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32 Cards in this Set
- Front
- Back
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List the 5 Millennium development goals (MDG)
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-promotion of education, nutrition for girls, women
-Improvement in family planning -Reduction in unsafe abortions -Skilled attendant at every birth -Infrastructure for emergency OB care |
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What are the 3 leading causes of death worldwide in OB patients
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1. hemorrhage
2. PIH 3. Sepsis |
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What risk factors are related to increased maternal mortality rates
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- increased maternal age
- Ethnicity (black is highest) - Obesity - Multifetal pregnancy - Cesarean delivery (venous thromboembolism, infection, anesthesia complications) - Health system characterisitics |
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What % of pregnant women experience some degree of morbidity such as:
-anemia, UTI, mental problems, HTN, or pelvic/perineal trauma |
50%
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Name 3 examples of severe maternal morbidity
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severe preeclampsia
severe hemorrhage sepsis |
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A near-miss event is defined as "survival of a life threatening event"
Name the 5 factors used to score this |
- organ system failure
-ICU admission -Transfusion > 3 units -Extended intubation -Surgical intervention |
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What anesthesia related problems are known to contribute to increased mortality in the OB pt
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Airway disasters (#1)
cardiac arrest local toxicity high spinal litigation |
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What are the factors that contribute to cardiac arrest during anesthesia of the OB patient
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- inadequate oxygenation
-Drug overdose -amniotic fluid embolus -cardiac disease -Hemorrhage -Anaphylaxis |
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What are the "common factors" seen in Anesthesia related "deaths"
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- Maternal obesity
- patient refusal of neuraxial anesth -Remote anesthetic location -Delay in anesthesia consult -insufficient planning - inadequate supervision of care |
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What dose of Bupivicaine was banned
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0.75%
we now use max of 0.25% |
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What are the signs and symptoms of local toxicity?
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-Tinnitus
-Agitation -Circumoral numbness/tingling -metallic taste -facial paresthesia -sudden drowsiness |
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What 4 things can we do to prevent high blockade levels
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-decrease dose of local
-prehydration -fractionate -phenylephrine for spinal shock |
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What are the 4 OB aspiration risk factors?
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- Ingestion of food shortly before labor
- Stress response * diverts blood from stomach - Drugs * opioids retard stomach emptying * Decrease LES tone - Decreased LES tone |
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Failed intubations place the OB pt at a higher risk of what?
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hypoxia and aspiration:
D/T: increased O2 metabolic demands, decreased FRC, Decreased LES tone |
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Why would you want to avoid persistent attempts at intubations in the OB patient
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b/c of increased bleeding from engorgement
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If you fail to Intubate your OB patient, do you want to continue with repeated doses of Sux
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no:
high doses (>300mg) can affect the fetus |
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What co-morbid conditions increase morbidity and mortality in the Fat pregnant women
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-HTN
-CAD -CVA -Diabetes -Cholelithiasis -Nonalcoholic fatty liver disease |
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What 2 conditions are 7 x more prevalent in the hypertensive pregnant women
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PIH and preeclampsia
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what are the obesity effects on ventilation?
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- increased
* O2 consump & CO2 product * Ve * WOB - decreased chest wall compliance - decreased lung volumes - Hypoxemia |
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What are symptoms of Pickwickian syndrome (obesity hypoventilation syndrome)
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hypercarbia
hypoxemia polycythemia sleep apnea pulmonary HTN CHF Predisposed to upper airway obs |
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Describe what happens to lung volumes in the obese pregnant pt
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Decreased IC
Decreased FRC V/Q mismatch |
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What factors decrease FRC in the Obese pregnant pt
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Positioning (supine, lithotomy, tren)
GETA Abdominal packing Faster onset of desaturation and hypoxemia |
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What are the cardiovascular changes in the OBESE pregnant pt
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- Cardiac output can double
- Increased blood volume - systemic HTN (BMI of 30 = 3 fold increase in HTN) - Pulmonary HTN - increased SV (d/t increased vol) - |
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What are the GI changes in the OBESE pregnant pt
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- high incidence of hiatal hernia
- greatly increased intragastric pressures - greater risk of aspiration pneumonitis * b/c larger volume of gastric contents with pH < 2.5 -Gestational diabetes/DM |
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What are the advantages of Epidural anesthesia for the OBESE pregnant pt
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- decreases respiratory work
- decreases O2 consumption - Prevents Increased cardiac effort from catecholamines - Controls HTN - Facilitates forceps deliveries - Avoids risks of GA |
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What are the disadvantages of Epidural Anesthesia for Obese pregnant pt's
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- Technically difficult
- Longer needles required - High block weakens respiratory fx's or impairs second stage efforts |
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Half of US maternal deaths are preventable through?
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-changes in patient, provider, or system factors
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What are things you can do to avoid an airway disaster
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- Use smaller size ETT (6-7)
- Preoxygenation - Consider regional anesthesia |
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What can you do for an Obese pregnant pt who is having dyspnea
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Elevate HOB 30 degrees
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__________ constitute the most common cause of anesthesia-related maternal death, and they occur most commonly in the postoperative period?
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Airway complications
occurs most commonly in the postoperative period |
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Continuous spinal anesthesia should be considered in emergency settings involving? (two things)
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potentially difficult intubation, and in cases of unintentional dural puncture
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Morbidly obese parturients are at high risk for what post op?
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Obstructive sleep apnea
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