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28 Cards in this Set
- Front
- Back
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What % of women will have Mec in labor?
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7-22%
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What % of infants have Meconium aspiration syndrome (MAS)?
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10% exposed to meconium stained amniotic fluid (MSAF)
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What is involved in second stage management of mec?
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use of bulb syringe; there is no longer the recommendation for suction at perineum
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What are the risk of intrapartum suctioning?
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Apnea & cardiac arrythmias
Worsening hypoxia delay in resusitation damage of upper airway |
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What can you do to prevent MAS?
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Amnioinfusion
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What are the potential mechanisms of amnioinfusion/
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dilution of mec, cushioning of umbilical cord
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What are complications of amnioinfusion?
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cord prolapse, amniotic fluid embolism, uterine rupture
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Does ACOG recommend amnioinfusion for Mec?
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No, not as mec prophalaxis
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What are adverse events r/t AI?
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*uterine overdistention/hypertonia
*uterine rupture w/previous uterine scar *FHR abnormalities *cord prolapse *placental abruption *chorioamnionitis *maternal death |
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What is recommended in the clinical setting?
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with standard peripartum surveillance, AI with thick mec does not prevent MAS
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Is AI recommended for prevention of MAS?
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ACOG & Williams obstetrics do not recommend
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What physiologic decreases are seen in the GI tract during labor?
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*lower esophageal sphincter pressure and tone
*motility of the GI tract *gastric emptying |
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What influences the decrease in gastric emptying?
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pain, emotional state, stress & analgesics
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What physiologic increases are seen in the GI tract during labor?
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*significant increase in gastrin levels
*mechanical effect of enlarged uterus increasing intragastric pressure |
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What increases with a fasting woman in labor?
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stomach concentration of HCL
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What places a woman at higher risk of pneumonitis?
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aspiration of substances with PH<2.5 & volumes >25cc
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What increases a woman's potential for increased Lactic Acid during labor?
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when glucose isn't readily available, fat breakdown occurs that leads to FFA released that oxidize into ketones.
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What are a woman's energy needs during labor?
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50-100 cals per hour
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What has a low rate of emesis during labor?
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ad lib intake of food/fluids
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When women have control over intake, what benefits are seen?
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decreased stress
decreased catacholamine production |
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What % of total maternal deaths in labor is from aspiration?
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1-4% (1 in 200,000)
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What is the number of aspiration deaths in the general population?
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4.7 in 10,000 mostly children and elderly
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What is the number of aspirations in c/s & did they lead to death?
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15 in 10,000, none lead to maternal death
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In regards to aspiration, what is morbidity related to?
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it is related to use of general anesthesia and skill of anesthesia providor-not intake
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What are co-morbidities of aspiration deaths?
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*hypertensive issues
*neuro disorders, esp seizures *gastritis, ulcers *previous abd. surgery *esophageal disease *obesity |
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When should potential of aspiration be discussed with pt?
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during prenatal care
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what kind of care is recommended for labor?
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supportive, not emergency
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What should be evaluated & reviewed in regards to aspiration?
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evaluate those at increased risk & adapt plan
Review practice patterns for anesthesia |
