Ob Anesthesia Iii

Front 1

How dangerous are embolic phenomena in pregnancy

Back 1

Second only to hemorrhage

Front 2

Risk factors venous thromboembolism:

Back 2

>35yrs age, hig parity, obesity, immobility, pelvic trauma, sugery during pregnancy, family hx, hereditary thrombophilia, pre-eclampsia, multiple gestation

Front 3

Why are pregnant women at high risk for VTE?

Back 3

Venous stasis (caval compression), hypercoagulability, damage to vessel wall; resolves 2 weeks post-partum

Front 4

Treatment of thromboemoli:

Back 4

Unfractionated heparin is administered to prolong aPTT 1.5-2x control;
Fractionated (low molecular wt. Heparin)
*Don't use coumadin b/c passes placenta

Front 5

Can a patient receiving anticoagulants get a CLE for labor pain?

Back 5

Yes, if interval passes before admin
Wait 2 hours after removing CLE before resuming LMWH
Switch a patient to unfractionated Heparin at 38weeks b/c it is reversible & monitorable

Front 6

Summary of recommendations for regional anesthesia & anticoagulants:

Back 6

1) if blood seen with puncture-wait 24hrs for dose of LMWH
2) Neuraxial aneshtesia shouldn't occur at least 10-12hrs after last dose of LMWH (longer if on higher doses)
3) First dose of LMWH given no sooner than 24hrs after neuraxial aneshtesia & indwelling catheters removed before LMWH initiation, first dose can be given 2 hrs after catheter removed
4) If pt. on LMWH & catheter in place do not remove for at least 10-12hr after last dose of LMWH
5)Safest neuraxial may be single-shot spinal

Front 7

After getting the epidural the B/P drops in a patient with mitral valve stenosis, what med should be given?

Back 7

Phenylephrine should be given b/c tachycardia NOT tolerated in MV dx; in aortic stenosis fluids should be given with drug (in valve dx there is a fixed SV, so to increase B/P best to increase SVR)

Front 8

If the mitral stenosis patient goes into Afib, what should you do?

Back 8

cardioversion if hypotension is serious, beta blocker with rapid onset (propanolol)

Front 9

Postpartum backache:

Back 9

d/t: softening of maternal ligaments & mechanical stresses of delivery;
2-Chloroprocaine associated with increased backache d/t preservatives but not on market anymore

Front 10

Maternal Neurologic injury d/t:

Back 10

-Compression of the lumbosacral trunk by the fetal head;
-Kinking or compression of the femoral, lateral femoral cutaneous, or peroneal nerves during lithotomy position

Front 11

Which nerve is the most commonly injured during vaginal delivery?

Back 11

Lumbosacral nerve