week 3 pain pathways (everything)

Question 1

which labs need to be obtained during the initial visit of the mother (11)

Answer 1

CBC 
Typing,
Rubella antibody, 
Cervical gonorrhea and chlamydia culture. 
VDRL, 
HBsAg (Hep B)
Pap, 
Urine complete, 
PPD (TB)
HIV (with consent)
BG

Question 2

15-20 weeks

Answer 2

MATERNAL ALPHA FETOPROTEIN: increase in neural tube defects (NTD) and decrease in Downs syndrome. Triple screening (AFP,HCG, Estriol). If abnormal, do U/S or amniocentesis
Folic acid decrease risk of NTD

Question 3

18-20 weeks

Answer 3

U/S for dating. Best time to access fetal development

Question 4

24-28 weeks

Answer 4

Glucose test for ALL

Question 5

28-30 weeks

Answer 5

RhoGAM to Rh(-ve) mom

Question 6

34-38 weeks

Answer 6

CBC

Question 7

36-40 weeks

Answer 7

Cervical chlamydia and gonorrhea culture in high risk patients

Question 8

does oxytocin level increase during labor

Answer 8

NO!

Question 9

so how does labor start if there is not increase to level of oxytocin
(2 answers)

Answer 9

there is increase sensitivity of myometrium to oxytocin

increase synthesis of prostaglandins by fetal membrane and decida helps to start labor

Question 10

the physiological presentation of labor:

Answer 10

• Increased sensitivity of myometrium to oxytocin
• synthesis of prostaglandins by fetal membrane and decida
• Lightening
• Braxton Hicks contraction
• Cervical effacement
• Bloody show due to breaking down of mucous plug
• Rupture of amniotic membrane
• Cervical dilatation

Question 11

Maternal physiology at labor there is a 300% increase in

Answer 11

in minute ventilation

Question 12

in labor what happens to maternal oxygenation?

Answer 12

60% increase in oxygen consumption

Question 13

maternal Hyperventilation in labor results in:

Answer 13

decrease PCO2 < 20 mmHg; transient hypoventilation; maternal and fetal hypoxemia; reduce uterine blood flow and fetal acidosis

Question 14

Each contraction pushes what vol of blood into the circulation?

what is this called?

Answer 14

300-500 ml of blood into circulation – auto transfusion

Question 15

maternal CO results in (increases by how much)

Answer 15

a 45% increase in cardiac output

Question 16

After delivery ,involution of uterus relieves inferior vena caval obstruction resulting in:

Answer 16

80% increase in cardiac output and stroke volume

Question 17

First
Latent
CO?

Answer 17

15% increase

Question 18

first
active phase
co

Answer 18

30% increase

Question 19

second phase CO

Answer 19

45%

Question 20

third phase CO

Answer 20

80%

Question 21

First latent phase start/end

events

Answer 21

Regular uterine contractions/ 4 cm dilatation

Cx effaces and slowly dilate

Question 22

first active phase start end

events

Answer 22

4 cm/10 cm (complete dilatation)

Regular intense contractions, fetal head descends into pelvis

Question 23

second phase start/end

events:

Answer 23

Complete cervical dilatation/delivery of baby

Baby undergoes all stages of cardinal movements (Engagement, Descent, Flexion, Internal rotation, Extension, External rotation, Expulsion)

Question 24

third phase start/end

events:

Answer 24

Delivery of baby/delivery of placenta

Placenta separates and uterus contracts to establish hemostasis

Question 25

first stage-- pain initial spot- progression. level of spinal anesthesia must cover what sections

Answer 25

Pain is initially T11-T12 then progress to T10-T12 and L1 during active labor. level of spinal anesthesia must cover T10-L1

Question 26

second stage- pain spot level of spinal anesthesia must cover what sections:

Answer 26

Pain through by pudendal nerve (S2-S4) Somatic pain caused by stretching of vagina and perineum by descent of fetus Level of spinal anesthesia is needed for S2-S4

Question 27

first stage- cause of pain? what is the pressure ?

Answer 27

1st stage: Cause of pain is uterine contractions and exceeds 25 mmHg pressure and dilate Cx.

Question 28

level of anesthesia for c section

Answer 28

T4

Question 29

how is pain and temperature mediated in the genitalia

Answer 29

autonomic nervous system- not lateral spinothalamic tract

Question 30

Uterus and Cx- pain levels ? pain is carried by what fibers

Answer 30

T10 to L1-2 Pain impulses carried in visceral afferent C fiber

Question 31

Perineum

Answer 31

S2,S3,S4 Pain impulses carried by somatic nerve fiber; pudendal nerves

Question 32

Inhalation agents | effects on uterus

Answer 32

Cause uterine relaxation - increase blood loss

Question 33

Parentral agents effects on labor

Answer 33

Opioids minimally decrease progression of labor

Question 34

Regional anesthesia is given for:

Answer 34

``` Primigravida Prolong labor High parenteral analgesic requirement Use of oxytocin Large baby Small pelvis Fetal malpresentation ```

Question 35

Vasopressors | a1 stimulation effects

Answer 35

uterine contraction

Question 36

Vasopressors | b2 stimulating effects

Answer 36

uterine relaxation

Question 37

Small dose on phenylephrine effects

Answer 37

increase blood flow increase bp

Question 38

Oxytocin uses

Answer 38

Used to induce labor and to prevent postpartum blood hemorrhage

Question 39

oxytocin complications:

Answer 39

Complication: fetal distress, uterine tetany, maternal water retention, hypotension, reflex tachycardia

Question 40

Ergot alkaloids | uses

Answer 40

to treat uterine atony

Question 41

What is used to treat PPH?

Answer 41

Prostaglandins

Question 42

Magnesium | uses

Answer 42

Use to stop premature contraction and to prevent eclamptic seizures

Question 43

magnesium side effects

Answer 43

Side effects: hypotension, heart block, muscle weakness and sedation. Also INCREASES blockage of non-depolarizing agents. Cardiac and respiratory arrest can occur

Question 44

treatment for magnesium side effects

Answer 44

Treatment D/C- mag Calcium Lasix

Question 45

B2 agonist

Answer 45

stop premature labor

Question 46

Hypotension

Answer 46

Ephedrine, oxygen, left uterine displacement and IV fluids. Small doses of phenylephrine can also be used

Question 47

Unintentional IV injection (of epidural)

Answer 47

Place supine with left uterine displacement | Thiopental or propofol to stop seizures

Question 48

Unintentional intrathecal injection

Answer 48

Place supine with left uterine displacement Ephedrine and fluids Intubation and ventilation in high spinal

Question 49

Postdural puncture headache

Answer 49

Bed rest Hydration Oral analgesic Caffeine

Question 50

Postdural puncture headache

Answer 50

blood patch

Question 51

Signs of Fetal Distress (7)

Answer 51

``` Repetitive late deceleration Loss of beat-to-beat variability Fetal heart rate < 80 Fetal scalp pH < 7.20 Meconium stained amniotic fluid Oligohydramnios Intrauterine growth retardation ```

Question 52

Obesity what % of ideal body weight BMI morbid obesity BMI

Answer 52

>20% of ideal body weight BMI >30 BMI>40

Question 53

obesity labs

Answer 53

High glucose, cholesterol and TG

Question 54

obesity PFT results

Answer 54

restrictive lung disease

Question 55

obesity breathing issues

Answer 55

increase work of breathing decrease ERV (expiratory reserve volume) decrease FRC decrease chest wall compliance

Question 56

in morbid obesity- closing capacity results in

Answer 56

In morbid obesity, closing capacity exceeds FRC - V/Q mismatch - arterial hypoxemia

Question 57

obesity distribution of lipid soluble drugs

Answer 57

Increase volume of distribution for lipid-soluble drugs

Question 58

treatment for pickwickian syndrome

Answer 58

Oropharyngeal appliances Positive pressure nasal mask Surgery

Question 59

Obesity-hypoventilation syndrome leading to (ten things total listed)

Answer 59

``` Hypercapnia Hypoxemia Somnolence; poor sleep at night Pulmonary HTN Systemic HTN RVH / LVH Dependent edema Cyanosis-induced polycythemia Rales Pulmonary edema ```