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

These are the four categories of HTN in pregnancy.

What are 1) cHTN, 2) gHTN, 3) PEC/eclampsia/HELLP, and 4) Pre-E w/ severe features

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

This is the week gestation that delineates chronic hypertension versus gestational hypertension

What is 20 weeks?

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

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?

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

Name the 3 types of placenta accreta spectrum

  • Placenta accreta—The placenta grows into a scar in the uterine lining.
  • Placenta increta—The placenta grows into the wall of the uterus.
  • Placenta percreta—The placenta grows through the uterus wall and possibly into nearby organs.

300

Where does the spinal cord typically terminate in adults?

L1-L2 (in children it can extend to L3)

300

What level do you need to achieve for labor analgesia during the first stage of labor? 

The first stage of labor includes innervation from the T10-L1

 The second stage of labor includes innervation from the sacral nerve roots (S2-S4) as well as T12-L1

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

Treatment for eclampsia


What is magnesium sulfate 4-6 g IV loading dose over 15-20 min followed by a 2 g/hr maintenance?

400

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

Frequency that methergine can be given? What about hemabate 

Methergine: every 2-4 hrs

Hemabate: every 13-90 minutes up to 8 doses (not to exceed 2mg)

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

Name 4 of the possible criteria for pre-eclampsia with severe features 

500

How long should you hold low dose prophylactic lovenox prior to neuraxial anesthesia?

12 hrs 

500

What is it called when increased abdominal pressure (such as during pregnancy) leads to entrapment of the lateral femoral cutaneous nerve, causing pain in this distribution 

What is meralgia parasthetica 

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?

600

This nerve block can be used for pain relief in the 1st stage of labor

What is a paracervical block?

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

For treatment of asymptomatic supraventricular tachycardia, when vagal maneuvers fail, this is the preferred first-line agent for treatment

What is adenosine?


700

Diagnostic Criteria for HELLP? (Tennessee Classification system)


The Tennessee classification system for HELLP syndrome requires all three criteria to be met: hemolysis (indicated by LDH > 2x upper limit of normal or 600 U/L) or serum bilirubin >1.2 mg/dL, elevated liver enzymes > 2x upper limit of normal (AST ≥ 70 U/L), and low platelet count (< 100,000/mm3). 

Here's a more detailed breakdown of the Tennessee classification system criteria:
  • Hemolysis:
    • Abnormal peripheral smear: Look for schistocytes, helmet cells, and burr cells. 

    • Increased bilirubin: Bilirubin levels may be elevated due to hemolysis. 

    • Elevated LDH: Lactate dehydrogenase (LDH) levels should be > 600 U/L. 

  • Elevated Liver Enzymes:
    • AST (Aspartate Aminotransferase) or ALT (Alanine Aminotransferase):AST or ALT levels should be > 70 U/L or twice the upper limit of normal. 

  • Low Platelet Count:
    • Platelet count: Platelet count should be < 100,000/mm3. 





700

For rotem, what is prolonged if you have a deficiency of factor VII? 

Clotting time in the Extem

700

Ideal blood volume for an epidural blood patch

Approximately 20cc 

  A multicenter study of over 500 patients reported >95% relief of PDPH when using epidural blood patch volumes of 15 mL or greater. It was noted, however, that injection volume greater than 20 mL showed no advantage.

800

Normal blood gas parameters in a parturient

pH, PaCO2, PaO2, bicarbonate 

7.40-7.45/30/100-107/18-20

800

During labor, a normal fetal scalp blood pH is considered to be greater than ...

> 7.25 is normal

7.20-7.25 is borderline

<7.20 suggests fetal distress or hypoxia 

800

Toxic dose of chloroprocaine?


12 mg/kg 

800

For pregnant patient's with type 1 von willebrand disease, what percentage factor VIII levels do you want? What is the treatment if below this?

>50% factor VIII levels. Treatment is desmopressin 

800

What are the 4 nerves blocked by the TAP block?

Intercostal, Subcostal, Iliohypogastric, and Ilioinguinal 

800

This is the year of the first reported use of neuraxial anesthesia in obstetrics by Dr. Oskar Kriese in Germany.

What is 1900?