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Physiology Kerry > 11 Maternal + Neonatal physiology > Flashcards

11 Maternal + Neonatal physiology Flashcards

1
Q

Major respiratory changes at birth

A

Loss plscental gas exchange

initiation ventilation newborn lung

commencement pulmonary g echange

est FRC

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2
Q

Major CVS change birth

A

Loos umbil circ to placenta

CLose DV

Functional closure - FO

Close Duct arteriosus

Increase pulmonary circ

change skin flow - rleate expore - thermoreg role
change RBF - decrease Renal casvular resistance

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3
Q

How are the 2 changes related

A

Major change - cesastio umbil flow
Bombardment - external seosnry stimuli when born

Loss placenta gas exchange - asphyxia -
central periph chemo stim
stim resp cent - initiation lung ventilation
(passge thru birth canal compression throax- expel some airway fluid_

Increase LV w/ vent - decre resist ex alveolar vessel
rise alv p02- removal HPV
- large decrease PVR -increase pul flow
rise art po2 constric DA - promote pulm flow

Loss VR _ umb vein - close dv - rall RAP
LAP increase – increase pulom flow
reversal pressure gradient - - func close
remove R->L shunt 0 further promot lung flow

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4
Q

Fxn of placenta

A 
Tranport
immunlog
metabolic
Endcine
(TIME)
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5
Q

Transport placental fuxn

A

Gas exchange

Nutrient

Waste remov

Aater and electro deliv

Tport other - drug

Heat

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6
Q

Immunlog

Metab

endo fxn

A

Protect infx

Rejection by mother - immune barier

Synth glycogen - cholesterol FA + Enzymes

4 Main homo
HCG HPL Oestriol Progesterone

other hormone - plac cotrico

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7
Q

What mech prevent immune rejection

A

Acquired defects in maternal immune competence

  • Increase susc cert infx (poli hep a+b malaria_ - cell med immune

Trophblast -
dont express Class I / II MHC
CAnt present antigen -> lympho
ant be recog act cytoT

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8
Q

Where is progesterone produce - preg

A

1st tri- corpus letue in ovary

Ramneder - placenta

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9
Q

Processes - sub X placetna

A

1 Diffusion
- water, gases, lipid drug

2 Fac diffusion
3 ATP
Both- carrier protein
against conc grad, involve energy expend, sat at high conc, competiton
-> fts fac diffusion - not inolve energy expend

Pinocyto
Large non lip sol / no carrier
Globulin
Plip
lipopreot
IgG - only class cross plcaetna - baby immune prote months
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10
Q

Foetal gluc level

A

Maternal level major factor -

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11
Q

What sub Carry placenta by active tpor

A 
AA
Ca
Fe
I
Water sol vit
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12
Q

Role HCG

A

Main CL - early preg - sim LH

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13
Q

Major role HPL =

A

Also - Chorionic GH + structure sim to HGH
reg gluc fetus
alter mother metab - promote foetal growth (use more fat so more gluc for baby)

Insulin antagonist - secretion controll gluc level - if fall = hpl increase
increased liplysis - more gluc for baby

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14
Q

Neonatal temperature regulation

Thermoneutral zone?

Typical value neonate and aduult

A

Ambinet temp == maint body temp not increase heat prod

metab - aerobic - min heat prod = min o2 consump

32-34’C term neo

25-30 adults

Prem - higher

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15
Q

Why neonate susecptible heat stress

A

1 Large SA to Vol ratio

2 Thin Subcut tissue

3 Lim sweat capactiy

4 lim Ability control environment

Evap losses can be large

Higher BMR - more heat to lose to main equil

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16
Q

What mech used neo - control temp

A

changes position - change skin flow

behavioural - cry
SKin vcon
Non shiv thermo - brown fat
Musc activity and shivery (poor develop)
Movement = heat (may lose insulating mat)

Warmth
behavo - cry remove
skin vdil
sweat (lim - evap heat loss can double)

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17
Q

Brown fat

A

Heat prod by metab

WHite fat- store energy reserve

Bronw - fat glob and large mito
uncopling ox physo = more ehat generate -
Cell cont glycogen - gluc metab

Abdomen, large blood vessl, interscap base neck

2-6% tbw neonate
Total body heat production - double increase brown fat activity

Oxygen reqd

RIch symp innerv - b recp - increase lipolysis
sympathethic control

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18
Q

How keep child warm

A

Warm blankent
insulating non op site insulating mater

theatre temp

warm humidif insp gas

warm IVF

Radiant heaters

Short op time

Min exporsure - wet surface

High SA to VOl - signif tfer and increase in temp can occur
monitoring important

19
Q

CVS changes during pregnancy

A

1 Increase CO - 30% SV + HR

2 Increase blood vol - 40-45% 
-plasma 50%
RCC 30% - phys anaem preg 
1200mls b term
Most increase - 1st 2 trimester - reamins constant - increase during third trim

3 Increase flow many tissue

4 Decreased TPR - Hormones
Placetna flow - AB shunt flow passive

Vdil - med pregoseterone

Decreased TPR + Inc BV = Inc CO
Most - present end 1st tri

20
Q

Spirometry preg

A

1 Decrease FRC - increase RV + ERV

2 TLC - norm/decreased - Elevatin diphargam = increase AP + tv diam

3 Higher MV - increase Vt + slight inc RR

21
Q

How is the neonatal airway different from the dult

A 
Upper
1 Nasal passage narrow
2 Tongue large
3 Nasal breathers
4 Nasal obstruct ~~ resp distress
Larynx
Epiglo - stiff U shpae, angled 45'
Glottis  high C3-C4 - C5 C6 in adult - anterior angulation back pressure - assis 
Cricoid narrowest - 
complete catil ring cant expend - 
Lower Airway
Trach - short 4-5cm w diam 6m
RMB - directer in line vs left
L - 45'
R - 30'

Periph a/way -diam <2mm - 50% a.way ressitance
Airway contrib 20% adult
can cause severe RDS (bronchilotis)

Less bornch muscle present
bronspasm - uncommon - response bdil poor

22
Q

What difference lung mechanics

A

1 Chest wall compliant - Compresion bithc canal

2 Ribs horriznla - absence bucket handle

1=2 - minimal thoracic component to bent

4 Diaphragm - breathing
impaird mech effecieny
low prop high ox capc - suceptible fatige
abdo distension - splint diaphrgam - Cause RDS
Disten stom bmc - impair spont vent

5 Alv vent - 120-140mls kg min (2x adulg- WOB 1% BMR min high RR - rather larger TV

6 I;E ratio 1

7 End exp pleural pressure ~ 0
rather remain neg adult

23
Q

Diffce lung vol and gas ehange

A

FRC 30mls kg
same adult
less stable - tend to atelectasis

FRC < CC - gas trapping small airway normal TV
AA grad inc 30mmhg v 5
increased venous admix - shunt non vent region

O2 consump - high weight bases
6-7mls kg v 3
- d/t higher BMR

O2 delivery - aided igh alveolar vent
high co
CO -> metab active
reapid inhal induction

Gas exchange reserve lower - smaller pulm bg membrane

24
Q

What diffrence respiratory control neonate

A

Control mech< develop - espec prem baby

Period resp common
pasues 5-10s / up 5 sleep - normal

Apneoic - >20sec - a/w bradyardi - abnormal

Hypoxia response blunt hypothermi aesp prem

25
Q

Comparison of parameters

A 
Dead space - 2.2 ml kg both
TV 7mls kg both
Vd/Vt - 0.3 both
Spec compl - .05 both
FRC 30mls kg both

Alveolar vent 120-140 mls kg min (60-70)
RR 30-40 (10-20)
IE 1 (v 1.5)
Oxyg consup 6-7 (3.5)

26
Q

Placental gas exchange

How do placenta and lungs compar as gas exchanging units

A

Gas exchage in placenta less efficent than lung

Min diff dist larger 3.5 um v 0.5 um

Perm Blood Blood Barrier lower v blood gas in lung

TSA plac term - 16m2 v 60m2
tfer 1/10th o2

Inefficnet gas exchange -
larger diff dist - lower gas permeability

27
Q

Foetus req increase oxygen supply grow how met

A

Increase maternal blood to placenta (20fold increase)

Increase foetal blood supply to placenta

Presence Foetal Hb - higher affinity - maternal HbA

[Hb] conc highe in foetus

Double bohr effect

28
Q

Whats uterine BF at term

A

500-750mls min
85% placenta
not autoreg -flow pressuredependent

Vessel foetal doexy to placenta - umbil artery

29
Q

What UA flow at term

A

Foetal CO term 1000mls min

25-55% to plcaenta

30
Q

Spec ft Hbf how assit foetus

A
  1. Lower P50
  2. 5 kpa vs 3.5

Foetal - higher affinity - load oxygen pcaetna -

Higher sat at given po2 - than adult
Hb 80% sat - po2 4kpa

31
Q

Why is the foetal hb a low P50

A

Higher adult Hb in RCC _ r shift present 2 3 dpg - 23 dpg bind b chain Hba - espec Deoxy -

fEOTAL HB - TETRAMETER - A2Y2
- No b chain hbf - insense 2 3 dpg shift

32
Q

How long Hbf persist

A

80% neonates hb is Hbf - decrease rapidly 6/12 - 5% hbf

smll amt in adults

33
Q

Whats the double bohr affect

A

Placenta - bohr affect operative maternal and foetal circ
Increase PCo2 - maternal intervillous sinus - assist o2 unload

Decrease PCO2 on foetal side - assist oxygen loading
Bohr - facil reciprocal o2 exchange for CO2

O2 disoc curve maternal and foetal move apart

34
Q

Special factors assit Co2 Transfer across placenta

A

1 Maternal hypvent - low maternal PCo2 - gradient

Double haldane fx
- oxygn disolace Co2 - deoxy carry inc co2

35
Q

Hb At birth

A

17-18g/dl

36
Q

WHat way does hb change in first year after birth

A

Decrase hb - phys anaemi infacny

Rapid dcrease - elim Hbf

Increase prod Hba

Art Po2 - neo higher - epo level - fall undetect -
RCC prod decrease hb fall

Dcrease oxygen deliver - compensate - shift right hbf replcae hba - RCC 2 3 DPG rise

[Hb] - fall far enough increase PO - RCC prod incrase
phys anaem infancy 6/12

37
Q

Po2 & SO2 PCO2 uterine + Umbilical vessel

A

Mater
UA pPO2 100mmhg - SO2 98% Pco2 32 mmhg

UV - 40mmHg - 75% 45mmhg

Foetal

UA - Po2 18 35% 55mmhg

UV _ Po2 28mmHg 70% - 40mmHg

38
Q

Outline Oxygen balance across placenta

A

page 255 add later

39
Q

First breath

A

Chest wall complaince - expel lung fluid - rest reabs lung after birth

40
Q

First breath curve after birth

A

High negative intathracic pressure -60-> 70

reduces with each subeseq breath

41
Q

How long take newborn breath and establish a normal FRC

A

Before del - lung 20mls kg fluid
some expell
rapidly repalce air - delivery ventilation

1st - neg itnratho pressure -preggesive easier - air liq interface - action surfactant in reducing surface tnesion

FRC rises rapildy after 1st breath
10min =17mls kg
60min - adult 30mls kg

42
Q

What o2 consump neonate - how deman met

A

6-7mls kg
temperate - drop 2 -doulbe consump
tehmroneut zone

How increase o2 demand ment
high vent 120 -140 ml kg min
x2 adult 
increase rr rather than TV - 7.kg adult
minim work breathing
43
Q

Amniotic fluid

A

FLuid in amnitoic cavity surround foetus

Ub cord passes thru cavit to place

UF of foetal plasm a- part eCF
later preg - foetal urineswalled - reabs gut
turns over day/2days

500-1500mls

vol peaks 34/40 - decrease slowly

Fxn -
decrease effective weigh - cushion
route recycleing renal output

space syettric growth

resit pressure contraction uterus during labour

Physiology Kerry (17 decks)

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