OB exam three

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OB exam three
2014-12-08 19:31:33
obstetrical anesthesia

OB emergencies, anesthesia for the morbidly obese parturient
Show Answers:

  1. Classic triad of AFE
    Amniotic fluid embolism

    • 1. Hypoxia
    • 2. hemdynamic collapse
    • 3. coagulopathy without obvious precipitated cause
  2. What is the primary factor that determines the diagnosis of AFE?
    Speed of onset of symptoms

    Right heart failure is the principle hemodynamic alteration
  3. Hallmark sign of Venous Air Embolism
    Mill-wheel murmur over the precordium

    Chest pain, dyspnea, decreased EtCO2, elevated CVP
  4. What are non-reassuring fetal heart rates?
    < 60 or > 160
  5. Placenta previa definition
    • Painless vaginal bleeding with the
    • placenta covering all or part of the cervix
  6. Three types of placenta previa
    • Marginal (partial)
    • Complete
    • Low-lying

    Marginal and complete must have C-Section.
  7. Double set-up
    • Monitors
    • (2) 16 or 18 g PIVs
    • Blood pump IV set primed
    • 2 units blood in the room
    • Bicitra
    • oxygen
    • skilled assistant
    • sterile prep and drape
  8. IF the patient is bleeding and needs a C-section, what anesthetic drugs should you choose?
    • Induce with ketamine (1mg/kg) and succ. (1.5mg/kg)
    • Use cricoid pressure
    • awake extubation
    • 50% N2O and O2
  9. Placenta Accreta definition
    placental implantations directly onto or into the myometrium giving rise to one of three conditions

    Incidence increases with uterine incisions
  10. Placenta accrete vera
    placenta implantation just onto the myometrium
  11. Placenta increta
    placental implantation into the myometrium
  12. Placenta percreta
    Placental implantation penetrating the myometrium thru the full thickness of the myometrium and possibly onto other abdominal contents

    Methotrexate after delivery may facilitate placental involution
  13. Abruptio placenta
    separation of normally implanted placenta after 20 weeks and before birth

    Painful vaginal bleeding!!!
  14. How much blood can be sequestered in the uterus?
    2500 mls
  15. Name the classifications of abruptio placenta
    • Concealed
    • Marginal
    • Complete
  16. What is the major fetal risk with abruptio placneta?
    Fetal hypoxia
  17. What is the definitive management of abruptio placenta?
    Empty the uterus
  18. Uterine rupture most reliable sign
    Fetal distress- non-reassuring heart tones with variable decels

    • other S&S:
    • vaginal bleeding, severe uterine or lower abd. pain, shoulder pain, severe maternal hypotesion/shock, loss of fetal heart tones
  19. Early decelerations
    Usually begin

    shows fetal head compression with descent into canal
  20. Deceleration
    Fetal heart rates changes with contractions
  21. Late decelerations
    fetal heart rate decreases after the contraction is over
  22. Variable decelerations
    • Fetal heart rate decreases not correlated with contractions
    • Umbilical cord compression usual culprit
    • Usually not bad unless FHT <60 or >160
  23. Fetal bradycardia
    Omnious sign


    Left or right uterine displacement then Oxygen then fluids then ephedrine
  24. Postpartum hemorrhage
    Defined as blood loss greater than 500ml after delivery, or as a 10% decrease in HCT from admission to the postpartum period or need to administer PRBC
  25. Primary postpartum hemorrhage
    • occurs during first 24 hours after delivery
    • more likely to result in maternal morbidity or mortality
  26. secondary postpartum hemorrhage
    occurs between 24 hours and 6 weeks postpartum
  27. What can you give to relax the uterus if exploration is necessary?
    • benzodiazepines
    • ketamine
    • inhalational anesthetics
    • opioids
    • 50-100 mcg NTG
  28. What is the main goal with uterine inversion?
    Get it back inside before the cervix begins to contract
  29. TRALI
    Transfusion related acute lung injury

    • Non-cardiogenic pulmonary edema from leukocyte antibodies a few hours after transfusion
    • Reactions most commonly caused by ABO incompatible blood

    Fever, chills, nausea, flushing, chest and flank pain
  30. What can you give to get potassium back into the cells?
    • Insulin/glucose
    • albuterol
    • bicarb
    • kayexlate
  31. What can you give to combat the citrate in the PRBCs?
    Calcium chloride
  32. Placenta previa has abnormal placental _________
  33. Placenta accreta has abnormal placental ________
  34. Abruptio placenta has _________ of the placenta with the uterus
  35. 5 ratings of apgar scale
    • A-appearance (skin color)
    • P- pulse
    • G- grimace
    • A- activity
    • R-respiration

    Ratings at birth and 5 minutes