MCQ Obstetrics Answer 31

The correct answer is A.

Aspiration pneumonitis is a major cause of anesthesia-related death in obstetrics. Most often, these aspiration events occur with the use of general anesthesia. Pregnant patients are at greater risk for aspiration because of the delayed gastric emptying that occurs during pregnancy and labor. Pregnancy is associated with increased levels of progesterone and displacement of the pylorus by the pregnant uterus.

Labor is associated with pain and stress. All of these factors lead to delayed gastric emptying. Aspiration pneumonitis is caused by acidic gastric juices entering the lungs and inducing a sometimes-lethal chemical pneumonitis. When epidural anesthesia is administered, there is a risk of complications, including the development of total spinal anesthesia.

The treatment for this complication is positive-pressure ventilation with 100% oxygen administered through an endotracheal tube. Therefore, when an epidural is going to be placed, the patient should be given an antacid (often 30 mL of 0.3 mL/L sodium citrate with citric acid, called Bicitra) to increase the stomach pH. This will help to prevent aspiration pneumonitis should an aspiration event take place during the administration of general anesthesia.

It is not necessary to give an antibiotic (choice B) prior to the administration of an epidural. Antibiotics are used during labor for the prevention of group B Streptococcus sepsis, for patients with chorioamnionitis, for patients in need of valve or endocarditis prophylaxis, or during cesarean delivery for the prevention of infection.

Aspirin (choice C) is not given prior to the placement of an epidural.

A clear liquid meal (choice D) or a regular "house" meal (choice E) should not be given to patients prior to the placement of an epidural. Intake of food or liquids during labor places the patient at greater risk of aspiration pneumonitis.

Patients in labor should be allowed small sips of water or ice chips.

Category: Obstetrics MCQs