
Term
| In the OB patient what happens to the airway resistance and pulmonary vasculature |
|
Definition
| BOTH DECREASE due to progesterone |
|
|
Term
| What structure in the thorax does progesterone act on to increase the Vt of the patient? What is Vt |
|
Definition
| Vt= tidal volume. Progesterone relaxes costochondrial muscles. |
|
|
Term
| What happens to the OB Patient's Cardiac System during pregnancy |
|
Definition
| The cardiac system is gradually changed over the course of the three trimesters. The first increase in Cardiac output occurs in the 1st trimester by 10%. By the end of pregnancy in the 3rd trimester the CO goes up by 40-50%. (Baby is bigger) HR increases by mid 2nd trimester as CO needs increases |
|
|
Term
| what happens to the SVR in the OB pt |
|
Definition
|
|
Term
| there is a 50% increase in minute ventilation at what point in the paturient |
|
Definition
| at the start of pregnancy until delivery |
|
|
Term
| at what point during the pregnancy does the paturient CO change |
|
Definition
| 10% change in first trimester |
|
|
Term
| when is the highest CO change in paturient |
|
Definition
| at cord clamping. increases 60-80% |
|
|
Term
| how much does plasma icnrease compared to RBC |
|
Definition
| Plasma increases 45% while RBC increase 15% |
|
|
Term
Increase or decrease
1. fibrinogen
2. platelet |
|
Definition
Fibrinogen INCREASES
Platelet DECREASES |
|
|
Term
| at what week is the paturient full stomach |
|
Definition
|
|
Term
| when is gastric emptying delayed for paturient |
|
Definition
| at 2nd stage of labor during pushing |
|
|
Term
| uterine perfusion is directly or inversely proportional to maternal MAP |
|
Definition
|
|
Term
| Uterine perfusion is directly or inversely proportional to uterine vascular resistance |
|
Definition
|
|
Term
| at TERM the CO from mom to uterus is ___% |
|
Definition
|
|
Term
| epidural anesthesia prolongs what stage of labor |
|
Definition
|
|
Term
| maternal blood is carried via the uterine arteries and blood flows into... |
|
Definition
|
|
Term
| aortocaval compression can be expected at what point in the paturient |
|
Definition
| 18-20th week of gestation |
|
|
Term
| Left uterine displacement involves elevating the right hip __cm |
|
Definition
|
|
Term
| fetal blood is more or less acidic in comparison to maternal blood..why is this important to know |
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Definition
| fetal blood is more acidic so if drugs cross they become ionized and that prevents them from leaving. |
|
|
Term
| what drugs do not cross the placenta |
|
Definition
1. roc
2. sux
3. glycopyroolate
4. insulin
5. heparin |
|
|
Term
Placental transfer of locals from greastest to least..
etiodcaine, mepivacaine, lidocaine, ropivacaine, bupivacaine |
|
Definition
Monkey's Eat Limes Rasberries and Bananas
Mepivacaine > etidocaine > Lidocaine > ropivacaine > bupivacaine |
|
|
Term
| The paturient is in the 2nd stage of labor, what is the best analgesia to give her and what area of pain is she having |
|
Definition
lower vagina, perineum S2-S3-S4 pain. Give
1. paracervical block
2. caudal block
3. pudendal block |
|
|
Term
| if the paturient has break through pain after the epidural.. do you bolus? |
|
Definition
| no. This is normal. Likely nothing to do with the epidural not working. Its because of the cervical size increasing and / or full bladder. |
|
|
Term
| Your patient is fully dilated and in severe pain. CAn you give a epidural |
|
Definition
| NO. If fully dilated can't give epidural |
|
|
Term
| what drugs do we give that increase intraoperative fetal bradycardia |
|
Definition
|
|
Term
| what level of a sensory block do pts need for c-section |
|
Definition
|
|
Term
| #1 risk for mortality and severe injury for mother/fetus is when during delivery/labor |
|
Definition
| INTUBATION/INSTRUMENTATION |
|
|
Term
| what kind of ETT do you use for paturient |
|
Definition
|
|
Term
| when the uterus is removed to help get the baby out during the c-section. the patient is at greatest risk for what... |
|
Definition
| Venous air embolism! B/C above heart. |
|
|
Term
| why does thiopental have the least toxic effect on the fetus? |
|
Definition
| b/c of its enormously high protein binding |
|
|
Term
| what induction drug do we give mom that might make the fetus floppy when its delivered |
|
Definition
|
|
Term
| PIH is a major cause of premature labor 2nd to ___ |
|
Definition
|
|
Term
| What exactly do women die of as a result of PIH 2x |
|
Definition
1. cerebral hemorrhage
OR
2. Pulmonary EDEMA |
|
|
Term
| list some risk factors for what women may get PIH |
|
Definition
1. Low SES
2. immediate family members
3. Extreme ages (young/old) |
|
|
Term
| PIH results in increase or decrease sensitivity to catecholamines |
|
Definition
| INCREASE SENSITIVITY TO CATECHOLAMINES |
|
|
Term
| describe some CNS disturbances assocaited with PIH |
|
Definition
1. headache
2. visual field disturbances
3. hyperreflexia
4. seizures |
|
|
Term
| PIH increases or decreases uteroplacental perfusion |
|
Definition
|
|
Term
| what are the three major manifestations of PIH in the paturient |
|
Definition
1. HTN >140 / >90
2. proteinuria
3. edema |
|
|
Term
| what is the mneumonic for PIH |
|
Definition
HELLP
H:hemolysis
EL: Elevated Liver enzymes
LP: Low Platelets |
|
|
Term
| PIH results in increase or decrease sensitivity to catecholamines |
|
Definition
| INCREASE SENSITIVITY TO CATECHOLAMINES |
|
|
Term
| describe some CNS disturbances assocaited with PIH |
|
Definition
| 1. headache 2. visual field disturbances 3. hyperreflexia 4. seizures |
|
|
Term
| PIH increases or decreases uteroplacental perfusion |
|
Definition
|
|
Term
| what are the three major manifestations of PIH in the paturient |
|
Definition
1. HTN >140 / >90
2. proteinuria
3. edema |
|
|
Term
| what is the mneumonic for PIH |
|
Definition
HELLP
H:hemolysis
EL: Elevated Liver enzymes
LP: Low Platelets |
|
|
Term
| since delivery is the definitive treatment for severe PIH. When can you expect the mother's body to return to a more normal state |
|
Definition
|
|
Term
| is there an increase in fibrin split products or decrease in PIH |
|
Definition
| INCREASE. Which means more chance for DIC |
|
|
Term
| Name five ways effects of magnesium on the paturient |
|
Definition
1. interferes with Ca transport
2. decrease muscle membrane excitability
3. decrease motor end plate sensitivity
4. inhibits release of AcH (increase NDMB)
5. tocolytic |
|
|
Term
| what dose of magnesium is given for PIH |
|
Definition
| loading dose of 4-6 Gm/30min; maintenance of 1-2gram/hr for up to 24 hours POST-partum |
|
|
Term
| why can we NOT give esmolol for pregnant lady |
|
Definition
| its beta selective and will decrease contractility |
|
|
Term
| why is the MOA of labeltol better than hydralzine for emergent situations |
|
Definition
| Hydralazine takes 20 minutes to peak. |
|
|
Term
| the early sign of mag toxicity |
|
Definition
|
|
Term
| Therapeutic Mag plasma levels for PIH is |
|
Definition
4-8. mag/mEq/L (4.5mg/dL -9mg/dL)
Normal mag is 1.8-2.2 mg/dL
1 mEq Mg = 0.5 mmol Mg = 12.3 mg Mg |
|
|
Term
| treatment for mag toxicity is |
|
Definition
| Ca, and Supportive measures. |
|
|
Term
| can mag cross placenta? What does it do |
|
Definition
| Yes. causes hypotonia in fetus |
|
|
Term
| UOP goal for PIH patient is |
|
Definition
|
|
Term
| is there an increase or decrease in plasma cholinesterase |
|
Definition
|
|
Term
| 4x T's of maternal hemorrhage are |
|
Definition
1. tone
2. tissue
3. trauma
4. thrombin |
|
|
Term
| primary Sx of Placenta previa is |
|
Definition
| painless vaginal bleeding |
|
|
Term
| pt begins having painless vaginal bleeding around 32 weeks gestation..what may this be |
|
Definition
|
|
Term
| Whats the major concern with placenta previa |
|
Definition
| obstruction of the cervical OS |
|
|
Term
| premature separation of the placenta from the uterine wall is called |
|
Definition
|
|
Term
| What are some risk factors for abruptio placenta |
|
Definition
1. HTN
2. Abdominal trauma
3. ETOH
4. Cocaine use
5. Multiparity |
|
|
Term
| the # 1 cause of DIC in the paturient is from |
|
Definition
|
|
Term
| pt begins to have acute, severe abd pain, vaginal bleeding that is overt or occult..what do you suspect |
|
Definition
| EMERGENCY...ABRUPTIO PLACENTA |
|
|
Term
| a patient with a parital retained placenta can be expected to bleed a lot or a little? How miuch |
|
Definition
| ALOT. Expect 2 Liters/ 5 minutes due to uterine atony. |
|
|
Term
| retained placenta secondary to abnormal implantation from accreta, increta, or percreta can result from what |
|
Definition
| 1. intrauterine infection |
|
|
Term
| where should the placenta be attached to in the body |
|
Definition
|
|
Term
| whats the difference in the three types of placenta implantation problems |
|
Definition
1. placental accreta (not all comes loose)
2. Placental increta (invades myometrium)
3. Placental Percreta (pierces through uterine wall)
All result in the placenta not completely coming off the wall, leading to atony and hemorrhage |
|
|
Term
| the majority of uterine ruptures is from |
|
Definition
| 80% occur spontaneously. NO PREDISPOSING FACTORS |
|
|
Term
| the patient in labor has sudden, intense, continuous, despite epidural,with change in uterine tone/contraction pattern, hypotension. fetal brady .. you suspect |
|
Definition
| uterine rupture. If it ruptures. baby gets no blood hence the brady/distress, and mom is bleeding out since CO is so high. |
|
|
Term
| what's the fetal mortality associated with traumatic uterine rupture |
|
Definition
|
|
Term
| #1 cause of maternal hemorrhage is |
|
Definition
|
|
Term
| name the side effects of oxytocin |
|
Definition
1. vasodilation
2. hypotension
3. tachycardia
4. N/V
5. mild chest pain |
|
|
Term
| name three drugs to treat uterine atony |
|
Definition
1. oxytocin
2. methylergonovine
3. prostaglandins - only give if first two fail. |
|
|
Term
|
Definition
1. hypertension 2. N/V Contraindicated in PIH 3. cholinergic effects
High doses of Methergine will cause LSD like sx since its in this class of drugs. |
|
|
Term
|
Definition
1. bronchospasms
contraindications in airway disease patients |
|
|
Term
| dose for prostaglandins for uterine atony is |
|
Definition
|
|
Term
| dose for methylergonovine for uterine atony |
|
Definition
|
|
Term
| A sudden onset of respiratory distress and decrease BP is highly suspicious of |
|
Definition
|
|
Term
| who's at more of a risk for a amniotic fluid embolus |
|
Definition
| multiparous patients during preciptious deliveries |
|
|
Term
| third leading cause of death to paturient |
|
Definition
|
|
Term
| treatment for amniotic fluid embolus |
|
Definition
1. CPR
2. Pressors
3. Aminocaproic acid to trt DIC
4. Bicarb
5. steroids
6. correct hypoxemia
7. LUD / HOB up |
|
|
Term
|
Definition
|
|
Term
| normal pH from the scalp of the fetus is |
|
Definition
|
|
Term
| at what scalp pH would the fetus be in such distress that it needs immediate delivery |
|
Definition
|
|
Term
| the first sign of persistent fetal asphyxia or non-reassuring fetal tracing is? What are some other signs that may also be present |
|
Definition
1st sign = loss of beat to beat variablity
other signs
1. bradycardia
2. meconium staining of amniotic fluid |
|
|
Term
| macrosomnia babies will be hyperglycemic or hypoglycemic |
|
Definition
|
|
Term
| fetus's who's mothers have gestational diabetes will be at increased risk for 2x |
|
Definition
1. macrosomia
2. hypoglycemia |
|
|
Term
| what coags are increased in prego women |
|
Definition
1. platelets
2. Factor VII
3. fibrinogen |
|
|
Term
| normal Hb for a pregnant women not taking iron would be expected around |
|
Definition
|
|
Term
| a women taking iron supplements might have a hb around |
|
Definition
|
|
Term
| Hb in the term paturient >___ suggests hemoconcentration |
|
Definition
|
|
Term
| there is a ___ % decrease in MAC values for prego women |
|
Definition
|
|
Term
| what might promote gastric emptying in the paturient on the unit |
|
Definition
|
|
Term
| best predictive value for airway difficulty for the paturient is |
|
Definition
| thyromental distance and mallampati |
|
|
Term
| The longer the labor the more/less edema |
|
Definition
|
|
Term
| describe how pre-existing asthma may affect the patruient |
|
Definition
1). 1/3 get better due to pregnancy
2). 1/3 get worse
3). 1/3 no change |
|
|
Term
| what are the risk factors for smoking paturients |
|
Definition
1. low birth weights
2. preterm babies
3. placental abruption |
|
|
Term
| a a paraplegic has a lesion above ___ then they might not need neuraxial anesthesia but they are at risk for ___ which is best treated preventatively with ___ |
|
Definition
| paraplegic's with lesions above T5 won't need neuraxial anesthesia for C-section, but they are at risk for autonomic hyper-reflexia and the best way to prevent this is to give them a neuraxial block. |
|
|
Term
| ____ anesthesia meds have been linked to herpes outbreaks |
|
Definition
|
|
Term
| does research show a correlation between fetal heart rate monitoring and fetal outcomes |
|
Definition
|
|
Term
| Pre-eclampsia causes ___ % of all maternal mortality. Via what two ways |
|
Definition
| Pre-eclampsia causes 25% of all maternal mortality (usually due to pulmonary edema and intracranial hemorrhage) |
|
|
Term
| name some risk factors for hemorrhage during c-section |
|
Definition
1. polyandrous
2. placenta previa
3. increta
4. percreta
5. fibroids on uterus |
|
|
Term
| for the eclampsia patients they need mag iv running for how long |
|
Definition
| 24 hours after delivery since sx do not go away right after birth |
|
|
Term
| what do you warn the scoliosis paturient before you give an epidural |
|
Definition
| 50% chance the block will not be perfect |
|
|
Term
| is there an increase risk in uterine rupture if vaginal delivery after a previous C-section |
|
Definition
| yes 0.2-0.8 increase risk |
|
|
Term
| at what week are we worried about facial edema and what does this mean for the paturient |
|
Definition
| at week 24, facial edema may indicate gestational HTN |
|
|
Term
|
Definition
| First day of the last menstural period. Add one week, subtract 3x months, and add one year. |
|
|
