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Personal OB > Class 1 Maternal and Fetal Physiology > Flashcards

Class 1 Maternal and Fetal Physiology Flashcards

1
Q

5 neurological changes with pregnancy.

A
  • ↓ MAC
  • ↓ epidural space
  • ↓ CSF
  • ↑ sensitivity to LA
  • epidural vein engorge
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2
Q

With pregnancy there is a net increase in ventilation, what 3 things contribute to that?

A
  • ↑ Minute ventilation
  • ↑ Tidal volume
  • ↑ RR
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3
Q

Increase in ventilation causes ________ to decrease and can lead to _________ _________

A
  • PaCO2

- Respiratory Alkalosis

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4
Q

What compensates for the respiratory alkalosis found in pregnant women?

A

-Metabolic acidosis by excreting bicarb

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5
Q

The _______ displaces the _______ and decreases _______ by _____%.

A
  • Uterus
  • Diaphragm
  • FRC
  • 20%
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6
Q

What 2 things lead to maternal hypoxia during induction?

A
  • ↓ FRC

- ↑ Maternal O2 consumption

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7
Q

________ is mandatory prior to induction!!!

A

Preoxygenation

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8
Q

What mechanisms aids in the delivery of O2 to the fetus?

A

-P50 hemoglobin increase from 27-30

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9
Q

Should you use a smaller or larger ETT and why?

A
  • Smaller

- Mucosal venous engorgement / edema

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10
Q

_________ scores increase throughout labor.

A

Mallampati

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11
Q

What causes hypervolemia and anemia during pregnancy?

A

-Increase in plasma volume (45%) that is greater than the increase in RBC (20%)

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12
Q

How O2 delivery optimized during pregnancy?

A
  • Increase in CO

- Right shift of oxyhemo curve

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13
Q

What causes the 40% increase in CO?

A

Increase in HR and Stroke volume

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14
Q

Peripheral vascular resistance drops by 15% why?

A

-Progesterone relaxes venous smooth muscle

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15
Q

Response to adrenergic drugs is _______

A

Blunted

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16
Q

________ _________ can be seen on CXR

A

Cardiac hypertrophy

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17
Q

________ ________ are often present on auscultation

A

heart murmurs

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18
Q

________ in plasma osmotic pressure

A

Decline

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19
Q

What 5 things can be seen when a prego lies flat?

A
  • Hypotension
  • Pallor
  • Nausea
  • Vomiting
  • Diaphoresis
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20
Q

How early can supine hypotension be seen?

A

20 weeks

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21
Q

Pregos are at a hypercoagulable state witch puts them at a greater risk of what?

A

-PE

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22
Q

BUN and Creatinine are ______ reduced.

A

Mildly

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23
Q

Renal blood flow and GFR are _______ by ______

A

Increased

50%

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24
Q

What 2 things decrease gastroesopheagal sphincter tone?

A
  • Stomach displacement by uterus

- Progesterone

25
Q

What increase acid secretion in pregos?

A

-Placental gastrin

26
Q

Pregos are at a greater risk for aspiration why?

A
  • > 25 cc of gastric fluid

- pH less than 2.5

27
Q

A 20% decrease in pseudocholinesterase does not affect succs length, why?

A

-Due to a simultaneous increase in volume of distribution.

28
Q

Why are pregos more susceptible to gallstones?

A

-Decreased CCK and contractile response

29
Q

What leads to higher fetal glucose transfer?

A
  • Maternal insulin resistance

- Higher plasma glucose levels

30
Q

What 5 ways do agents cross the placenta?

A
  • Diffusion
  • Bulk flow
  • Active transport
  • Pinocytosis
  • Breaks
31
Q

What is oxygen transfer dependent on?

A

-Maternal uterine flow vs. fetal umbilical flow

32
Q

What has the smallest storage to utilization ratio in the fetus?

A

–Oxygen (42 ml stored, 21 ml/min consumption)

33
Q

How long can a fetus survive w/ O2 deprivation?

A

-10 minutes

34
Q

What 2 compensatory mechanisms are present during O2 deprivation?

A
  • Redistribution

- Anaerobic metabolism

35
Q

How are the Oxyhemo curves of the fetus and mother shifted and why?

A
  • Fetus to the left
  • Maternal to the right
  • Allows for transfer of O2 from mother to fetus
36
Q

Placental blood has a PaO2 of what?

A

-40 mmHg

37
Q

Fetal hemaglobin is _______ than maternal hemaglobin.

A

Higher

38
Q

Who’s Hgb has a lower affinity for CO2, mom or fetus?

A

Fetus

39
Q

How does CO2 cross into the placenta?

A

Simple diffusion

40
Q

Uterine blood flow represents ______ of CO at about _______ ml per minute?

A

10%

-600-700 mls/min

41
Q

What is non pregnant uterine blood flow?

A

50 mls/min

42
Q

Where does uterine blood flow go?

A
  • 80% placenta

- 20% myometrium

43
Q

Name the 3 factors that influence uterine blood flow.

A
  • Systemic BP
  • Uterine vasoconstriction
  • Uterine Contractions
44
Q

How does propofol effect UBF?

A

-Mild reduction via maternal hypotension

45
Q

At what dose will Ketamine effect UBF.

A

->1.5 mg/kg

46
Q

Volatile agents effect on UBF?

A
  • Decrease via hypotension

- Less than 1 MAC has minor effects

47
Q

______ and ______ have little effects on UBF

A
  • Nitrous

- Opioids

48
Q

High serum LA can result in what?

A

-Uterine vasoconstriction

49
Q

Uterine blood flow may _______ with neuriaxial analgesia due to a reduction in maternal __________ levels that ________ vasoconstriction as long as _______ is normal

A
  • Improve
  • Catecholamines
  • Reduces
  • Blood pressure
50
Q

What does filing the babies lungs with O2 do?

A

-Decreases pulmonary vascular resistance

51
Q

Increased pulmonary blood flow increases ______ volume and closes the ________.

A
  • Left ventricle

- Foramen ovale

52
Q

What closes the ductus?

A

-Increase O2 tension

53
Q

What will hypoxia or acidosis do?

A

Increase R to L shunting through ductus

54
Q

When does normal labor start?

A

-40 weeks +/- 2 weeks after LMP

55
Q

What stage of labor is from onset of true labor until complete dilation?

A

1st stage

56
Q

Name the 2 phases of 1st stage?

A
  • Latent = dilation 2-4 cm

- Active = Dilation to 10 cm w/ regular contractions

57
Q

Describe the 2nd stage of labor

A

-Complete dilation till infant delivered

58
Q

What is 3rd stage of labor?

A

-Time from delivery of infant to placenta delivery

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