Obstetric Anesthesia 2

Placental Conditions Requiring Cesarean Section

• Placenta previa is a placental condition that necessitates an elective cesarean section before labor begins.

Fetal Circulation Features

• The foramen ovale bypasses pulmonary circulation during fetal development.

Uterine Rupture Signs

• A sign of uterine rupture during labor is prolonged variable decelerations, along with fetal bradycardia and loss of station and cessation of uterine contractions.

Category III Fetal Heart Rate Management

• Immediate intrauterine resuscitation measures are the most appropriate management for a category III fetal heart rate tracing.

Risk of Venous Thromboembolism (VTE)

• The highest risk of VTE occurs postpartum.

NSAID Use in Late Pregnancy

• Avoid NSAIDs in late pregnancy as they can cause premature closure of the ductus arteriosus and fetal renal injury.

Sinusoidal Fetal Heart Rate Pattern

• A sinusoidal fetal heart rate pattern signifies fetal anemia or acidemia, and it is not associated with fetal well-being.

Medication for Severe Preeclampsia

• Magnesium sulfate is an appropriate medication for preeclampsia with severe features.

Maternal Cardiac Conditions Requiring Anesthesia Titration

• Careful titration of neuraxial anesthesia is necessary for patients with aortic stenosis to maintain preload.

Maternal Cardiac Output During Labor

• Maternal cardiac output depends on heart rate during labor due to decreased preload, and stroke volume during uterine contractions.

Magnesium Sulfate's Effect on Neuromuscular Blockers

• Magnesium sulfate potentiates non-depolarizing neuromuscular blockers.

Fetal Circulation Shunt

• The ductus venosus primarily directs oxygenated blood from the umbilical vein to the systemic circulation.

Venous Stasis in Pregnancy

• Compression of the inferior vena cava by the gravid uterus facilitates venous stasis in the lower extremities during pregnancy.

Postpartum Cardiac Output Increase

• Increased sympathetic tone causes the greatest immediate increase in cardiac output postpartum.

Painless Vaginal Bleeding During Pregnancy

• Painless vaginal bleeding during the third trimester is indicative of placenta previa.

Side Effect of Intrathecal Opioid Addition

• The most common side effect of adding intrathecal opioids to neuraxial anesthesia is pruritus.

Contraindicated Uterotonic Drug in Hypertension

• Methylergonovine is a uterotonic drug contraindicated in hypertensive patients due to its vasoconstrictive effects.

Combined Spinal-Epidural Technique for Labor Analgesia

• The combined spinal-epidural technique is often used for labor analgesia because it provides rapid onset of analgesia with the option for continuous infusion. It reduces the risk of hypotension compared to spinal anesthesia, and requires lower doses of local anesthetics compared to epidural alone.

General Anesthesia During Cesarean Section

• Severe coagulopathy is a maternal condition that most commonly necessitates the use of general anesthesia during a cesarean section

Anesthesia Technique for Fetal Distress During Labor

• Epidural anesthesia is most suitable for relieving fetal distress during labor to allow vaginal delivery.

Safest Time for Non-Obstetric Surgery

• The safest time for non-obstetric surgery during pregnancy is the second trimester.

Placental Condition Involving Fetal Blood Vessels

• Vasa previa is a condition where fetal blood vessels cross over the cervical os.

Fetal Bradycardia After Spinal Anesthesia During Cesarean

• Decreased maternal cardiac output and uteroplacental perfusion is the most likely cause of fetal bradycardia after spinal anesthesia during a cesarean section.

Uterine Abnormality Associated with Placenta Adherence

• Placenta accreta is an uterine abnormality associated with abnormal adherence or invasion of the placenta into the uterine wall.

Prolapsed Umbilical Cord Intervention

• The most suitable intervention for a prolapsed umbilical cord is emergency cesarean delivery to relieve compression along with maternal repositioning.

Avoiding Hypocapnia in Pregnancy

• Avoiding hypocapnia during laparoscopic surgery in pregnant patients is essential to prevent preterm labor and to reduce uteroplacental perfusion due to vasoconstriction.

Factors Increasing Aspiration Pneumonitis Risk

• Reduced gastric emptying and increased gastric acidity increase the risk of aspiration pneumonitis during pregnancy.

Reduced Albumin Levels During Pregnancy

• Reduced albumin levels during pregnancy indicate reduced drug binding, increasing free drug concentrations and thus decreasing oncotic pressure leading to increase fetal edema.

Excessive Uterine Contractions During Labor

• Excessive uterine contractions during labor primarily cause reduced fetal oxygenation because of uteroplacental insufficiency. This can happen due to reduced fetal oxygenation.

Emergency Cesarean Section Anesthetic Induction

• Propofol, Ketamine or Etomidate are all appropriate drugs for rapid induction during an emergency cesarean section.

Hematologic Change Compensating for Blood Loss in Delivery

• Increased plasma volume helps compensate for estimated blood loss (EBL) during delivery.