The Mom
The Baby
Pharmacology
High Risk
Potpourri
Labor
100
What is the estimated blood volume for a pregnant patients in cc/kg?
100
Normal range for FHR
What is 110-160 bpm?
100
A synthetic prostaglandin. It acts by binding to prostaglandin E2 receptors causing myometrial contraction
What is carboprost or Hemabate or 15-methyl-PGF2α?
100
The leading cause of pregnancy-related deaths in the US
What is depression (suicide)?
100
A prolonged infusion of oxytocin is most likely to produce a clinically significant decrease in this electrolyte
What is sodium?
100
What is the second stage of labor?
Fully dilated to delivery of baby
200
Fibrinogen cutoff for transfusion in pregnancy? How about non-pregnant patients?
Approx. 200 for pregnant patients (normal by third trimester is 300-600mg/dL) . For non-pregnant patients the cutoff is 100-150, unless it is intracranial surgery in which case you want it to be 150-200
200
What are early decelerations? What do they indicate?
Early decelerations are caused by fetal head compression during uterine contraction, resulting in vagal stimulation and slowing of the heart rate. This type of deceleration has a uniform shape, with a slow onset that coincides with the start of the contraction and a slow return to the baseline that coincides with the end of the contraction.
200
This is the antidote for magnesium toxicity
Calcium gluconate 1 g IV push over 3 minutes OR calcium chloride 10% 500 mg over 5-10 min
200
These are the three prominent changes in the CV system in pregnancy
What are 1) decreased SVR, 2) increased SV/CO, and 3) increased HR?
200
This system is the mechanism for the increase in maternal blood volume during pregnancy
What is sodium retention via renin-angiotensin-aldosterone system?
200
Frequency that methergine can be given?
Every 2-4 hrs
300
The normal Cr range in pregnancy
What is 0.4 to 0.8 mg/dL?
300
The uteroplacental blood flow at term in ml/min
What is 700ml/min?
300
Clonidine functions as a sympatholytic by this mechanism (name specific receptor, neurotransmitter, and action)
What is stimulating presynaptic α2-receptors leading to decreased release of norepinephrine at both central and peripheral adrenergic terminals
300
These are the four categories of HTN in pregnancy.
What are 1) cHTN, 2) gHTN, 3) PEC/eclampsia/HELLP, and 4) siPEC?
300
In the setting of LAST, this is the dose of Intralipid 20% emulsion administration
100cc IV over 2-3 min (if <70kg, 1.5 cc/kg bolus)
250cc over 15-20 min (if <70kg, 0.25cc/kg/min)
400
Name two clotting factors that decrease in pregnancy?
XI, XIII, and Protein S decline. Protein C is constant. You also get dilutional thrombocytopenia
400
This is the associated cause of this fetal heart tracing
What is (utero)placental insufficiency?
400
This drug causes smooth muscle relaxation in the uterus via release of nitric oxide
What is nitroglycerin?
400
This is the week gestation that delineates chronic hypertension versus gestational hypertension
What is 20 weeks?
400
This nerve block can be used for pain relief in the 1st stage of labor
What is a paracervical block?
500
How does FEV1, FEV1/FVC, flow volume loops, and closing capacity change during pregnancy?
They are unchanged. (FRC decreases, oxygen consumption increases, minute ventilation increases- mostly due to an increase in tidal volume). Remember, closing capacity does not change with obesity or position, but it does increase with age.
500
Fetal blood flow is characterized by these three anatomic communications between the left and right circulations
What are the ductus venosus, the foramen ovale, and ductus arteriosus
500
This drug causes uterine relaxation by beta-2 receptor stimulation
What is terbutaline?
500
These are the symptoms for a diagnosis of PEC
What are 1) cerebral or visual sx (new-onset HA, blurred vision, flashing lights or sparks, scotomata), 2) pulmonary edema, 3) liver transaminases ≥ 2x the upper limit of normal, 4) Cr >1.1 mg/dL or a doubling of sCr, 5) proteinuria ≥ 0.3 g/24-hrs or P/Cr ratio ≥ 0.3 (mg/dL) or 2+ on UA dipstick, 6) platelet count <100,000/microL
500
This is the waiting period before you can proceed with NB in a parturient on UFH low dose (5K BID or TID)
What is there is no wait and you can place immediately?
600
This system is the last to return to its pre-pregnancy state
What is the renal or GU system?
600
Fetal hemoglobin has a greater O2 affinity than adult hemoglobin owing to a decreased interaction between hemoglobin F and this molecule
What is 2,3-DPG?
600
This is the site of action for opioids administered in the intrathecal space (name receptor and location)
What is mu receptors in the dorsal horn of the spinal cord, in the substantia gelatinosa?
600
This is the beginning stages in the pathophysiology of PEC
What is abnormal remodeling of the spiral arteries?
600
The structure labeled #2
What is the ligamentum flavum?
700
DAILY DOUBLE
In a preoxygenated 80 kg woman – this is the time to desaturation if you assume O2 consumption is 10ml/kg/min (hint: the FRC in pregnancy is 20 ml/kg)
700
The APGAR score for the following newborn: some flexion of the arms/legs, weak cry after suctioning, slow and irregular respirations, HR 110, pallor all over body and extremities
What is APGAR 5?
700
In non-laboring women undergoing CD, this is the ED90 of oxytocin that has been determined to be sufficient in producing adequate uterine contractions
What is 0.35 IU?
Butwick AJ et al. Minimum effective bolus dose of oxytocin during elective Caesarean delivery. Br J Anaesth. 2010 Mar;104(3):338-43
700
This is the first line medication treatment for eclampsia
What is magnesium sulfate 4-6 g IV loading dose over 15-20 min followed by a 2 g/hr maintenance?
700
This is the year of the first reported use of neuraxial anesthesia in obstetrics by Dr. Oskar Kriese in Germany.
What is 1900?
800
Normal blood gas parameters in a parturient
pH, PaCO2, PaO2, bicarbonate
7.40-7.45/30/100-107/18-20
800
The targeted preductal SpO2 one minute after birth
What is 60-65%
800
For treatment of asymptomatic supraventricular tachycardia, when vagal maneuvers fail, this is the preferred first-line agent for treatment
What is adenosine?
800
These are the drugs you can use to blunt the sympathetic response to DL that can be used with a pregnant patient with HTN.
What are 1) remifentanil, 2) fentanyl, 3) lidocaine, 4) labetalol, 5) esmolol, 6) nitroglycerin, 7) nicardipine
800
FINAL JEOPARDY
In a preoxygenated 80 kg woman – this is the time to desaturation if you assume O2 consumption is 10ml/kg/min (hint: the FRC in pregnancy is 20 ml/kg)