Cardiovascular changes during pregnancy

Question 1

Which is abnormal finding during pregnancy? (a) S4 heart sound, (b) TR, (c) RBBB, (d) Cardiomegaly

Answer 1

(a), increase volume > S3 heart sound, cardiomegaly, and TR, LV dilation alter the conduction > RBBB, right axial deviation.

Question 2

MAC of isoflurane (a) increase (b) decrease

Answer 2

(b) decrease 30% during pregnancy

Question 3

Neuraxial anesthesia: Why increase spread?

Answer 3

Due to epidural vein engorgement

Question 4

Pregnant patients appear anemic: Why?

Answer 4

Plasma volume increase 45% and RBC volume increase 20% . Normal Hb 12.0

Question 5

Coagulation: Protein S, C

Answer 5

S: Decreased, C: Resistance

Question 6

Platelet counts

Answer 6

Variable due to increase production and destruction

Question 7

Smaller tube is needed for pregnant women: why?

Answer 7

Mucosal capillary engorgement

Question 8

Change in Mallampathi score

Answer 8

Increase by 1

Question 9

Why is Minutes ventilation increased during pregnancy? Total lung capacity (Increase/Decrease), What remains unchanged? What is increase?

Answer 9

Progesterone, Decrease, IRV, TV

Question 10

During labor, fetus may become acidotic, Why?

Answer 10

The maternal respiratory alkalosis cause fetal acidosis due to hypercapnic vasoconstriction.

Question 11

BUN/Cr during pregnancy (Increase/Decrease)

Answer 11

Decrease due to increase RBF

Question 12

Pregnancy effect on Succinylcholine

Answer 12

prolong SCC effect due to plasma cholinesterase decrease

Question 13

Hormonal changes during pregnancy:

1. Progesterone
2. Total T3, T4, Free T3, T4, and TBG
3. Gastrin
4. Cortisol
5. Vasopressin

Answer 13

1 Increase (estrogen and lactogen too)

2. Total T3/T4 increase due to increase TBG but Free T3 remains same. Free T4 slightly increase during 1st trimester since fetal need maternal thyroid hormone for organogenesis then decrease.
3. Same
4. Increase
5. Normal

Question 14

Hepatobiliary function

1. hepatic blood flow
2. AST/ALT, ALP
3. Incidence of gallstone disease
4. Albumin

Answer 14

1. same
2. ALT/ALT same, ALP: Double (placental secretion)
3. Increase
4. Decrease

Question 15

Normal pH in parturient

Answer 15

1. 7.42-7.44

Question 16

Reason that minute ventilation increases during pregnancy

Answer 16

1. Increased CO2 production 2. increase progesterone

Question 17

HCO3 during pregnancy

Answer 17

Decrease to 21