Obstetric Anesthesia Practice Questions

Q: A 22-year-old primigravid woman at term presents to the labor room with contractions every 2 minutes. Her prenatal course was unremarkable, and she takes no medications and has no known drug allergies. Examination reveals her cervix to be 6 cm dilated and 100% effaced, with the fetus at 0 station. The fetal heart rate has a baseline in the 150s and is reactive. The patient desires an epidural for pain relief. Which of the following should be given orally shortly before the epidural is placed?

Antacid. **Explanation:** The correct answer is **A. Antacid**. **Why Antacids are given:** Pregnant women are at a significantly increased risk of **aspiration pneumonitis (Mendelson Syndrome)** during labor. This is due to several physiological changes: increased intra-abdominal pressure from the gravid uterus, progesterone-mediated relaxation of the lower esophageal sphincter, and delayed gastric emptying. Before administering neuraxial anesthesia (like an epidural), it is standard practice to administer a non-particulate antacid (e.g., **Sodium Citrate**). The goal is to increase the pH of the gastric contents. If an emergency arises requiring general anesthesia or if the patient vomits and aspirates, a higher gastric pH ( >2.5) significantly reduces the risk of severe chemical pneumonitis. **Why other options are incorrect:** * **B. Antibiotic:** Routine prophylactic antibiotics are not indicated for the placement of an epidural. They are reserved for specific indications like Group B Strep (GBS) prophylaxis or prior to a Cesarean section. * **C. Aspirin:** Aspirin is an antiplatelet agent and is contraindicated immediately before neuraxial anesthesia due to the risk of an epidural hematoma. * **D. Clear liquid meal:** While clear liquids are often allowed in early labor, they do not provide the protective pH-neutralizing effect required before an anesthetic procedure. **NEET-PG High-Yield Pearls:** * **Mendelson Syndrome:** Defined as aspiration of gastric contents with a pH 25 ml (0.4 ml/kg). * **Non-particulate antacids** (Sodium Citrate) are preferred over particulate ones (Magnesium hydroxide) because they are less harmful if aspirated. * **Prokinetic agents** (Metoclopramide) may also be used to facilitate gastric emptying in laboring patients.

Question 1

A pregnant patient at full term has both mitral stenosis and mitral regurgitation. If the obstetrician plans to conduct a normal delivery, what would be the preferred method of analgesia?

Accepted Answer

Neuraxial analgesia

Answer

Parenteral opioids

Answer

General anesthesia

Answer

Inhalational analgesia

Question 2

A term gestation patient with critical aortic stenosis presents to labor, and her cervix is 6 cm dilated. Your approach to the treatment of this patient includes all except:

Accepted Answer

Restrict IV fluids to decrease cardiac preload.

Answer

Provide epidural analgesia.

Answer

Limit activity.

Answer

Perform pulmonary artery catheterization.

Question 3

A 22-year-old primigravid woman at term presents to the labor room with contractions every 2 minutes. Her prenatal course was unremarkable, and she takes no medications and has no known drug allergies. Examination reveals her cervix to be 6 cm dilated and 100% effaced, with the fetus at 0 station. The fetal heart rate has a baseline in the 150s and is reactive. The patient desires an epidural for pain relief. Which of the following should be given orally shortly before the epidural is placed?

Accepted Answer

Antacid

Answer

Antibiotic

Answer

Aspirin

Answer

Clear liquid meal

Question 4

Which of the following drugs is the vasopressor of choice in pregnancy?

Accepted Answer

Ephedrine

Answer

Phenylephrine

Answer

Methoxamine

Answer

Mephentermine

Question 5

Which of the following statements regarding neuraxial opioids for labor and delivery is true?

Accepted Answer

Systemic absorption is similar to intramuscular administration.

Answer

Opioids should never be used as a sole agent.

Answer

The most common side effect is fetal bradycardia.

Answer

Intrathecal morphine is associated with a quick peak in concentration and early onset maternal respiratory depression.

Obstetric Anesthesia — MCQs

Obstetric Anesthesia — MCQs

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