,Table of Contents
Chapter 1 — Physiologic Changes of Pregnancy
Chapter 2 — Uteroplacental Anatomy, Blood Flow, Respiratory Gas Exchange, Drug Transfer,
and Teratogenicity
Chapter 3 — Local Anesthetics and Toxicity
Chapter 4 — Obstetric Medications
Chapter 5 — Ethical and Legal Considerations in Obstetric Anesthesia
Chapter 6 — Nonobstetric Surgery during Pregnancy
Chapter 7 — Fetal Assessment and Monitoring
Chapter 8 — Maternal Infection and Fever
Chapter 9 — Non-neuraxial Analgesic Techniques
Chapter 10 — Choice of Neuraxial Analgesia and Local Anesthetics
Chapter 11 — Ultrasound and Echocardiographic Techniques in Obstetric Anesthesia
Chapter 12 — Impact of Neuraxial Analgesia on Obstetric Outcomes
Chapter 13 — Anesthetic Considerations for Women Receiving Cesarean Delivery
Chapter 14 — Difficult Airway Management in the Pregnant Patient
Chapter 15 — Anesthesia for Multiple Gestation and Breech Presentation
Chapter 16 — Obstetric Emergencies
Chapter 17 — Newborn Resuscitation
Chapter 18 — Postcesarean Analgesia
Chapter 19 — Management of Postdural Puncture Headache
Chapter 20 — Neurologic Deficits Following Labor and Delivery
Chapter 21 — Postpartum Tubal Ligation
Chapter 22 — Hypertensive Disorders of Pregnancy
Chapter 23 — Endocrine Disorders
Chapter 24 — Thrombophilias/Coagulopathies
Chapter 25 — Cardiovascular Disease
Chapter 26 — Respiratory Disease in the Pregnant Patient
, Chapter 27 — Renal and Hepatic Disorders
Chapter 28 — Neurologic and Neuromuscular Diseases
Chapter 29 — Psychiatric Disorders and Substance Abuse
Chapter 30 — Obesity
Chapter 31 — Management of the Opioid Dependent Parturient
Chapter 32 — Fetal Surgery and In Utero Procedures
Chapter 33 — Cardiopulmonary Resuscitation in the Pregnant Patient
Chapter 1 — Physiologic Changes of Pregnancy
1. Which mechanism accounts for physiologic anemia during normal pregnancy?
A. Decreased synthesis of renal erythropoietin molecules
B. Accelerated peripheral destruction of red blood cells
C. Greater rise in plasma volume than red blood cell mass
D. Sequestration of maternal erythrocytes in the placenta
Answer: C
Rationale: Maternal plasma volume increases by forty to fifty percent while red blood cell
volume expands by twenty to thirty percent, producing a state of relative hemodilution. This
physiological dilution decreases blood viscosity to optimize uteroplacental perfusion while
maintaining adequate maternal oxygen transport.
Keywords: physiologic anemia, plasma volume expansion, hemodilution
2. When a patient at 36 weeks of gestation turns supine and develops sudden hypotension and
tachycardia, which immediate maneuver restores venous return?
A. Placement of a wedge under the right hip to achieve left uterine tilt
, B. Rapid intravenous administration of a pure arterial vasoconstrictor
C. Elevation of the head of the bed to thirty degrees in the midline axis
D. Bilateral passive leg elevation to augment central blood distribution
Answer: A
Rationale: Left uterine displacement relieves inferior vena cava compression by the gravid
uterus, restoring maternal venous return, stroke volume, and systemic blood pressure.
Aortocaval compression can reduce maternal cardiac output by up to twenty-five percent in the
un-tilted supine position at term.
Keywords: aortocaval compression, supine hypotensive syndrome, left uterine tilt
3. What respiratory parameter experiences the most pronounced decrease at term pregnancy?
A. Closing capacity of dependent lung segments
B. Vital capacity during forced maximal effort
C. Anatomic dead space within conduction paths
D. Functional residual capacity of the lungs
Answer: D
Rationale: Upward diaphragmatic displacement by the gravid uterus reduces maternal
functional residual capacity by approximately twenty percent in the sitting position and up to
thirty percent in the supine position at term. This decline occurs predominantly via progressive
reductions in expiratory reserve volume and residual volume.
Keywords: functional residual capacity, respiratory physiology, lung volumes
4. During preoxygenation prior to rapid sequence induction for an emergent cesarean delivery,
the anesthesiologist notes rapid arterial desaturation within seconds of apnea. Which
physiologic combination directly accelerates this desaturation in term parturients?
A. Increased tidal volume paired with expanded thoracic dead space
B. Decreased functional residual capacity and elevated oxygen uptake
Chapter 1 — Physiologic Changes of Pregnancy
Chapter 2 — Uteroplacental Anatomy, Blood Flow, Respiratory Gas Exchange, Drug Transfer,
and Teratogenicity
Chapter 3 — Local Anesthetics and Toxicity
Chapter 4 — Obstetric Medications
Chapter 5 — Ethical and Legal Considerations in Obstetric Anesthesia
Chapter 6 — Nonobstetric Surgery during Pregnancy
Chapter 7 — Fetal Assessment and Monitoring
Chapter 8 — Maternal Infection and Fever
Chapter 9 — Non-neuraxial Analgesic Techniques
Chapter 10 — Choice of Neuraxial Analgesia and Local Anesthetics
Chapter 11 — Ultrasound and Echocardiographic Techniques in Obstetric Anesthesia
Chapter 12 — Impact of Neuraxial Analgesia on Obstetric Outcomes
Chapter 13 — Anesthetic Considerations for Women Receiving Cesarean Delivery
Chapter 14 — Difficult Airway Management in the Pregnant Patient
Chapter 15 — Anesthesia for Multiple Gestation and Breech Presentation
Chapter 16 — Obstetric Emergencies
Chapter 17 — Newborn Resuscitation
Chapter 18 — Postcesarean Analgesia
Chapter 19 — Management of Postdural Puncture Headache
Chapter 20 — Neurologic Deficits Following Labor and Delivery
Chapter 21 — Postpartum Tubal Ligation
Chapter 22 — Hypertensive Disorders of Pregnancy
Chapter 23 — Endocrine Disorders
Chapter 24 — Thrombophilias/Coagulopathies
Chapter 25 — Cardiovascular Disease
Chapter 26 — Respiratory Disease in the Pregnant Patient
, Chapter 27 — Renal and Hepatic Disorders
Chapter 28 — Neurologic and Neuromuscular Diseases
Chapter 29 — Psychiatric Disorders and Substance Abuse
Chapter 30 — Obesity
Chapter 31 — Management of the Opioid Dependent Parturient
Chapter 32 — Fetal Surgery and In Utero Procedures
Chapter 33 — Cardiopulmonary Resuscitation in the Pregnant Patient
Chapter 1 — Physiologic Changes of Pregnancy
1. Which mechanism accounts for physiologic anemia during normal pregnancy?
A. Decreased synthesis of renal erythropoietin molecules
B. Accelerated peripheral destruction of red blood cells
C. Greater rise in plasma volume than red blood cell mass
D. Sequestration of maternal erythrocytes in the placenta
Answer: C
Rationale: Maternal plasma volume increases by forty to fifty percent while red blood cell
volume expands by twenty to thirty percent, producing a state of relative hemodilution. This
physiological dilution decreases blood viscosity to optimize uteroplacental perfusion while
maintaining adequate maternal oxygen transport.
Keywords: physiologic anemia, plasma volume expansion, hemodilution
2. When a patient at 36 weeks of gestation turns supine and develops sudden hypotension and
tachycardia, which immediate maneuver restores venous return?
A. Placement of a wedge under the right hip to achieve left uterine tilt
, B. Rapid intravenous administration of a pure arterial vasoconstrictor
C. Elevation of the head of the bed to thirty degrees in the midline axis
D. Bilateral passive leg elevation to augment central blood distribution
Answer: A
Rationale: Left uterine displacement relieves inferior vena cava compression by the gravid
uterus, restoring maternal venous return, stroke volume, and systemic blood pressure.
Aortocaval compression can reduce maternal cardiac output by up to twenty-five percent in the
un-tilted supine position at term.
Keywords: aortocaval compression, supine hypotensive syndrome, left uterine tilt
3. What respiratory parameter experiences the most pronounced decrease at term pregnancy?
A. Closing capacity of dependent lung segments
B. Vital capacity during forced maximal effort
C. Anatomic dead space within conduction paths
D. Functional residual capacity of the lungs
Answer: D
Rationale: Upward diaphragmatic displacement by the gravid uterus reduces maternal
functional residual capacity by approximately twenty percent in the sitting position and up to
thirty percent in the supine position at term. This decline occurs predominantly via progressive
reductions in expiratory reserve volume and residual volume.
Keywords: functional residual capacity, respiratory physiology, lung volumes
4. During preoxygenation prior to rapid sequence induction for an emergent cesarean delivery,
the anesthesiologist notes rapid arterial desaturation within seconds of apnea. Which
physiologic combination directly accelerates this desaturation in term parturients?
A. Increased tidal volume paired with expanded thoracic dead space
B. Decreased functional residual capacity and elevated oxygen uptake
