She Ain't Normal
This pregnancy-related pulmonary change is the single biggest reason parturients desaturate rapidly during apnea.
What is decreased functional residual capacity?
Key Point: Diaphragmatic elevation from the gravid uterus reduces FRC.
Clinical Takeaway: Pregnant patients desaturate quickly — preoxygenate aggressively and expect a shorter safe apnea time.
This is the MOST common cause of postpartum hemorrhage.
What is uterine atony?
Key Point: Uterine atony accounts for ~70–80% of PPH.
Clinical Takeaway: Always assess uterine tone first in hemorrhage.
Local anesthetic systemic toxicity (LAST) during obstetric anesthesia is MOST commonly caused by:
What is sympathetic blockade?
Key Point: Neuraxial anesthesia causes vasodilation and ↓ venous return.
Clinical Takeaway: Assume hypotension will happen — prevent it rather than react.
The MOST important immediate treatment of a high spinal is:
•Correct Answer: C. Airway and ventilatory support
•Key Point: Respiratory failure may occur rapidly.
•Clinical Takeaway: Secure airway early and support ventilation.
•Barash says: Management of high spinal anesthesia requires prompt airway and ventilatory support. (Barash 8th ed., Ch. 41)
This inflammatory marker is normally elevated during pregnancy, limiting its diagnostic utility
What is the erythrocyte sedimentation rate (ESR)?
Key Point: Increased fibrinogen elevates ESR.
Clinical Takeaway: ESR is less useful for diagnosing inflammation in pregnancy.
This arterial blood gas change is expected in normal pregnancy.
What is decreased PaCO₂?
Key Point: Progesterone stimulates ventilation.
Clinical Takeaway: Normal PaCO₂ in pregnancy is ~30 mmHg, not 40.
This uterotonic is considered first-line therapy for uterine atony.
Key Point: Oxytocin is effective and well tolerated.
Clinical Takeaway: Start early — don’t wait for massive bleeding
This is the FIRST-line treatment for suspected local anesthetic systemic toxicity.
What is 20% lipid emulsion therapy?
Key Point: Lipid acts as a lipid sink for local anesthetics.
Clinical Takeaway: Lipid must be immediately available on L&D.
Carboprost (Hemabate): correct dose and repeat interval?
•Correct Answer: A. 250 µg IM q15–90 min (max 2 mg)
•Key Point: Potent prostaglandin F2α.
•Clinical Takeaway: Always check asthma history before administration.
•Barash says: Carboprost is given as 250 µg IM every 15–90 minutes to a maximum dose of 2 mg. (Barash 8th ed., Ch. 41)
One adult dose of pooled platelets is expected to increase the platelet count by approximately:
What is 30,000–60,000 per microliter?
Key Point: Platelet response is predictable in the absence of consumption.
Clinical Takeaway: Lack of response suggests ongoing hemorrhage or DIC.
This airway change in pregnancy most increases the risk of difficult and traumatic intubation.
What is mucosal edema from capillary engorgement?
Key Point: Increased capillary permeability causes a friable, edematous airway.
Clinical Takeaway: Use smaller ETTs, gentle technique, and have backup airway plans.
This medication for uterine atony is contraindicated in patients with hypertension or preeclampsia.
What is methylergonovine (Methergine)?
Key Point: Potent arterial vasoconstrictor.
Clinical Takeaway: Methergine can precipitate stroke or MI in hypertensive patients.
This finding MOST strongly suggests intrathecal rather than intravascular local anesthetic injection during epidural dosing.
What is rapid dense motor block?
Key Point: Intrathecal injection causes motor block; intravascular causes CNS/cardiac toxicity.
Clinical Takeaway: Sudden motor block = spinal until proven otherwise.
Methylergonovine (Methergine): standard dose?
•Correct Answer: B. 0.2 mg IM
•Key Point: Ergot alkaloid with strong vasoconstriction.
•Clinical Takeaway: Never give IV; avoid in hypertension.
•Barash says: Methylergonovine is administered as 0.2 mg IM for uterine atony. (Barash 8th ed., Ch. 41)
A standard adult dose of cryoprecipitate (10 units) increases fibrinogen by approximately:
What is 80–100 mg/dL?
Key Point: Cryo is fibrinogen-dense but must be dosed appropriately.
Clinical Takeaway: One or two units won’t meaningfully correct hypofibrinogenemia.
This neural pathway is primarily responsible for pain during the first stage of labor.
What are T10–L1 visceral afferent fibers?
Key Point: Uterine contractions and cervical dilation transmit pain via T10–L1.
Clinical Takeaway: Effective labor analgesia must cover lower thoracic dermatomes.
This uterotonic should be avoided in patients with asthma due to risk of bronchospasm.
What is carboprost (Hemabate)?
Key Point: Prostaglandin F2α causes bronchoconstriction.
Clinical Takeaway: Always ask about asthma before giving Hemabate.
This is the MOST common cause of local anesthetic systemic toxicity during labor epidural use.
What is intravascular epidural catheter migration?
Key Point: Epidural veins are engorged in pregnancy.
Clinical Takeaway: Aspiration and test dosing are essential.
bor epidural use.
Misoprostol typical dose for postpartum hemorrhage?
•Correct Answer: C. 800–1000 µg PR/SL
•Key Point: Prostaglandin E1 analog.
•Clinical Takeaway: Useful when other uterotonics unavailable.
•Barash says: Misoprostol is commonly administered as 800–1000 µg rectally or sublingually. (Barash 8th ed., Ch. 41)
During postpartum hemorrhage, a fibrinogen level of 150 mg/dL should be interpreted as:
What is critically low?
Key Point: Pregnancy begins with elevated fibrinogen levels.
Clinical Takeaway: “Normal” lab values may represent severe depletion.
This cardiovascular adaptation allows cardiac output to increase by up to 50% during normal pregnancy
What is increased stroke volume and heart rate?
Key Point: Both HR and SV increase to meet metabolic demands.
Clinical Takeaway: Small decreases in preload can cause large drops in cardiac output.
This uterotonic is commonly used as adjunctive therapy when other agents are unavailable or contraindicated.
This uterotonic is commonly used as adjunctive therapy when other agents are unavailable or contraindicated.
Pregnancy increases the spread of spinal anesthesia primarily because of a reduction in this anatomic factor
Pregnancy increases the spread of spinal anesthesia primarily because of a reduction in this anatomic factor
Target fibrinogen level during massive obstetric hemorrhage?
•Correct Answer: C. >200 mg/dL
•Key Point: Pregnancy starts hypercoagulable.
•Clinical Takeaway: 'Normal' fibrinogen may represent depletion.
•Barash says: Fibrinogen levels should be maintained above 200 mg/dL in obstetric hemorrhage. (Barash 8th ed., Ch. 41)
The precise trigger and pathophysiology of amniotic fluid embolism is:
No body knows?
Anaphylactoid more likely than occlusive embolism