Show:
Obstetric Anesthesia
Platelets & Pregnancy
Integument!
100
This synthetic agonist-antagonist opioid, which has similar potency to morphine and a "ceiling effect" on respiratory depression, may cause this fetal heart tracing abnormality...
What is Butorphanol (Stadol) & pseudosinusoidal.
100
21yo G1 @ 26wks ega is found to have a platelet count of 40K. She mentions her PCP told her she had low platelets during a visit prior to this pregnancy. Most likely diagnosis? Treatment options?
Immune thrombocytopenic purpura. Corticosteroids, IV IG, platelet transfusion, splenectomy.
100
A healthy 31yo G2P2 sees you for a postpartum visit and complains of noticable hair loss. How do you counsel her?
Most likely normal "telogen effluvium". Recovery is spontaneous, usually resolving within 15 months. No effective treatments are available.
200
According to the ACOG committee opinion on obstetric anesthesia, what is the time frame recommended from decision to incision for indicated cesarean delivery?
What is 30 minutes.
200
31 yo multiparous pt has her first OB visit at 34 wks. Routine lab analysis shows platelets of 19K. All other blood counts are normal, she has an unremarkable exam and vitals are normal. She denies any bleeding history. Peripheral smear shows clumps of platelets. Diagnosis?
Pseudothrombocytopenia. Accounts for ~1% of thrombocytopenic gravidas. It is often associated with the anticoagulant (ethylenediaminetetraacetic acid [EDTA]) in purple or lavender top tubes.
200
22yo G1 at 28 wks presents to your clinic as an add-on with concerns about darkened patches of skin on her face. On exam you note darker, light-brown pigmented patches in a malar distribution on her face and upper lip. Diagnosis?
Melasma. Results from melanin deposition in the epidermis & dermal macrophages. Worsens with UV light exposure. More pronounced in women with darker skin tone. Usually resolves postpartum. Use of sun block decreases severity. Treatments include skin bleaches, topical steroids.
300
Differences between spinal and epidural blockade?
SPINAL: fine needle, subarachnoid space, rapid onset EPIDURAL: large-bore needle, catheter placement, epidural space, onset is 15-30 minutes
300
A pt with severe maternal ITP undergoes an SVD at term. What is most likely to be seen on evaluation of the fetus - normal platelets or thrombocytopenia?
There is a risk of worsening thrombocytopenia following delivery as fetal spleen activity increases (platelets have already undergone opsonization). Typically newborns have no serious sequelae - ~15% of newborns will have platelets <50K, only 3% will have serious bleeding complications.
300
Most common type of malignancy to metastasize to the placenta and fetus?
What is malignant melanoma. Represents about 30% of such metastases. Other culprits are hematopoietic malignancies and lung cancer.
400
Mechanism of hypotension seen with regional anesthesia? Treatments?
-Sympathectomy -> loss of vessel tone -> decreased venous return to right side of heart -> decreased cardiac output -> hypotension. -Prophylaxis: IV access, leftward displacement of uterus -Treatment: fluid boluses, exaggerated leftward uterine displacement, failing these measures, vasopressors (ephedrine, phenylephrine).
400
Of gestational thrombocytopenia, ITP, and HELLP syndrome, the condition most likely associated with abnormal platelet function. Name the test used to gauge platelet function.
What is HELLP / hypertensive thrombocytopenia. Thromboelastogram.
400
A 25yo G1 at 35 wks presents to your clinic with a diffuse rash. She tells you it began last week with itching and "bumps" in her "stretch marks" and has since spread over her abdomen, sparing her umbilicus, and to her chest. Diagnosis? Outcomes? Tx?
What is Pruritic Urticarial Papules and Plaques of Pregnancy. No maternal or fetal danger. Treatment is aimed at symptom relief - with topical antipruritics, topical steroids, oral antihistamines.
500
AUDIO DAILY DOUBLE!!! Pathways for pain felt in this patient (during first stage of labor)? Second stage of labor?
First stage: from uterus through visceral afferent (sympathetic) nerves entering the spinal cord through thoracic spinal nerves 10, 11, & 12. Second stage: perineum -> seonsery fibers of sacral nerves 2, 3, & 4.
500
Postpartum pt presents with headaches / confusion and mild fever. She is normotensive on arrival. Lab evaluation reveals creatinine of 3.0, hct of 20, platelets of 25,000, and 1+ protein on her urinalysis. The peripheral smear is notable for schistocytes. Diagnosis? Treatments? Bonus question - how would you descriminate between two obvious diagnoses?
What is thrombotic thrombocytopenic purpura-hemolytic uremic syndrome. This pentad of findings (micorangiopathic hemolytic anemia, thrombocytopenia, neurologic abnormalities, renal dysfunction, fevers) is seen in only 40% of patients. Plasma exchange,glucocorticoids, immunosuppression. Antithrombin III levels - these are usually low in preeclampsia but normal in TTP-HUS.
500
Proposed pathogenesis of PUPPP
Unknown. Possibly an inflammatory process in response to rapid abdominal distention in primigravidas, multiple gestation pregnancies, macrosomia, excess maternal weight gain.