Ob Week 3 & 4/quiz 2

Front 1

Cephalic, breech and shoulder are potential:
A. lie
B. Position
C. presentation

Back 1

c

Front 2

Cephalic presentation can be judged by degrees of neck flexion. Name 3 kinds of cephalic presentation?

Back 2

1. Brow
2. vertex
3. face

Front 3

The alignment of maternal spine to fetal spine is:
A. presentation
B. lie
C. position

Back 3

B

Front 4

What term describes the relationship of a specific bony part to the mom's pelvis?

Back 4

position

Front 5

In vertex position, what part is down?

Back 5

occiput

Front 6

facial presentations have what position?

Back 6

Mentum

Front 7

Breech presentations have what position?

Back 7

sacrum

Front 8

Shoulder presentations have what position?

Back 8

acromion

Front 9

Name 3 reasons Occiput presentations are important:

Back 9

1. put more pressure on sacral nerve
2. can prolong labor and increase discomfort
3. watch for shoulder dystocia

Front 10

3 anesthetic considerations for Occiput posterior position?

Back 10

1. Add lipid sol opioids (fentanyl) to local
2. regional tech. should NOT paralyze perineal muscles
3. want T10-L1block

Front 11

Name 3 types of breech presentation.

Back 11

1. complete
2. incomplete
3. frank

Front 12

Which type of breech presentation is most common?

Back 12

frank

Front 13

Which type of breech presentation is most associated with cord prolapse?

Back 13

incomplete

Front 14

For an elective CS d/t breech presentation, what techniques can be used?

Back 14

GA or RA

Front 15

For vag delivery of breech presentation, what techniques can be used?

Back 15

epidural analgesia
(remember dont want to parlayze perineal muscles)

Front 16

which method of delivery has the lowest risk of adverse outcomes in breech presentations?

Back 16

planned CS

Front 17

Which method of delivery has higher risk of poor outcomes for breech presentation babies: CS or vag?

Back 17

vag

Front 18

Name 2 anesthetic emergencies to consider when faced with breech presentation?

Back 18

1. fetal head entrapment ( before 32 weeks)
2. uterine hypertonus

Front 19

RSI with 2-3 MAC IA will produce uterine relaxation in how long?

Back 19

2-3 min

Front 20

For emergent uterine relaxation, what drug can be used?

Back 20

NTG50-100 mcg at a time

Front 21

For external version of breech presentation, more pain = (more or less) success?

Back 21

less

Front 22

Chances for external version success is better if:

Back 22

presenting part not in pelvis, normal amt amniotic fluid, fetal back not posterior, pt not obese, or pt ruptured or dilated

Front 23

7 potential fetal hazards with multiple gestations

Back 23

1. preterm delivery
2. congenital abnormalities
3. polyhydramnios
4. cord prolaspe
5. cord entanglement
6. IUGR
7. malpresentation

Front 24

Maternal risks with multiple gestation pregnancies?

Back 24

1. PROM
2. PTL
3. prolonged labor
4. abruption
5. operative delivery
6. uterine atony

Front 25

Anesthetic consideration for mult gestation pregnancies/vag delivery

Back 25

1. Vigilance!!!!
2. LUD important-at ^ risk aortocavl compression
3. Need large bore IV
Need to be in OR so can CS emergently

Front 26

Name 3 maternal factors contributing to the ^ CS rate:

Back 26

1. increasing # of nullip moms
2. ^ obestiy
3. increasing maternal age

Front 27

Name 5 obstetric factors contributing to ^ CS rate:

Back 27

1. more inductions
2. fewer vag breech deliveries
3. less forceps use
4. fewer TOLACs
5. ^ availability in undeveloped countries

Front 28

Name 3 fetal factors contributing to ^ CS rate:

Back 28

1. more macrsomia
2. more multiple gestations
3. EXIT procedures

Front 29

Name 4 practice envirnment factors contributing to ^ CS rate:

Back 29

1. malpractice concerns
2. FHR monitoring
3. convenience
4. concern for pelvic floor injury

Front 30

Name 4 fetal reasons for CS?

Back 30

1. macrosomia
2. malpresentation
3. cord prolapse with bradycardia
4. nonreassuring fetal status

Front 31

6 maternal reasons for CS?

Back 31

1. dystocia
2. precclampsia
3. active herpes
4. chorioamnionitis
5. hemorrhage
6. cardiac or pulm dz

Front 32

Reasons for EMERGENT CS?

Back 32

1. uterine rupture
2. mom in danger
3. severe PIH
4. severe fetal distress

Front 33

T or F: cord prolapse is an indication for emergent CS.

Back 33

F: only if baby is bradycardic

Front 34

T or F: severe PIH with normal plt count is emergency indication for CS.

Back 34

F: only if plt count low

Front 35

Which of the following are indication for GA with CS?
A. pt refusal to cooperate with neuraxial
B. failure of neuraxial
C. need urgent, not time for neuraxial

Back 35

all are

Front 36

Which has higher risk for death: vag or CS?

Back 36

CS

Front 37

optimal uterine incision to delivery time is?

Back 37

<90 sec

Front 38

a uterine incision to delivery time of 90-180 sec means?

Back 38

neonate compromised

Front 39

Lower APGARS, and fetal acidosis are seen with uterine incision to delivery times of how much?

Back 39

>180 sec

Front 40

Which is more effective for denitrogenation: 4 deep breaths over 30 sec or 8 DB in one minute?

Back 40

8 DB over 1 min

Front 41

Why is dextrose not used in parturients?

Back 41

Can cause fetal hypoglycemia

Front 42

Correct time to give Bicitra?

Back 42

< 30 min prior

Front 43

ranitidine is given to GA CS pt for?

Back 43

lower acidity/raise pH of gastric secretions

Front 44

reglan is given to GA/CS pts to?

Back 44

increase LES tone and ^ gastric motility

Front 45

ATB can be administered o GA CS pt when? Choose all that apply
A. before incision
B. intraop
C. after cord clamping
D. When I feel like it

Back 45

A, C

Front 46

Thipental in preg: dose, peak, Cross placenta?

Back 46

4 mg/kg, readily crosses. Peaks 1-2 min

Front 47

Ketamine in preg

Back 47

1mg/kg, crosses placenta, but no bad effects, no resp depression

Front 48

Etomidate in preg

Back 48

.2-.3 mg/kg, ^ n&V, can potentiate seizures, watch for adrenal insufficiency, depresses cortisol prod in babies

Front 49

Midazolam in preg

Back 49

crosses placenta, causes neonate depression, .3 mg/kg induction dose, limited use

Front 50

Sux in preg

Back 50

1-1.5 mg/kg, agent of choice, intubating conditions in 45 sec. small amts cross placenta

Front 51

What drug can prolong sux blockade?

Back 51

Reglan

Front 52

Alternate agent for RSI in preg moms?

Back 52

Roc-.6-1.2 mg/kg

Front 53

Which NMB should be avoided in HELLP syndrome?

Back 53

Vec Liver metab)

Front 54

Which of the following ar ereasons for failed intubation in preg moms?
A. airway edema
B. obesity
C. large breasts

Back 54

All are

Front 55

LES tone is (increased or decreased) during preg?

Back 55

decreased

Front 56

Which of the following contribute to increase intragastric pressure?
A. sux fasciculations
B. uterus pushing up
C. lithotomy position
D. obesity

Back 56

All are correct

Front 57

Drugs used during labor that can ^ N&V include:
A. Mg
B. tocolytics
C. ergots
D. prostaglandins

Back 57

All are correct

Front 58

Hallmark sign of aspiration:

Back 58

hypoxia on room air

Front 59

Two conditions that can cause fetal hypoxia

Back 59

1. hypotension
2. maternal hyperventialtion

Front 60

Why is LUD important?

Back 60

prevents aortocaval compression

Front 61

The higher the MAC, the ( more or less) uterine tone?

Back 61

less

Front 62

Most common cause of maternal mortality in CS with GA?

Back 62

failed intubation or aspiration

Front 63

How much circoid pressure?

Back 63

10 N before asleep
30 N after asleep

Front 64

Reglan effects are antagonized by:

Back 64

atropine
opioids

Front 65

Does reglan cross placenta barrier?

Back 65

yes

Front 66

Best time for cardiac surgery in preg mom?

Back 66

2nd trimester

Front 67

Moms with transplanted hearts will respond to atropine: T or F?

Back 67

False (denervated heart)

Front 68

What kind of drugs will produce chronotropic and inotropic effects in transplanted hearts?

Back 68

direct acting sympathomimetics ( isuprel)

Front 69

What is recommended anesthesia technique for mom with tranplanted heart?

Back 69

epidural

Front 70

methergine can do what to coronary vessels?

Back 70

cause spasm

Front 71

preferred pressor in cardiac /preg pt?

Back 71

neo

Front 72

vasopressors ( epi, vasopressin, dopa) do what to uterine blood flow?

Back 72

decrease it

Front 73

CO increases by how much during preg?

Back 73

40-50%

Front 74

pregnancy causes decrease in what HD parameters?

Back 74

PVR, SVR

Front 75

Time of greatest change in CO related to preg/labor/delivery?

Back 75

Postpartum ( goes up 75% more thatn predelivery)

Front 76

Management goals for AI in preg mom?

Back 76

no aortocaval compression, normal to slightly ^ HR, prevent ^ SVR, avoid myocardial depression

Front 77

Which anesthetic technique recommended for AI mom?

Back 77

epidural

Front 78

Pts with PPH shouldn't receive neuraxial anesthesia. Why?

Back 78

Cant tol decrease in SVR d/t sympathectomy

Front 79

pts with Marfans syndrome can have
A. dural ectasia
B. Cspine instability
C. increased risk of Ao dissection
D. pulm stenosis

Back 79

A, B, C

Front 80

L-R shunt causes?

Back 80

high pulm low

Front 81

Can pts with Eisenmengers syndrome tol preg?

Back 81

no-counseled to term

Front 82

Why is preg bad for pts with L-R shunt?

Back 82

can't tol drop in SVR-this increases hunt

Front 83

Most common cardiac condition you will deal with in preg pts?

Back 83

MVP

Front 84

leading cause of neonatal mortality?

Back 84

Preterm labor

Front 85

Threshhold of viability is?

Back 85

22-24 weeks

Front 86

period of greatest vulnerability in fetal development?

Back 86

15-56 days

Front 87

Is any anesthetic agent a proven teratogen?

Back 87

No

Front 88

Neostigmine should be given with which anticholinergic during pregnancy?

Back 88

Atropine ( no fetal bradycardia, crosses placenta)

Front 89

What effect does maternal hyperventialtion have on baby?

Back 89

vasoconstriction of umbilical vessels
shift fetal O2dissoc. curve left

Front 90

Epi and levo do what to uterine blood flow?

Back 90

decrease it

Front 91

maternal hypotension does what to UBF?

Back 91

decreasesit

Front 92

Tx for maternal hypotension: Neo or ephedrine?

Back 92

ephedrine

Front 93

Most common non OB surgeries in preg pts?

Back 93

appy/chole

Front 94

Laparoscopy can do what to UBF?

Back 94

decrease it d/t ^ intraabdominal pressure

Front 95

When should anesthetist start mainaining LUD?

Back 95

18-20 wks

Front 96

Why are steroids given to moms in preterm labor?

Back 96

speeds fetal lung maturity

Front 97

Example of prostaglandin synthetase inhibitor used for tocolysis?

Back 97

indocin

Front 98

MOA of terbutaline?

Back 98

beta adrenergic agent taht hits beta 1 and 2 ( only 2 results in uterine relaxation, 1 causes tachycardia)

Front 99

MOA of procardia as tocolytic?

Back 99

prevents release of Ca from sarcoplasmic reticulum-no calcium, less muscle contraction

Front 100

What is the main goal of tocolysis?

Back 100

get 2-7 days more intrauterine time-time to get mom steroided up and to a facility that can care for preterm infant

Front 101

anesthetic technique of choice for preterm vag delivery?

Back 101

continuous epidural infusion

Front 102

Does mom need to be fully dilated to deliver preterm baby?

Back 102

No- 6-7 cm may be enough for small baby

Front 103

Why should CS deliv be avoided for preterm delivery?

Back 103

anesthetic further depress already compromised baby

Front 104

PPTL spinal dose:

Back 104

lido 75 mg with fent 10-25 mcgs
OR
bupiv 7.5 mg with fent 10-25 mcgs

Front 105

PPTL epidural dose:

Back 105

(after negative test does)
3% choroprocaine with fent 50-100 mcgs

Front 106

If using GA for PPTL, is an LMA appropriate?

Back 106

NO! always intubate-aspiration risk still there

Front 107

Spinal level needed for PPTL?

Back 107

T4 ( tugging on peritoneum)

Front 108

Laparoscopy disadvantages: 2 major?

Back 108

1. fetal acidosis from absorption of CO2, trauma from trocar

Front 109

Leading cause of maternal death?

Back 109

hemorrhage

Front 110

Major maternal risks during preg?

Back 110

difficult intubation, aspiration

Front 111

Is Nitrous teratogenic?

Back 111

maybe in animals...

Front 112

4 MAJOR things to avoid in aneshtetic management of moms:

Back 112

1. hyperventilation
2. hypoxemia
3. hypotension
4. acidosis

Front 113

Preterm babies: high risk of which complictions?

Back 113

acidosis, ICH

Front 114

Terbutaline can cuase which o fhte following?
A. pulm edema
B. hypotension
C. hyperglycemia
D. hypokalemia

Back 114

All are correct

Front 115

How long does need for reduced MAC last after delivery? (important if doing PPTL)

Back 115

12-36 hours

Front 116

When does reflux risk return to normal after delivery?

Back 116

second PP day