Ch 18 Urologic Considerations In Pregnancy Flashcards
The presence of this hormone cases vasodilatation and prostacyclin-mediated smooth muscle relaxation
Progesterone
The following alterations in the cardiovascular system during pregnancy
Increased O2 demand
Increased nutrient demand
Increased cardiac output
Decreased SVR
Decreased MAP
There is a decrease in mean arterial pressure to ~10mmHg by the ________ trimester
Occurs in the 2nd trimester
Cardiac output in pregnancy increases by how many percent?
30 to 50%
This syndrome is described as — the gravid uterus may lessen venous return by compression of the inferior vena cava and less often, the aorta.
Supine hypotensive syndrome
- more prominent as the pregnancy progresses
The diaphragm gets displaced by ___ cm in pregnancy
4cm
Chest wall expansion occurs secondary to the relaxation of the ligamentous attachments increasing chest circumference by up to _____ cm
7cm
What occurs to tidal volume in pregnancy?
Increased PROGESTERONE drives chronic hyperventilation increasing tidal volume by up to 50% by 8 wks AOG
Respiratory changes in pregnancy result in a state of chronic maternal
A) metabolic acidosis
B) metabolic alkalosis
C) respiratory acidosis
D) respiratory alkalosis
C) chronic maternal respiratory acidosis
What happens to serum Crea in pregnancy?
Decreases to 0.8mg/dL = increased GFR
Mechanical compression by the gravid uterus exerts direct compression of the ureters more predominantly on the RIGHT or LEFT?
RIGHT
What happens to maternal calcium and albumin during pregnancy?
Declines due to the fetal calcium requirements
Decreased cardiac output in pregnant patients undergoing urologic surgery may be ameliorated by the following maneuver:
a. Aggressive intraoperative fluid resuscitation
b. Administration of alpha receptor agonists
c. Use of only regional anesthesia
d. Right-side elevation allowing displacement of the uterus off the vena cava
e. High lithotomy position to increase venous return from lower extremities
d. Right-side elevation allowing displacement of the uterus off the vena cava
Changes in renal tubular function during pregnancy result in alterations of urine chemistries EXCEPT for:
a. glycosuria.
b. proteinuria.
c. pyuria.
d. albuminuria.
e. calcinuria.
C. Pyuria
Symptomatic physiologic hydronephrosis of pregnancy should be primarily managed by:
a. percutaneous nephrostomy.
b. conservative measures.
c. antibiotic prophylaxis.
d. ureteral stent.
e. Alpha-blocker therapy.
b. conservative measures
Which of the following statements is FALSE regarding imaging in pregnant patients?
a. Ultrasound and magnetic resonance imaging are the techniques of choice.
b. Routine imaging with magnetic resonance imaging (MRI) should employ use of gadolinium contrast.
c. Radiation from computed tomography (CT) scan is usually at a dose lower than that associated with fetal harm.
d. Safety of nuclear medicine studies is dependent on the isotope utilized.
e. None of the above.
b. Routine imaging with magnetic resonance imaging (MRI) should employ use of gadolinium contrast.
Current practice recommendations for pregnant women undergoing nonobstetric surgery include:
a. Anesthetic agents should be avoided due to teratogenic effects.
b. Elective surgery is best accomplished in the first trimester.
c. Use of fetal heart rate monitoring during the first trimester to influence delivery decisions.
d. Surgery should be performed at an institution with neonatal and pediatric services.
e. None of the above.
d. Surgery should be performed at an institution with neonatal and pediatric services.
Which of the following statements regarding stone disease in pregnancy is TRUE?
a. Approximately 30% of pregnant women with symptomatic calculi pass the stone spontaneously.
b. Stone events in pregnancy carry an increased risk of maternal and fetal morbidity.
c. Complication rates of ureteroscopy in pregnant women is 27%.
d. Ureteroscopy and stent placement should always be performed without fluoroscopic guidance.
e. None of the above.
b. Stone events in pregnancy carry an increased risk of maternal and fetal morbidity.
Counseling of female patients with myelomeningocele (MMC) desiring pregnancy includes:
a. Women with MMC in general are considered to have normal fertility.
b. There is no risk of genetic transmission of neural tube defects to the offspring.
c. Patients with preexisting renal insufficiency do not have increased risk during pregnancy of worsening renal function.
d. Women with MMC do not require folic acid supplementation during conception.
e. None of the above.
a. Women with MMC in general are considered to have normal fertility.
All of the following regarding placenta percreta are correct EXCEPT:
a. Prior cesarean section is the predominant risk factor for abnormal placentation.
b. Biopsy prior to surgical intervention is indicated for placenta percreta.
c. A multidisciplinary team is mandated to deliver specialized care.
d. Preoperative counseling should include discussion of ureteral catheters, stents, urinary tract inMury, or possible extirpative surgery with urinary diversion.
e. None of the above.
b. Biopsy prior to surgical intervention is indicated for placenta percreta.
