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S5 - Regional/OB - Test 1 > Maternal A&P > Flashcards

Maternal A&P Flashcards

1
Q

increased stroke volume correlates with increasing levels of what hormone?

A

estrogen

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2
Q

what happens to BP if abdominal aorta is compressed

A
  • upper body BP normal
  • lower body BP (including uterus) decreases
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3
Q

TSH in pregnancy

A

decreases during 1st trimester then returns to normal

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4
Q

EBL in vaginal delivery vs. uncomplicated C section

A
  • vaginal: 500 mL
  • C section: 800-1000 mL

(estimations are v inaccurate)

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5
Q

why can a pt have significant hypoxemia in between contractions?

*book

A

uncontrolled pain causes exaggerated hyperventilation during contractions

  • minute ventilation can increase as much as 140%
  • increased oxygen consumption during labor
  • i guess decreased FRC would contribute to this too?

something i read said that they use more O2 than they can get on room air, so to give NC or facemaks supplemental?

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6
Q

why does pregnancy increase risk of gallbladder disease?

A
  • biliary stasis
  • greater bile secretion
  • increased cholesterol
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7
Q

what musculoskeletal change of pregnancy might make neuraxial techniques more difficult?

*book

A

uterine growth = lumbar lordosis = narrowed distance between interspinous processes

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8
Q

2 factors that cause up to an 80% increase in CO after delivery

A
  1. relief of aortocaval compression
  2. contracted uterus
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9
Q

what GI changes make all parturients “full stomachs”?

A
  • increased gastrin
  • increased gastric volume
  • decreased gastric pH
  • stomach displacement may create outflow obstruction
  • delayed gastric emptying (book says its only delayed during labor?)
  • increased intragastric pressure
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10
Q

when might a parturient need a tilt > 15 degrees to relieve aortocaval compression

A

large uterus

(polyhydramnios or multiple lil bbys)

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11
Q

expected fibrinogen levels at term

what should you suspect if < 200-250 & what should you do about it?

*clinical pearl*

A
  • normal: > 400 mg/dL
  • 200-250: suspect severe hemorrhage, consider giving FFP/cryo
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12
Q

changes in venous capacitance

what does this cause

A
  • loses tone
  • allows blood volume to pool
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13
Q

why might increased progesterone cause increased LA sensitivity?

*book

A

causes changes in protein channels within neuronal membranes

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14
Q

uncomplicated elective C section patients can have clear liquids up to ___ hours prior

A

2

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15
Q

O2 consumption during rest vs. labor of parturient pt

A
  • rest: increases up to 33%
  • labor: increases 100% or more
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16
Q

serum cholinesterase activity in pregnant pts

A
  • decreases by 30% or more in 1st/2nd trimesters
  • slightly recovers by term

prolongation of cholinesterase-dependent drugs is not clinically significant

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17
Q

thyroid gland during pregnancy

A

enlarges 50-70%

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18
Q

preggos are more dependent on what system for BP maintenance

A

RAAS

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19
Q

one of the most effective ways to assess for effective L uterine displacement

*clinical pearl*

A

visualize displacement of uterus from perspective of pt’s HOB

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20
Q

effect of progesterone on vasculature

*book

A

vasodilation

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21
Q

blood volume during pregnancy - increased or decreased?

by how much?

A

increases 25-40%

(85-100 mL/kg)

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22
Q

what hormone may contribute to greater incidence of carpal tunnel during pregnacy?

A

relaxin

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23
Q

what causes the 3rd heart sound heard in pregnant women?
when is this usually heard by?

A
  • early closure of mitral valve
  • heard in most women by 20 weeks
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24
Q

sensitivity to epi, norepi, and phenylephrine during pregnancy

A
  • decreased sensitivity
  • uterine circulation is more sensitive than systemic circulation
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25
Q

SvO2 in a supine pregnant pt

*book

A

decreased d/t decreased CO

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26
Q

effect of progesterone on resp. drive

*book

A

sensitizes resp centers, increasing ventilatory response to CO2

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27
Q

why might a pregnant pt have a brachial plexus neuropathy

A

anterior neck flexion and slumping shoulders that usually accompany lordosis

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28
Q

why might a pregnant pt have sensory loss to the anterior thigh

~why do I care~

A

increased lumbar lordosis tends to stretch the femoral cutaneous nerve

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29
Q

when does CO normalize?

A

approx 2 weeks postpartum

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30
Q

increased uteroplacental blood flow depends on what 3 factors?

A
  1. substantial decrease in uterine vascular resistance
  2. increased CO
  3. increased intravascular volume
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31
Q

RBF, CrCl, and GFR during pregnancy

what explains this change?

*clinical pearl*

A
  • all increased
  • increased CO
  • relaxin causes vasodilation
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32
Q

parturient dependence on SNS for maintenance of hemodynamic stability

A

increases, peaking at term and then returning to nonpregnant state within 36-48 hours postpartum

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33
Q

effects of vascular remodeling of arteries in uterus

A

increased vessel diameter and length (diameter > length)

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34
Q

what factors account for hyperventilation of pregnancy?

*book

A

changes in:

  • wakefulness
  • central chemoreflex drive for breathing
  • acid-base balance
  • metabolic rate
  • CBF
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35
Q

blood glucose after carb load in pregnant vs. nonpregnant

A

levels will be higher in pregnant despite hyperinsulinemic response

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36
Q

contractility in parturients

*book

A

increased

  • increased HR
  • decreased SVR
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37
Q

what results in reduced interspinous gap in parturient pts

A

increased lumbar lordosis

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38
Q

BP changes in pregnancy

A
  • little changes in SBP
  • DBP may decrease up to 15mmHg
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39
Q

why should nasal intubation generally be avoided in pregnant pts

A

potentially significant epistaxis

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40
Q

plasma volume during pregnancy

A

increases 40-50%

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41
Q

according to the book and not MB, what should you expect if your parturient pt has a “normal” Cr of 0.8-1?

*clinical pearl*

A

“normal” or slightly increased indicates poor renal function

Cr decreased during pregnancy

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42
Q

normal H&H in pregnancy

A

12/35

(the book says hgb 9-10 is typical without iron supplements)

43
Q

what part of the kidneys filter and almost completely reabsorb glucose?

A

proximal tubule

44
Q

why are murmurs common during pregnancy?

what types is normal and what type is concerning

A
  • hyperdynamic state
  • systolic common
  • diastolic pathologic
45
Q

why do parturient pts have decreased neuraxial requirements

A

IVC compression causes engorged epidural veins and decreased volume of epidural & subarachnoid spaces

46
Q

RSI with cricoid pressure should be used in parturient pts starting when?

A

> 12 weeks

47
Q

airway mucosal changes in pregnancy

*book

A

increased mucosal friability and vascularity of upper airway

48
Q

minute ventilation at term

A

increased by 50%

49
Q

normal sodium bicarb level in parturient pt

why?

A
  • approx 20 mEq/L
  • metabolic compensation for respiratory alkalosis of pregnancy (kidneys respond by increasing bicarb excretion)
50
Q

functions of relaxin

A
  • relaxation of pelvic ligaments
  • renal vasodilation (book)
51
Q

what happens to the subcostal angle during pregnancy

A

progressively widens from 68.5 to 103.5 degrees

52
Q

EF in parturients

*book

A

increased LVEDV + LVESV unchanged
= increased EF

53
Q

effects of increased alveolar ventilation in preggos

A
  • decreased PaCO2
  • increased PaO2
54
Q

what happens to CO during pregnancy?

what contributes to this?

A
  • increases approx 40%
  • initially d/t increased HR
  • by 2nd trimester, SV increased > HR
55
Q

why do parturient pts have decreased afterload?

*book

A

dilutional anemia of pregnancy = decreased blood viscosity = decreased afterload

(also vasodilation r/t prostacyclin and progesterone)

56
Q

why do pregnant patients have decreased chest wall excursion?

*book

A

elevated diaphragm and increased anterior-posterior diameter of thoracic cage

57
Q

when does blood volume return to normal after pregnancy?

*book

A

~6 weeks postpartum

58
Q

what should you expect if your parturient pt’s hgb is > 13

*book

A

may be a sign of preeclampsia

59
Q

does neuraxial anesthesia typically impact gastric emptying during labor?

*book

A

not unless opioid boluses are used to supplement

60
Q

FRC in pregnancy & why

A

decreased d/t upward pressure of diaphragm

61
Q

what causes total T3 & T4 to increase during the first trimester?

A

estrogen-induced increase in thyroid binding globulin

62
Q

why are pregnant women insulin resistant

A

placental lactogen

63
Q

BUN & Cr during pregnancy

*book

A

both decreased

64
Q

parturient plasma levels of renin and angiotensin II

A

increased

(baseline renin in 3rd trimester is 12x greater)

65
Q

dysrhythmias common in 3rd trimester

A

tachyarrhythmias (ex. SVT)
- book: most common in pregnancy are PACs, PVCs, and sinus tach

66
Q

effect of prostacyclin on vasculature

*book

A

vasodilation

67
Q

platelet count during pregnancy

A

remains stable or slightly decreased

68
Q

type of LVH seen by 20 weeks gestation

A

eccentric

69
Q

what causes aortocaval compression?

at what point in pregnancy is this seen?

A

IVC compression against vertebral column as uterus enlarges (16-20 wks)

70
Q

preload in partriurients

A

increased d/t increased volume

71
Q

response to vasoconstrictors during pregnancy

A

generalized reduced response to exogenous and endogenous vasoconstrictors

72
Q

cerebral blood flow and cerebral vascular resistance in pregnancy

A
  • CBF = increased
  • resistance = decreased
73
Q

consequences of aortocaval compression

*clinical pearl*

A
  • decreased venous return
  • significantly decreased SV and ultimately decreased CO (can have severe hypotension)
  • decreased uterine perfusion & fetal oxygenation
74
Q

parturient vasopressin clearance

A

clearance at term/near term increased 3-4x

75
Q

liver changes in parturient

A

displaced slightly upward and to the right
- blood flow doesn’t change

76
Q

coagulation factors increased during pregnancy

A

factors VII, VIII, IX, X, XII
fibrinogen

77
Q

serum albumin in parturients

*book

A

decreased by up to 60%

according to MB it “decreases somewhat”

78
Q

ETT recommendation for parturients

A

generally smaller than would normally use (6-6.5)

79
Q

what causes pregnancy-induced increased minute ventilation

*book

A

Vt & RR both increase (but RR increase is negligible- 1-2 breaths/min)

80
Q

what causes physiologic anemia of pregnancy

A

dilution r/t plasma volume increasing > RBC volume

81
Q

when does LES tone return to normal?

*book

A

~4 weeks postpartum

82
Q

how early in pregnancy can CV changes begin

A

4th week

unclear what changes this includes

83
Q

MAC in pregnant pts

why?

*clinical pearl*

A

decreased as much as 30%

  • increased plasma endorphins
  • increased progesterone (CNS depressant)
84
Q

mechanisms of hypoxia in parturients

*clinical pearl*

A
  • increased O2 consumption
  • reduced apnea tolerance (decreased FRC)
85
Q

when is widening of pubic symphisis evident

A

30 wks

this seems irrelevant

86
Q

positioning to relieve aortocaval compression

A

relieved by tilting to the left 15 degrees or by placing a 15cm wedge under right hip

87
Q

when do parturient changes in respiratory anatomy peak (increased subcostal angle, increased circumference of lower rib cage, etc)

A

37 weeks gestation

88
Q

most common valve problems in partriurients

A

94% have tricuspid and pulmonic regurg

(27% have mitral regurg)

89
Q

Vd in parturients

A

increased

90
Q

% of CO that perfuses the uterus at term

A

10-20%

91
Q

how does placental growth create a low-resistance vascular pathway

A

eliminates intramyometrial microcirculation and creates an intervillous space

92
Q

why might a pregnant mom have decreased glucose levels in the 3rd trimester

A

baby and placenta have higher glucose demands

93
Q

what point in pregnancy is renal plasma flow 75% greater vs. nonpregnant

A

16 wks

94
Q

consequence of loss of sympathetic-controlled vasoconstriction with epidural anesthesia

A

maternal hypotension

95
Q

what causes vertical measurement of the chest cavity to decrease?

A

elevated position of diaphragm

96
Q

what effect does progesterone have on GI tract

A
  • decreased motility and LES tone (= heartburn)
  • gallbladder hypomotility
97
Q

accounts for partial compensation of aortocaval compression

*book

A

Azygous system (lateral flow)

98
Q

when does CO return to normal after pregnancy?

*book

A

~2 weeks postpartum

99
Q

changes in angiotensin II during pregnancy

A
  • concentrations increase 2-3x
  • decreased sensitivity to AT II
  • uterine circulation even less responsive to AT II
100
Q

what organ makes vasopressinase

A

placenta

(is this considered an organ or just like a weird blob in there? unsure)

101
Q

when does GFR return to normal?

A

3 months postpartum

102
Q

when can the fetal thyroid gland produce enough thyroid hormone to not solely rely on mom’s?

why is T4 important to the bébé?

A

end of 1st trimester

T4 is important to organ development

103
Q

EKG changes in parturient

*book

A
  • changes from LAD (d/t elevated diaphragm)
  • QRS shift
  • small Q-T inversions in lead III
  • transient ST-T wave changes

S5 - Regional/OB - Test 1 (13 decks)

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