Obstetric Anesthesia 1
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Questions and Answers

Which of the following correctly defines the stages of labor?

  • Stage 1: Onset of contractions to complete dilation; Stage 2: Fetal delivery; Stage 3: Placenta delivery (correct)
  • Stage 1: Onset of contractions to complete effacement; Stage 2: Uterine recovery; Stage 3: Delivery of fetus
  • Stage 1: Cervical dilation; Stage 2: Placental delivery; Stage 3: Fetal delivery
  • Stage 1: Contractions to placental delivery; Stage 2: Cervical dilation; Stage 3: Postpartum recovery

    • Why is aortocaval compression concerning in pregnant patients during the supine position?

  • It causes an increase in maternal cardiac output.
  • It compresses the inferior vena cava and aortoiliac vessels, decreasing preload. (correct)
  • It enhances oxygenation by improving venous return.
  • It leads to increased blood flow to the uterus.

    • Which physiologic change contributes to dilutional anemia during pregnancy?

  • Increased cardiac output
  • Increased hematopoiesis
  • Plasma volume increases more than red blood cell volume (correct)
  • Decreased vascular resistance

    • What is the most effective way to prevent supine hypotension in a parturient?

    <p>Use left uterine displacement.</p> Signup and view all the answers

    Which respiratory change makes pregnant patients more prone to rapid desaturation during apnea?

    <p>Reduced functional residual capacity and increased closing capacity</p> Signup and view all the answers

    Which fetal heart rate (FHR) pattern is most concerning?

    <p>Variable decelerations without variability</p> Signup and view all the answers

    What is the primary cause of postdural puncture headache (PDPH)?

    <p>Leakage of cerebrospinal fluid from the puncture site</p> Signup and view all the answers

    Which medication is most appropriate to treat uterine atony in a hypertensive patient?

    <p>Oxytocin</p> Signup and view all the answers

    Which symptom indicates aortocaval compression during pregnancy?

    <p>Diaphoresis, nausea, and hypotension</p> Signup and view all the answers

    What is the most significant contributor to the increased risk of venous thromboembolism (VTE) in pregnancy?

    <p>Increased clotting factors and hypercoagulable state</p> Signup and view all the answers

    How is maternal cardiac output affected immediately postpartum?

    <p>It increases significantly due to autotransfusion and decreased venous capacitance.</p> Signup and view all the answers

    What is the primary reason for decreased maternal PaCO2 during pregnancy?

    <p>Increased respiratory rate and tidal volume</p> Signup and view all the answers

    Which anesthetic consideration is most relevant for a patient with gestational thrombocytopenia and platelet count of 65,000/mm³?

    <p>Avoid neuraxial anesthesia due to risk of bleeding.</p> Signup and view all the answers

    Why is labor analgesia not associated with delayed labor progression?

    <p>Dilute local anesthetic and opioids do not significantly affect uterine contractions.</p> Signup and view all the answers

    Which physiologic adaptation explains why pregnant patients have a higher risk of difficult airway management?

    <p>Engorgement of airway capillaries and edema</p> Signup and view all the answers

    What is the most likely cause of decreased maternal PaCO2 during painful contractions?

    <p>Hyperventilation due to pain-induced tachypnea</p> Signup and view all the answers

    Which medication combination is recommended to reduce the risk of aspiration during induction in a parturient?

    <p>Sodium citrate and metoclopramide</p> Signup and view all the answers

    How does hypocapnia during pregnancy affect uteroplacental blood flow?

    <p>It increases uterine vascular resistance, decreasing blood flow.</p> Signup and view all the answers

    Which uteroplacental adaptation allows continuous oxygen and nutrient delivery to the fetus during contractions?

    <p>Large intervillous space</p> Signup and view all the answers

    What intervention is indicated for a patient experiencing fetal bradycardia due to umbilical cord compression?

    <p>Relieve cord compression by maternal repositioning.</p> Signup and view all the answers

    What is the preferred treatment for tachysystole in labor?

    <p>Nitroglycerin or beta-2 agonists</p> Signup and view all the answers

    Why do laboring women with neuraxial analgesia require close monitoring of blood pressure?

    <p>Sympathetic blockade decreases systemic vascular resistance, leading to hypotension.</p> Signup and view all the answers

    Which factor increases the likelihood of uterine atony?

    <p>All of the above</p> Signup and view all the answers

    What is the most appropriate initial treatment for postpartum uterine atony?

    <p>Oxytocin infusion and manual massage</p> Signup and view all the answers

    Which medication is NOT safe for treating postpartum hemorrhage in a hypertensive patient?

    <p>Methylergonovine</p> Signup and view all the answers

    Which physiologic change during pregnancy impacts the effectiveness of general anesthetics?

    <p>Decreased MAC requirement by 25-30%</p> Signup and view all the answers

    Which fetal circulation shunt bypasses the liver?

    <p>Ductus venosus</p> Signup and view all the answers

    What is the mechanism of ion trapping of local anesthetics in the fetus?

    <p>Acidic fetal pH ionizing the drug, preventing it from crossing back to the maternal circulation</p> Signup and view all the answers

    Which change in maternal respiratory physiology increases the risk of rapid desaturation during apnea?

    <p>All of the above</p> Signup and view all the answers

    Which drug is most effective in treating maternal hypotension during spinal anesthesia?

    <p>Phenylephrine</p> Signup and view all the answers

    What is the primary determinant of placental drug transfer?

    <p>Maternal blood concentration of the drug</p> Signup and view all the answers

    Why is the closing capacity reduced during pregnancy?

    <p>Compression of the diaphragm by the gravid uterus</p> Signup and view all the answers

    Which stage of labor is most affected by dense neuraxial anesthesia?

    <p>Stage 2</p> Signup and view all the answers

    Which change occurs in uteroplacental circulation during contractions?

    <p>Reduced perfusion due to increased vascular resistance</p> Signup and view all the answers

    Which symptom is most concerning for amniotic fluid embolism?

    <p>Respiratory distress and disseminated intravascular coagulation (DIC)</p> Signup and view all the answers

    What is the primary function of the ductus arteriosus in fetal circulation?

    <p>To connect the pulmonary artery to the aorta</p> Signup and view all the answers

    Which drug combination is most appropriate for the treatment of amniotic fluid embolism?

    <p>AOK = Atropine, ondansetron, and ketorolac</p> Signup and view all the answers

    Why is phenylephrine preferred over ephedrine for treating hypotension in parturients?

    <p>It increases fetal oxygenation by maintaining maternal blood pressure without reducing uteroplacental perfusion.</p> Signup and view all the answers

    Which condition requires emergent cesarean section to prevent fetal compromise?

    <p>Prolonged decelerations with loss of variability</p> Signup and view all the answers

    What is the primary benefit of co-loading fluids during spinal anesthesia for cesarean delivery?

    <p>To minimize maternal hypotension</p> Signup and view all the answers

    What is the recommended treatment for a postdural puncture headache?

    <p>Epidural blood patch with 15-20 mL of autologous blood</p> Signup and view all the answers

    Which medication is most likely to cause neonatal respiratory depression if administered in labor due to accumulation of active metabolites?

    <p>Meperidine</p> Signup and view all the answers

    What is the physiologic explanation for the rightward shift of the maternal oxyhemoglobin dissociation curve during pregnancy?

    <p>Increased oxygen unloading to meet fetal demands</p> Signup and view all the answers

    Match the following terms with their corresponding outcome:

    <p>Labor analgesia = Epidural Elective cesarean section = Scheduled spinal Urgent situation = Immediate spinal Stat situation = Emergent general anesthesia</p> Signup and view all the answers

    Match the following obstetric conditions with their definitions:

    <p>Accreta Vera = Abnormal adherence of placenta to myometrium Accreta Increta = Abnormal implantation of placenta to myometrium Accreta Percreta = Perforation of placenta through uterine wall Vasa Previa = Umbilical vessels travel across the opening of the cervix</p> Signup and view all the answers

    How many mL of local anesthetic (LA) should be administered per desired segment to be blocked?

    <p>1-2 mL</p> Signup and view all the answers

    What is the desired dermatome level to block in c-sections?

    <p>T4</p> Signup and view all the answers

    When is a pregnant woman considered to have a full stomach and requires rapid sequence induction (RSI)?

    <p>From 20 weeks gestation to 1 day postpartum</p> Signup and view all the answers

    Uterine and placental blood flow are NOT autoregulated - dependent on maternal cardiac output

    <p>True</p> Signup and view all the answers

    Study Notes

    Stages of Labor

    • Stage 1: Contractions to complete dilation
    • Stage 2: Fetal delivery
    • Stage 3: Placenta delivery

    Aortocaval Compression

    • Concerning in pregnant patients in supine position
    • Compresses inferior vena cava and aortoiliac vessels
    • Decreases blood flow, reducing preload

    Dilutional Anemia in Pregnancy

    • Plasma volume increases more than red blood cell volume
    • This leads to dilution of red blood cells

    Preventing Supine Hypotension

    • Use left uterine displacement
    • Avoid neuraxial anesthesia
    • Provide aggressive fluid boluses

    Respiratory Changes in Pregnancy

    • Increased minute ventilation
    • Reduced functional residual capacity and closing capacity
    • This makes pregnant patients more prone to rapid desaturation during apnea

    Concerning Fetal Heart Rate (FHR) Patterns

    • Variable decelerations without variability

    Postdural Puncture Headache (PDPH)

    • Leakage of cerebrospinal fluid from the puncture site

    Uterine Atony Treatment

    • Oxytocin is the appropriate medication for hypertensive patients

    Aortocaval Compression Symptoms

    • Tachycardia and hypertension
    • Diaphoresis, nausea, and hypotension

    Venous Thromboembolism (VTE) Risk

    • Increased clotting factors and hypercoagulable state is the most significant contributor

    Maternal Cardiac Output Postpartum

    • It decreases initially due to loss of preload
    • It increases significantly due to autotransfusion and decreased venous capacitance

    Maternal PaCO2 During Pregnancy

    • Decreased PaCO2 is due to increased respiratory rate and tidal volume

    Anesthetic Considerations for Thrombocytopenia

    • Avoid regional anesthesia due to bleeding risk

    Labor Analgesia and Labor Progression

    • Neuraxial analgesia does not significantly affect uterine contractions.

    Difficult Airway Management in Pregnancy

    • Engorgement of airway capillaries and edema contribute

    Amniotic Fluid Embolism Symptoms

    • Respiratory distress and disseminated intravascular coagulation (DIC)
    • Consider in patients with maternal hypertension and tachycardia.

    Uterine Atony Risk Factors

    • Retained placental tissue
    • Use of terbutaline

    Postpartum Uterine Atony Treatment

    • Oxytocin infusion and manual massage

    Medications Not Safe for Hypertensive Patients with Postpartum Hemorrhage

    • Oxytocin
    • Misoprostol
    • Methylergonovine
    • Carboprost

    Physiologic Changes Affecting General Anesthetics in Pregnancy

    • Decreased MAC requirement by 25-30%
    • Increased hepatic metabolism of anesthetics is not a contributing factor.

    Fetal Shunt Bypassing the Liver

    • Ductus venosus

    Ion Trapping of Local Anesthetics in the Fetus

    • Acidic fetal pH ionizing the drug, preventing it from crossing back to the maternal circulation

    Risk Factors of Rapid Desaturation

    • Decreased functional residual capacity (FRC)
    • Increased oxygen consumption
    • Reduced expiratory reserve volume

    Drugs Effective for Treating Maternal Hypotension During Spinal Anesthesia

    • Ephedrine

    Determinants of Placental Drug Transfer

    • Maternal blood concentration of the drug

    Reduced Closing Capacity During Pregnancy

    • Compression of the diaphragm by the gravid uterus

    Stage of Labor Most Affected by Dense Neuraxial Anesthesia

    • Stage 2

    Changes in Uteroplacental Circulation During Contractions

    • Reduced perfusion due to increased vascular resistance
    • 6.5

    Phenylephrine vs Ephedrine for Treating Hypotension

    • Phenylephrine is preferred as it increases fetal oxygenation without reductions in uteroplacental perfusion

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    Description

    This quiz covers key concepts in obstetrics, focusing on the stages of labor, maternal physiological changes during pregnancy, and potential complications. Additionally, it discusses fetal heart rate patterns and treatment strategies for maternal conditions. Test your understanding of these critical aspects of maternal and fetal health.

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