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210 Cards in this Set
- Front
- Back
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Placenta plays an important role in
a) metabolism (carb, amino acid) b) substrate transport c) synthesizing compounds d) all of the above |
a) metabolism (carb, amino acid)
b) substrate transport c) synthesizing compounds |
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T/F placental O2 consumption accounts for 40% of total uterine O2 uptake
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True
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The placenta has (choose 2)
a) one artery b) two arteries c) one vein d) 2 veins |
2 arteries (return deoxy blood to placenta)
1 vein (carries O2 to fetus) |
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T/F the placenta converts steroid precursors into estrogens and progesterone
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True
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Progesterone can
a) make bones/joints more supple b) make a mom crazy c) a only d) b only e) both a & b |
a) make bones/joints more supple (helps open broad ligaments for birth)
b) make a mom crazy |
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During pregnancy the O2-Hb curve is shifted to the
a) left b) right |
Right, meaning there is less affinity for O2 so that mom can offload O2 to fetus
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The arterial and venous PO2 in fetus is (pick 2)
a) arterial 35mmHg b) arterial 40mmHg c) venous 35mmHg d) venous 40mmHg |
arterial 35mmHg
venous 40mmHg |
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The Fetal O2-Hb curve is shifted to the
a) right b) left |
left, which will make the fetus ACIDOTIC PaO2 = 20 torr
(vs adult = 27 torr) |
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Will the fetal PO2 ever increase to more than 50-60mmHg?
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No, even with high O2 flow rates to mom, because fetus relies on CV function for adequate O2
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Does Fetal Hb have a higher/lower affinity for O2 ?
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Higher! O2-Hb curve is shifted to left P50 = 19-21mmHg (vs adult 27mmHg)
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T/F The fetus has higher Hgb concentrations?
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True
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Which of the following can shift the O2-Hb curve to the right? (pick 2)
a) pregnancy b) dec. 2-3 DPG c) hyperthermia d) alkalosis |
Pregnancy, hyperthermia
(alkalosis & dec. 2-3 DPG shift curve to left) |
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T/F A small change in the amount of O2 the fetus receives makes a big difference
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True, because PaO2 is already low, and placenta and fetus really utilize the small amount they get
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The normally low fetal PaO2 is important for keeping
a) ductus arteriosus open b) pulmonary vascular bed constricted c) ductus venosus open d) pulmonary vascular bed dilated |
a) ductus arteriosus open
b) pulmonary vascular bed constricted |
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The ductus venosus is located at
a) junction of the pulmonary trunk and descending aorta b) junction of the umbilical vein and IVC c) between the RA & LA |
junction of the umbilical vein and IVC
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The ductus arteriosus is located at
a) junction of the pulmonary trunk and descending aorta b) junction of the umbilical vein and IVC c) between the RA & LA |
a) junction of the pulmonary trunk and descending aorta
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The foramen ovale is located at
a) junction of the pulmonary trunk and descending aorta b) junction of the umbilical vein and IVC c) between the RA & LA |
c) between the RA & LA
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Oxygenated blood from the umbilical vein brought via IVC to RA is preferentially shunted to
a) the RV so that it can then go to the PA b) to the LA through the patent foramen ovale c) directly to the head via the carotids |
b) to the LA through the patent foramen ovale
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T/F When inutero the fetus receives no blood to the lungs, as it is not breathing at this time
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False, a small % of blood is delivered to the lungs
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T/F maternal infusions of crystalloid may result in a significant increase in fetal ECF
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True
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Deoxygenated blood from head enters RA and then goes to RV then to where?
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Pulmonary branch and on to the Ductus arteriosus
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Oxygenated blood travels up ______________ from placenta to the IVC and through the _______________ to the RA and then on to the _________
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umbilical vein, foramen ovale, the head & heart (preductal circulation)
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At birth the fetal circulation changes from a parallel system to _____________ and then on to _____________ as an adult
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transitional, series
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T/F Fetal cardiac output is considered
bi-ventricular |
True, because in the fetus the outputs of the RV & LV mix, whereas in adults it does not!
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In the fetus an increase in preload does/does not increase ventricular output
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Does NOT! BUT a increase in preload will lead to IMMEDIATE DROP in Cardiac output!!!
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An decrease in fetal afterload will cause a(n) increase/decrease/no change in cardiac output
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No change!!
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Would an infusion of Isuprel lead to an increase in fetal cardiac output?
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NO!! d/t the fetus beta-adrenergic receptors being relatively unresponsive
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In the fetal circulation when the heart rate decreases the stroke volume increases slightly/increases by a large amount
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Increases only slightly d/t lower compliance of fetal myocardium
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The fetus responds to severe hypoxemia by
a) decreasing HR b) decreasing CO c) increasing blood flow to heart & brain d) decreases CMOR2 e) b, c & d only f) all of the above |
a) decreasing HR
b) decreasing CO c) increasing blood flow to heart & brain d) decreases CMOR2 |
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What is the "dividing line" for a healthy fetus pH?
a) 7.30 b) 7.20 c) 7.15 |
pH 7.20
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Is meconium always a sign of fetal distress?
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No, only when associated with other signs of fetal asphyxia
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Which statement about FHR patterns is MOST likely true?
a)Early declerations indicate fetal hypoxia b) Maternal drug administration does not influence FHR c) Short-term (beat-beat) variability is an insensitive indicator of fetal well-being d) Sustained HR > 180 bpm may be indicative of fetal hypoxia |
Sustained HR > 180 bpm may be indicative of fetal hypoxia
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T/F Fetal carotid chemoreceptors are quite active and respond to even slight changes in arterial oxygenation
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FALSE!! Aortic chemoreceptors are more active!!!
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T/F Hypoxia is the most common fetal stress occurring during labor and delivery
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TRUE
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The tocodynamometer determines (choose all that apply)
a) approx onset of contraction b) duration of contraction c) strength of contraction d) offset of contraction |
onset, duration, offset
CAN NOT DETERMINE STRENGTH |
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The fetus' initial response to hypoxia is
a) increased HR b) decreased HR c) increased CO d) decreased CO |
DECREASED HR
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The fetus' response to prolonged hypoxia is
a) increased HR b) decreased HR |
INCREASED HR
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Which of the following cause a change in FHR? (choose all that apply)
a) Terbutaline b) atropine c) maternal fever d) intrauterine infection |
a) Terbutaline
b) atropine c) maternal fever d) intrauterine infection |
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The normal FHR is _________________
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110-160
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Short term variability in FHR can be defined as (choose 2)
a) an abrupt increase in FHR b) Difference between 2-3 beats c) results from influence of parasympathetic tone on FHR |
b) Difference between 2-3 beats
c) results from influence of parasympathetic tone on FHR |
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T/F FHR variability is normal
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True, reflects presence of normal intact pathways form cerebral cortex, cardiac conduction. Presence predicts early neonatal health
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Absence of variability can be a sign of (choose all that apply)
a) early neonatal health b) fetal hypoxia c) fetal sleep state d) decreased CNS activity from drugs |
b) fetal hypoxia
c) fetal sleep state d) decreased CNS activity from drugs |
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T/F the presence of accelerations in FHR most likely precludes presence of significant fetal metabolic acidosis
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True
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T/F The FHR can accelerate in response to fetal movement in a healthy fetus, and represents a REACTIVE non-stress test
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True
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Early decelerations occur (choose all that apply)
a) simultaneous with uterine contractions b) coincide with onset & offset of uterine contraction c) are usually < 20bpm below baseline d) result from vagal activity secondary to MILD hypoxia |
a) simultaneous with uterine contractions
b) coincide with onset & offset of uterine contraction c) are usually < 20bpm below baseline d) result from vagal activity secondary to MILD hypoxia |
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Variable declerations
a) vary indepth, shape &/or duration b) are abrupt c) result from umbilical cord compression d) a only e) all of the above |
a) vary indepth, shape &/or duration
b) are abrupt c) result from umbilical cord compression |
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With FHR decelerations which of the following would be considered mild-mod
a) < 100 bpm b) < 80 bpm c) < 60 bpm |
< 80 bpm (become worried)
< 100 bag/mask (mom) < 60 run to the OR |
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Variable decels are generally indicative of (choose all that apply)
a) hypoxia r/t uteroplacental insufficiency b) a normal increase in vagal tone r/t fetal head compression c) maternal fever d) umbilical cord compression e) a result of sympathiomemtic drugs |
a) hypoxia r/t uteroplacental insufficiency
b) a normal increase in vagal tone r/t fetal head compression c) maternal fever d) umbilical cord compression e) a result of sympathiomemtic drugs |
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Late decelerations can be described as ( choose all that apply)
a) smooth, repetitive, occur with each contraction b) are 10-30 sec AFTER beginning & END of contraction c) Result from hypoxemia, or decomp. of cardiac circulation |
) smooth, repetitive, occur with each contraction
b) are 10-30 sec AFTER beginning & END of contraction c) Result from hypoxemia, or decomp. of cardiac circulation |
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T/F A combination of late decelerations and decreased/absent FHR is an ominous sign of fetal distress
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TRUE!!
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T/F Late decels in FHR can occur 15 seconds after peak and have a relatively normal heart rate (110-160)
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TRUE
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Early decels in FHR can be caused by
a) head compression b) cord compression c) uteroplacental insufficiency |
head compression
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Late decels in FHT can be caused by
a) head compression b) cord compression c) uteroplacental insufficiency |
uteroplacental insufficiency
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Variable decels in FHT can be caused by
a) head compression b) cord compression c) uteroplacental insufficiency |
cord compression
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Accelerations in FHR can be caused by
a) head compression b) cord compression c) uteroplacental insufficiency d) a hypoxic response/acidosis |
a hypoxic response/acidosis
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Loss of beat to beat variability can be caused by ( choose all that apply)
a) Asphyxia b) Drugs c) fetal sleep d) acidosis |
a) Asphyxia
b) Drugs c) fetal sleep d) acidosis |
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Treatment for early decels in FHR would be
a) deliver baby b) fluids, O2, position change c) fluids, O2, postion change, aminio-infusion d) O2 position change |
Deliver
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Treatment for late decels in FHR would be
a) deliver baby b) fluids, O2, position change c) fluids, O2, postion change, aminio-infusion d) O2 position change |
Fluids, O2, position change
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Treatment of variable decels in FHR would be
a) deliver baby b) fluids, O2, position change c) fluids, O2, postion change, aminio-infusion d) O2 position change |
Fluids, O2, position change, amnio infusion
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Treatment of accelerations in FHR would be
a) deliver baby b) fluids, O2, position change c) fluids, O2, postion change, aminio-infusion d) O2 position change |
Fluids, O2, position change
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During the transition to extrauterine life, how/what causes the ductus venosus to close?
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The venosus closes with clamping of the cord
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During the transition to extrauterine life, how/what causes the ductus arteriosus to close?
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A decreased PVR with lung expansion (increase in alveolar O2 tension & pH)
increased SVR blood flow diminishes and becomes bidirectional |
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During the transition to extrauterine life, how/what causes the foramen ovale to close?
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Closes d/t high LA pressure and decreased RA with increased PA blood flow
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Persistent Pulmonary Hypertension (PPHN) of newborn occurs when the ______ remains elevated after birth
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PVR
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What could be some contributing factors to (Persistant Pulmonary HTN of Newborn PPHN? (choose all that apply)
a) hypoxia b) acidosis c) hypovolemia d) hypothermia |
a) hypoxia
b) acidosis c) hypovolemia d) hypothermia |
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What is treatment for PPHN?
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Positive pressure ventilation
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Clamping the umbilical cord results in
a) an increased SVR b) a decreased SVR c) no change in the SVR |
an increased SVR
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Expansion of fetal lungs during transition to extrauterine life results in
a) increased PVR b) decreased PVR c) no change in the PVR |
decreased PVR
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Respiration in the fetus as it transitions to extrauterine life is the major physiological stimulus for _______________________
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Release of surfactant into alveoli
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During transition to extrauterine life which of the following would happen in the fetus
a) increased pH, decreased PCO2, increased PO2 b) decreased pH, increased PCO2, decreased PO2 c) increased pH, increased PCO2, increased PO2 |
increased pH, decreased PCO2, increased PO2
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How much negative pressure does it take the fetus in transition to extrauterine life to inflate their lungs?
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Less than or equal to 70 cm negative pressure
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Retained fetal lung fluid is thought to be the cause of
a) transient tachypnea of the newborn (TTN) b) persistent pulmonary HTN c) none of the above |
transient tachypnea of the newborn (TTN)
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Which of the following babies would be more prone to having retained fetal lung fluid? (choose any that apply)
a) a term vaginal birth b) a preterm vaginal birth c) a C-section birth |
b) a preterm vaginal birth
c) a C-section birth These babies don't have the "squeeze" to their chest to push the fluid out |
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At birth there is a catecholamine surge, why is this important?
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production & release of surfactant
mediation of preferential blood flow to the vital organs during labor/delivery stress Thermoregulation of newborn |
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What is the major mechanism for newborn heat regulation?
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Non-shivering thermogenesis
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What neurotransmitter is released in response to to cold that facilitates oxygenation of brown fat?
a) epinephrine b) norepinephrine c) dopamine |
norepinephrine
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T/F the newborns physiological response to cold increases O2 consumption?
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True
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Limitations of FHR monitoring include (choose all that apply)
a) electronic FHR consistently assoc with high rate of operative delivery b) Failure of FHR to reduce incidence of cerebral palsy c) Abnormal FHR tracing has a poor positive predictive value for abnormal outcome d) Need to maintain FHR tracing as a legal document |
a) electronic FHR consistently assoc with high rate of operative delivery
b) Failure of FHR to reduce incidence of cerebral palsy c) Abnormal FHR tracing has a poor positive predictive value for abnormal outcome d) Need to maintain FHR tracing as a legal document |
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"Free" unbound drug is (choose 2)
a) ionized b) un-ionized c) active d) inactive |
un-ionized
active |
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Fetal acidemia enhances/doesn't effect maternal-fetal transfer of drugs
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Enhances results in ION TRAPPING
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Fick Equation for diffusion takes into consideration ( choose any that apply)
a) physical characteristics of drugs b) area of interface between maternal & fetal blood c) distance between maternal & fetal blood d) concentration of free drug in maternal & fetal blood |
a) physical characteristics of drugs
b) area of interface between maternal & fetal blood c) distance between maternal & fetal blood d) concentration of free drug in maternal & fetal blood |
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There will be "ion trapping" of weak bases such as local anesthetics and narcotics with
a) fetal acidosis b) fetal alkalosis |
fetal acidosis
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How does the "first pass effect" protect the fetal brain?
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Because 70-85% of umbilical venous blood passes through liver before reaching heart and brain (while the liver does not metabolize will it does absorb a large amt of drugs
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T/F Dilution of drug-laden hepatic venous blood with drug-free blood from the IVC & SVC protects the fetal brain
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TRUE
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T/F Distribution of anesthetic drugs is different in the fetus & adult (for reasons not understood) but may protect the fetal brain
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TRUE
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T/F When general anesthesia is done to deliver a baby, the anesthesia gasses will not be excreted by the fetus until
the baby is born |
TRUE
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T/F Apgar scoring of a newborn helps differentiate between infants who require resuscitation & those who need only routine care
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TRUE
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Apgar scores are assessed at (choose any that apply)
a) 1 & 5 minutes b) 1 & 10 minutes c) every 5-10 minutes if initial scores are low d) a only |
1 & 5 minutes
every 5-10 minutes if initial scores are low |
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Concerning Apgar scores if the newborns heart rate is <100 what would the score be
a) 0 b) 1 c) 2 |
1
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Concerning Apgar scores if the newborns muscle tone is limp/absent what would the score be
a) 0 b) 1 c) 2 |
0
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Concerning Apgar scores if the newborn responds to noxious stimuli is grimacing what would the score be
a) 0 b) 1 c) 2 |
1
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The newborn's trunk is pink & it's extremities are blue, what would the apgar score for this parameter be
a) 0 b) 1 c) 2 |
1
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Neurobehavioral testing is a short/long term process used to assess the newborns neurologic and reflex behavior
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Long term
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The newborn has irregular, slow, shallow & gasping respiratory effort what would the Apgar score be?
a) 0 b) 1 c) 2 |
1
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A MAC concentration of inhalation agent
a) does not cause gross depression even for long periods of exposure b) cause dose and time dependent neonatal depression c) causes no depression |
cause dose and time dependent neonatal depression
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SubMAC doses of inhalation agents
a) does not cause gross depression even for long periods of exposure b) cause dose and time dependent neonatal depression c) causes no depression |
does not cause gross depression even for long periods of exposure
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N2O 50%
a) does not cause gross depression even for long periods of exposure b) cause dose and time dependent neonatal depression c) causes no depression |
causes no depression
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Narcotics & Barbiturates cause/do not cause a decrease in beat-to-beat variability
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CAUSE
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IV/IM doses of demerol to mom cause maximum fetal depression
a) within minutes of injection b) in second hour following injection c) demerol does not cause fetal depression only morphine does d) within 23 hours |
in second hour following injection
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Both Barbiturates and Phenothiazines can cause decrease in BTB variability & neurobehavioral changes in newborn which one DOES NOT cause a depression in Apgar scores given in usual doses?
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Phenothiazines (phenergan)
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You have just given your highly anxious mom and injection of 10mg Valium, how do you suspect the fetus/newborn will handle this? (choose any that apply)
a) a decrease in BTB variability only b) respiratory depression c) hypotonia, lethargy d) interference with temperature control e) slow excretion of drug |
IN ADDITION TO BTB VARIABILITY WOULD ALSO SEE
b) respiratory depression c) hypotonia, lethargy d) interference with temperature control e) slow excretion of drug |
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Ketamine doses of 1mg/kg (choose any that apply)
a) cause a decrease in Apgar scores b) cause no change in Apgar scores c) cause muscle rigidity/chest wall spasm d) cause no neurobehavioral changes |
b) cause no change in Apgar scores
d) cause no neurobehavioral changes |
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Ketamine 2mg/kg doses (choose any that apply)
a) cause a decrease in Apgar scores & respiratory depression b) cause no change in Apgar scores c) cause muscle rigidity/chest wall spasm d) cause no neurobehavioral changes |
a) cause a decrease in Apgar scores & respiratory depression
c) cause muscle rigidity/chest wall spasm |
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Local Anesthetic effects on the fetus include ( choose any that apply)
a) no effects on Apgar score b) decrease Apgar score c) no effects on neurobehavioral status d) decreases neurobehavioral status |
no effects on Apgar score
c) no effects on neurobehavioral status |
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Thiopental 4mg/kg will/will not cause decreased uterine blood flow
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WILL CAUSE! 2-3mg/kg will NOT decrease uterine blood flow
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Adding NaBicarb to lidocaine will (choose any that apply)
a) bring PKa closer to pH which speeds onset b) increase amt of ionized drug c) decrease amt of ionized drug |
bring PKa closer to pH
decrease amt of ionized drug |
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Of the following local anesthetics which will deliver the most to baby?
a) Marcaine (bupivicaine) b) Carbocaine (mepivicaine) c) Xylocaine (lidocaine) |
b) Carbocaine (mepivicaine) because it is the least ionized and not protein bound like marcaine
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Uterine blood flow increases during pregnancy by
a) an amt greater than 10 fold b) only slightly c) there is no change to the uterus blood flow (the placenta receives any blood diverted to the area) |
an amt greater than 10 fold
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T/F There is a direct correlation between UBF and fetal PO2
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TRUE
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Which of the following is involved in controlling uterine vascular tone (choose any that apply)
a) prostacycline b) nitric oxide c) atrial natriuretic peptide d) protein kinase C |
a) prostacycline
b) nitric oxide c) atrial natriuretic peptide d) protein kinase C |
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With hypotension which would be the best choice for a treatment
a) vasoconstrictor b) fluids c) neither of the above |
fluids, B/C THERE IS A REDUCED SENSITIVITY TO VASOCONSTRICTORS IN PREG. & UTERINE ARTERY IS MAXIMALLY DILATED
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Ketamine 2mg/kg doses (choose any that apply)
a) cause a decrease in Apgar scores & respiratory depression b) cause no change in Apgar scores c) cause muscle rigidity/chest wall spasm d) cause no neurobehavioral changes |
a) cause a decrease in Apgar scores & respiratory depression
c) cause muscle rigidity/chest wall spasm |
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Local Anesthetic effects on the fetus include ( choose any that apply)
a) no effects on Apgar score b) decrease Apgar score c) no effects on neurobehavioral status d) decreases neurobehavioral status |
no effects on Apgar score
c) no effects on neurobehavioral status |
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Marcaine (bupivicain) is highly ionized and highly protein bound, while Carbocaine is only slightly ionized and protein bound, which one will have the most cross to the fetus
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Carbocaine
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Thiopental 4mg/kg will/will not cause decreased uterine blood flow
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WILL CAUSE! 2-3mg/kg will NOT decrease uterine blood flow
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Adding NaBicarb to lidocaine will (choose any that apply)
a) bring PKa closer to pH b) increase amt of ionized drug c) decrease amt of ionized drug |
bring PKa closer to pH
decrease amt of ionized drug |
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Uterine Blood Flow (UBF) is equal to_______________
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uterine arterial pressure - uterine venous pressure / uterine vascular resistance
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Which of the following can decrease uterine arterial pressure (choose all that apply)
a) venal caval compression b) hemorrhage c) drug induced hypotension d) sympathetic blockade |
AORTOCAVAL COMPRESSION not venal caval compression
b) hemorrhage c) drug induced hypotension d) sympathetic bl |
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What beta adrenergic given to pregnant women to stop contractions can cause hypotension?
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Terbutaline
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Signs & symptoms of aortocaval compression would include (choose all that apply)
a) nausea b) diaphoresis c) syncope d) pale skin |
a) nausea
b) diaphoresis c) syncope d) pale skin |
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Which of the following can cause Increased uterine VENOUS pressure
(choose all that apply) a) venal caval compression b) uterine contractions c) drug induced uterine hypertonus d) drug induced skeletal muscle hypertonus |
a) venal caval compression
b) uterine contractions c) drug induced uterine hypertonus d) drug induced skeletal muscle hypertonus |
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T/F Pain relief from epidural anlgesia could increase UBF by decreasing circulating catchols and preventing periods of hyperventilation during painful contractions
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TRUE
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T/F IV local anesthetics can cause a uterine hypertonus
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TRUE
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Women who have regional anesthesia for labor and delivery will secrete more/less catecholamines
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LESS
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Does an epidural anesthetic WITHOUT hypotension cause decreased UBF?
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NO, but in the presence of hypotension it will
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T/F Acute stress causes a 25% increase in plasma NE and a 50% decrease in UBF
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TRUE
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T/F Ephedrine is the vasopressor of choice because even with overshoot on correction of low BP there is not a decrease in UBF
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TRUE
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As a general rule if maternal BP is low and HR greater than 100 what vasopressor would you give?
a) ephedrine b) phenylephrine |
phenylephrine (b/c ephedrine increase HR)
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Do clinical doses of narcotics, muscle relaxants and local anesthetics change uterine tone or frequency, intensity or duration of contractions?
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NO
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With barbiturates, will uterine blood flow decrease if there is no hypotension?
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NO
only in the presence of hypotension |
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Can barbiturates inhibit uterine contractions
a) no b) it's dose dependent c) always inhibits uterine contractions |
it's dose dependent
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Ketamine does/does not increase uterine tone causing decreased UBF
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Does, but is dose dependent
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T/F Inhaled agents in doses less than or equal to 0.5 MAC and N2O have little or no effect on UBF
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TRUE
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T/F It is mechanical ventilation itself and not hypocapnia that causes decreased uterine blood flow
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TRUE
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T/F Unintentional injection of bupivicaine has been associated with transient uterine hypertonus and fetal bradycardia
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TRUE
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What is the preferred vasodilator for initial tx of severe HTN in pregnant women?
a) Esmolol b) Labetolol c) Hydralazine |
Hydralazine, b/c it either improves or doesn't change uterine blood flow
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MgSO4 is used in preeclampsia what effect does it have on UBF?
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Increases it, may decrease uterine vascular resistance
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Esmolol & Labetolol do/do not decrease UBF
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DO NOT
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Prostaglandins cause
a) vasodilation b) vasoconstriction |
vasodilation
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T/F Prostaglandin E-2 (Cervidil) is given to induce labor and soften the cervix
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TRUE
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The OB-GYN asks you to give Pitocin 20mcg to your patient after delivery to promote uterine contractions you give it
a) IV push b) place it in an IV bag |
place it in an IV bag, if given IVP you can cause HYPOTENSION
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Prostaglandin F2 (Hemabate)is given in the post-partum period to promote uterine contractions (when pitocin doesn't work) your patient is an asthmatic, is this medication contraindicated?
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YES, causes bronchospasm
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Methergine is (choose all that apply)
a) given IM b) given IV c) contraindicated in pt who has received ephedrine d) contraindicated in presence of HTN |
a) given IM
c) contraindicated in pt who has received ephedrine d) contraindicated in presence of HTN |
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Drugs used to decrease uterine atony include ( choose all that apply)
a) Terbutaline b) Mg c) Indomethacin/motrin d) Ntg e) inhalation agents |
a) Terbutaline
b) Mg c) Indomethacin/motrin d) Ntg e) inhalation agents |
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Alcohol can reduce uterine atony (contractions) as it is a smooth muscle relaxant, when would it be dangerous to consume it?
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Between gestation weeks 3-8
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If prostaglandins are given prior to delivery of fetus what problem could result?
a) inhibit closure of ductus arteriosus b) inhibit closure of ductus venosus c) inhibit closure of foramen ovale d) there isn't a problem with doing this |
inhibit closure of ductus arteriosus
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In regards to changes in maternal physiology the changes seen in lung volumes are (choose all that apply)
a) increase in Vt b) decrease in Vt (d/t lack of space to expand lungs with fetal growth) c) increased inspiratory reserve d) decreased expiratory reserve volume |
a) increase in Vt
c) increased inspiratory reserve d) decreased expiratory reserve volume |
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Do minute and alveolar ventilation increase or decrease in the pregnant woman?
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INCREASE
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Functional residual capacity in the pregnant woman increases/decreases
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DECREASES
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PCO2 is decreased to about 30-32 at onset of labor what is probably attributed to?
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Progesterone
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A pregnant woman requires a higher/lower MAC for rapid induction
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LOWER, DUE TO DEPRESSED FRC!
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Why do pregnant women get hypoxic so quickly?
a) decreased FRC b) increased O2 consumption |
a) decreased FRC
b) increased O2 consumption |
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T/F Of the O2 delivered to the Uterus, 40% of that is delivered to the placenta & 60% is to the fetus
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TRUE
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A pregnant woman's blood volume increases by
a) 50cc/kg b) 100cc/kg c) 200cc/kg |
100cc/kg
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T/F Plasma volume increases by 40% and RBC volume increases by 20% in the pregnant woman
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TRUE
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How much blood loss (in a pregnant woman) must there be at delivery to cause hypovolemia
a) loss of 1/2 total volume b) loss of 1/3 total volume c) any blood loss will cause hypovolemia in a pregnant woman |
loss of 1/3 total volume
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By the first trimester how much is the cardiac output increased
a) 10% b) 20-30% c) there is no increase until the 2nd and 3rd trimesters |
20-30%
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When does the cardiac output of a pregnant woman that is laboring increase the most?
a) early first stage b) last first stage c) second stage d) post-partum period |
post-partum period it increases by 80%! Think about your pt with a cardiac history, this is a very dangerous period for them & they MUST be monitored
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T/F Epidural anesthesia can help decrease cardiovascular stress
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True, because pain/stress of labor causes release of catechols
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Your patient has HTN, but is bleeding vaginally post-partum, is it OK for her to receive methergan to help clamp down on the uterus to decrease bleeding?
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NO! it is a potent vasoconstrictor and can obstruct venous return to heart worsening HTN
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Vena caval compression is almost complete at term gestation how does the body compensate for this?
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Blood is returned via the paravertebral and epidural veins
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What can you do for the pregnant woman to help decrease the effects of vena caval compression?
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Place in left lateral decub position
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What effect does aortoiliac compression have on the FHR?
a) decreases it b) increases it c) it has no effect on it |
decreases it
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With aorta-iliac compression
a) femoral pulse may be absent b) it is important to keep uterus off midline c) both of the above |
a) femoral pulse may be absent
b) it is important to keep uterus off midline |
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T/F Distention of paravertebral veins in epidural space reduces LA dosages by 30-50%
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True, will take less LA to get same effect as in a non-pregnant woman
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T/F Distention of paravertebral veins can increase the incidence of intravascular injection of LA
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TRUE
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The placenta secretes gastrin which can (choose 2)
a) decrease gastric juice volume b) increase gastric juice volume c) increase pH d) decrease pH |
increase gastric juice volume
decrease pH |
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T/F 50% of women in labor have greater than 25cc gastric juice with a pH of 2.5
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TRUE (board question)
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While aspiration used to be the #1 cause of mortality in pregnant women what is the #1 cause now?
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Failed Airway
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Why are pregnant women more vulnerable to aspiration? (choose all that apply)
a) uterine displacement b) Estrogen c) pain 4) drugs |
a) uterine displacement
b) Estrogen c) pain 4) drugs |
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The benefits of antacids in a pregnant woman are (choose all that apply)
a) increase gastric pH b) increase sphincter tone c) decrease pyloric tone (increase motility) |
a) increase gastric pH
b) increase sphincter tone c) decrease pyloric tone (increase motility) |
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T/F Bicitra is an example of a nonparticulate antacid and must be given 10 min prior to induction and will neutralize 250ml gastric content for 1-3hrs
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TRUE
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Can regional anesthesia help prevent aspiration pneumonitis?
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YES, although not proven, when pt is numb they can still close glottis but are unable to bring up gastric contents d/t decreased muscle strength
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You are getting ready to do a post-partum tubal ligation on a woman who is 3 days out from delivery, what do you need to be concerned about?
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Pregnant women have lower pseudocholinesterase levels which will affect any muscle relaxants you give during the case ( decreased 60% 3 days out vs 10% during labor and 20% 1 day out)
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Renal function changes in pregnancy include (choose all that apply)
a) increased GFR b) decreased GFR c) increased BUN d) decreased serum Cr e) decreased BUN |
increased GFR
decreased serum Cr decreased BUN |
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Can a quadriplegic give birth to a baby vaginally?
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YES, because the uterus is under autonomic control
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Progesterone is secreted early in pregnancy to ____________________
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Inhibit uterine contraction
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Oxytocin is the most important neurohormone released during pregnancy, what is its function?
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Uterine contraction, operates on a positive feedback system
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Beta stimulation of uterus
a) inhibits contractions b) stimulates contractions |
inhibits contractions
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Alpha stimulation of uterus
a) inhibits contractions b) stimulates contractions |
stimulates contractions
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The rise in estrogen in late pregnancy (choose all that apply)
a) decreases progesterone secretion b) increases alpha receptor sensitivity c) decreases beta receptor sensitivity d) increases beta receptor sensitivity e) increases progesterone secretion |
a) decreases progesterone secretion
b) increases alpha receptor sensitivity c) decreases beta receptor sensitivity |
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Sensory innervation for the uterus & cervix occurs at
a) S2-S4 b) T11-L1 c) L1- L4 |
T11-L1
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Sensory innervation for the birth canal occurs at
a) S2-S4 b) T11-L1 c) L1- L4 |
S2-S4
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T/F The second stage of labor involves expulsion of the fetus which involves uterine force (endogenous oxytocin) and auxillary force (the mothers ability to firm diaphram to push
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TRUE
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One mechanism of labor "Internal Rotation" can be inhibited if _________________
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The pelvic muscles are too relaxed
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Psychoprophylaxis for the pregnant woman involves (choose all that apply)
a) education (lamaze) b) therapeutic techniques c) gate theory (diversion/motivation) |
a) education (lamaze)
b) therapeutic techniques c) gate theory (diversion/motivation) |
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What are the benefits of psychoprophylaxis (choose all that apply)
a) psychological b) decreased meds c) decreased forceps delivery d) decreased "twilight anesthesia" (scopolamine) |
a) psychological
b) decreased meds c) decreased forceps delivery d) decreased "twilight anesthesia" (scopolamine) |
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Does psychoprophylaxis shorten labor, decrease the number of C-sections or decrease the number of maternal/fetal complications?
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NO!!
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A common drug used for pain control during the 1st stage of labor is Demerol which of the following may be effects seen in the fetus following maternal injection (choose any that apply)
a) Decreased BTB varaibility b) neurobehavioral changes (50mg) c) resp. depression 2hrs after IM injection d) 3-6 day half life |
a) Decreased BTB varaibility
b) neurobehavioral changes (50mg) c) resp. depression 2hrs after IM injection d) 3-6 day half life |
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Valium 10mg can cause what in the fetus (choose all that apply)
a) decreased BTB variability b) decreased tone/activity c) decreased ability for thermal control d) slow excretion of drug |
a) decreased BTB variability
b) decreased tone/activity c) decreased ability for thermal control d) slow excretion of drug |
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Phenergan can cause (choose 2)
a) decrease in BTB variability b) decrease in respiratory drive c) no change in BTB variability d) no change in respiratory drive |
decrease in BTB variability
no change in respiratory drive |
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The indications for general anesthesia for vaginal delivery include (choose all that apply)
a) unmanageable pt b) retained placenta c) need for rapid uterine relaxation d) multiple births |
a) unmanageable pt
b) retained placenta c) need for rapid uterine relaxation d) multiple births |
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Induction agents for general anesthesia for vaginal birth include (choose all that apply)
a) Thiopental b) Ketamine c) propofol d) midazolam |
a) Thiopental (if BP not stable use Ketamine)
b) Ketamine Propofol is too short acting Midazolam is contraindicated |
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The following drugs could be used for uterine relaxation except
a) inhalation agents b) Ntg c) valium |
valium
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Indications for a "Double set-up" include (choose all that apply)
a) r/o placenta previa b) suspected funic (cord) presentation c) multiple gestation |
a) r/o placenta previa (usually dx with ultrasound now)
b) suspected funic (cord) presentation EMERGENCY c) multiple gestation |
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The nerves involved in the early 1st stage of labor are (choose all that apply)
a) somatic sensory afferents b) visceral afferent/sympathetic c) post-ganglionic d) pre-ganglionic e) located at T11-L1 f) C-fibers g) unmyelinated |
d) pre-ganglionic
e) located at T11-L1 f) C-fibers g) unmyelinated |
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Put the following nerves in order of easiest to block to hardest to block
(C-fibers, A-delta, B-fibers) |
B-fibers
C-fibers A-delta |
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B-fibers are (choose all that apply)
a) myelinated b) unmyelinated c) pain transmitting d) non-pain transmitting e) pre-ganglionic f) post-ganglionic |
a) myelinated
d) non-pain transmitting f) post-ganglionic |
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Would you expect to see hypotension after you block A-delta, C-fiber, or B-fiber nerves?
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B-fiber nerves
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During the late 1st stage which nerves would you be blocking?
a) A-delta b) C-fiber c) B-fiber |
a) A-delta
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A-delta fibers are associated with
a) pain sensation b) temperature c) proprioception/pressure d) motor |
pain sensation
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A paracervical block would be used in what stage of labor
a) 1st stage b) 2nd stage c) 3rd stage |
1st stage
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Would a paracervical block be a visceral or somatic block?
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visceral
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Complications associated with a paracervical block include (choose all that apply)
a) intravascualr injection b) fetal scalp injection c) vasovagal syncope |
a) intravascualr injection
b) fetal scalp injection c) vasovagal syncope (from PPT page 5) |
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Lumbar sympathetic block (choose all that apply)
a) done a L2-3 b) in 2nd stage of labor c) can decrease risk of fetal brady d) affects visceral nerves e) convert abnormal labor pattern to normal |
a) done a L2-3
c) can decrease risk of fetal brady d) affects visceral nerves e) convert abnormal labor pattern to normal |
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Pudendal nerve block (choose all that apply)
a) sensory & motor innervation for lower vag, perineum, anal sphincters b) Done during 2nd stage of labor only c) used for spontaneous vag. delivery |
a) sensory & motor innervation for lower vag, perineum, anal sphincters
b) Done during 2nd stage of labor only c) used for spontaneous vag. delivery |
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A lumbar epidural covers what area
a) S2-4 b) L2-5 c) L5-S1 |
b) L2-5, but can inject higher doses and cover up to T10-L1
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T/F Caudal block although not done much anymore would be injected through the sacral hiatus and cover the 1st stage of labor as well as the 2nd
|
True
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T/F A "double catheter technique" could be used with a patient who has aortic stenosis if worried about hypotension
|
True
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A fibers
a) mediate sharp pain sensation b) mediate motor & proprioception c) do not mediate pain sensation d) mediate aching pain |
mediate sharp pain sensation
mediate motor & proprioception |
