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Maternal and fetal physiology Flashcards

1
Q

MAC is ___ (increased/decreased) in pregnancy

A

Decreased

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2
Q

Pregnancy causes ___ (increased/decreased) sensitivity to local anesthetics

A

Increased

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3
Q

Ventilation in pregnancy is ___ (increased/decreased)

A

Increased

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4
Q

Tidal volume is increased ___% at term

A

40%

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5
Q

Respiratory rate ___ (increases/decreases) during pregnancy

A

Increases—15%

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6
Q

Mean maternal wt increases by:

A

17% or approx 12kg

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7
Q

how much does the uterus weigh?

A

1 kg

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8
Q

how much does amniotic fluid weigh?

A

1 kg

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9
Q

how much does the fetus and placenta weigh?

A

4 kg

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10
Q

how much do blood volume and interstitial fluid weigh?

A

2 kg

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11
Q

How much does the deposition of new fat and protein weigh?

A

4 kg

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12
Q

Minute ventilation is ___ (increased/decreased) during pregnancy

A

Increased—50% d/t progesterone

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13
Q

PaCO2 ___ (increases/decreases) during pregnancy to ___-___ mm Hg

A

Decreases to 28-32 mm Hg

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14
Q

PaCO2 decreases during pregnancy d/t ___ventilation, respiratory ___osis,

A

Hyperventilation, respiratory alkalosis

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15
Q

Body compensates to respiratory alkalosis during pregnancy by excreting ___ ions to maintain a normal pH…this leads to ___ (what acid-base balance?)

A

Bicarbonate ions; leads to metabolic acidosis

Pregnancy is a state of partially compensated respiratory alkalosis

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16
Q

Expanding uterus pushes the diaphragm __

A

Cephalad (up towards head)

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17
Q

FRC decreases by ___% in pregnancy

A

20%

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18
Q

There are no changes in vital capacity or total lung capacity during pregnancy—T/F?

A

True

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19
Q

Maternal oxygen consumption ___ (increases/decreases) during pregnancy

A

increases

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20
Q

Heart size increased d/t:

A

increased blood volume and increased stretch and force of contraction

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21
Q

Heart rate steadily increases _____ (%) above baseline during 1st and 2nd trimester

A

15-20%

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22
Q

PR interval and uncorrected QT are:

A

SHORTENED

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23
Q

What causes an increase in stroke volume?

A

Increased estrogen levels

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24
Q

At term, skin blood flow is _____ higher than during non-pregnancy

A

3-4 x

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25
Q

SVR is increased or decreased during pregnancy at term?

A

DECREASED (20%)

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26
Q

What is compressed during aortocaval compression?

A

aorta and inferior vena cava – depending on positioning and gestational age

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27
Q

Blood returns from lower extremities through ____, _____, _____, and _____ veins

A

intraosseous
verterbral
paravertebral,
epidural

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28
Q

Collateral return is not as great, resulting in decreased

A

right atrial pressure

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29
Q

SV and CO decreased by _____% when in supine position at term

A

10-20%

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30
Q

Symptoms of supine hypotension syndrome (aka overt caval compression)

A

HoTN
Bradycardia
Sweating
Pallor
N/V

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31
Q

How to prevent supine hypotension syndrome:

A

Place a rigid wedge under right hip and/or tilt table w left side down–> displace uterus to left

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32
Q

Postpartum increase in CO is d/t:

A

relief of vena cava compression
decreased lower extremity venous pressure
sustained myocardial contraction
loss of low-resistance placental circulation

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33
Q

Hypoxic ventilatory response is ____ (increased/decreased) during pregnancy to ____ normal level

A

increased
2x normal levels

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34
Q

What secondarily contributes to the increased hypoxic ventilatory response?

A

Elevations in estrogen and progesterone

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35
Q

Diaphragm excursion ____ (increased/decreases) by___ cm

A

increases
2cm

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36
Q

chest wall excursion is ____ (increases/decreases)

A

decreases

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37
Q

_____ causes relaxation of the ligamentous attachments to the lower ribs

A

Relaxin (ribs in more horizontal position)

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38
Q

Capillary engorgement of the ____, ____, and ____ mucosa begins early in 1st trimester and increases through pregnancy

A

Larynx
Nasal
oropharynx

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39
Q

_____ on the nasal mucosa may cause rhinitis and epitaxis d/t vasodilation

A

Estrogen

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40
Q

Dyspnea is a common complaint in the first and 2nd trimesters, due to:

A

Increased resp drive
Decreases PaCo2
Increased O2 consumption
Increased pulmonary blood volume
anemia
nasal congestion

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41
Q

Exercise has ____ effect on ventilation or alveolar gas exchange

A

No

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42
Q

What makes the mother prone to hypoxia during pregnancy?

A

↓FRC & ↑O2 Consumption

Preoxygenate & RSI w/ Cricoid Pressure

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43
Q

What Respiratory changes helps delivery of oxygen to fetus?

A

Increase of P50 Hemoglobin from 27 to 30 mmHg

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44
Q

What are the Neuro Changes of Pregnancy?

A

Decreased MAC, Epidural Space, and CSF

Engorged Epidural Veins

Increased LA Sensitivity

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45
Q

What are the Respiratory Changes of Pregnancy?

A

↑TV (40%)

↑RR (15%)

↑Minute Ventilation (50%)

↓PaCO2

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46
Q

Which of the following is decreased during Pregnancy? (Select 3)

A. Vital Capacity

B. Total Lung Capacity

C. Functional Residual Capacity

D. Dead Space

E. Airway Resistance

A

↓FRC (20%)

↓Dead Space

↓Airway Resistance

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47
Q

Why should Hyperventilation be avoided in Pregnancy during Anesthesia?

A

Low PaCO2 causes uterine vasoconstriction decreasing placental blood flow & left HgbO2 shift

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48
Q

What Intubation equipment should be available for Pregnant Patients?

A

Smaller ETT

Shorter Handle

Avoid Nasal Intubation

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49
Q

How is Oxygen Delivery optimized during Pregnancy?

A

↑Cardiac Output

Right HgbO2 Shift

↓PVR d/t Increased Progesterone

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50
Q

How is Plasma Volume affected by Pregnancy?

A

Increased Plasma Volume d/t Increased Renin

in excess of red cell mass (RBC vol inc ~20%), i.e. relative hypervolemia.
Inc. renin –> inc. aldosterone –>sodium/H20 retention

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51
Q

What are the different phases of changes in Cardiac Output during Labor?

A

Latent Phase: ↑15%
Active Phase: ↑30%
Second Stage: ↑45%
Postpartum: ↑80%

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52
Q

What are the CV changes during Pregnancy?

A

Blunted response to Adrenergic drugs

Cardiac Hypertrophy

Heart Murmurs

↓Plasma Colloid Osmotic Pressure

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53
Q

How does the blood change in a pregnant patient?

A

Depressed Cell-Mediated Immunity

Hypercoagulation

PT/PTT decreases by 20%

PT normal range: 9.6-12.9 seconds
PTT normal range: 24.7-35 seconds

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54
Q

Which Coagulation Factors are Increased during Pregnancy?

A

1, 7, 8, 9, 10, 12

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55
Q

Which Coagulation Factors are Decreased during Pregnancy?

A

11 & 13

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56
Q

Which Coagulation Factors are unaffected by Pregnancy?

A

2 & 5

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57
Q

What are the Renal Changes during Pregnancy?

A

↑Blood Flow & Filtration

↓BUN & Creat

Mild Glycosuria & Proteinuria

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58
Q

How does pregnancy affect the Gastroesophageal Sphincter?

A

Reduced Competence & Tone

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59
Q

What are the GI Changes during Pregnancy might increase Aspiration Risk?

A

Increased Acid Secretion & Gastric Fluid

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60
Q

How is the Gallbladder affected by Pregnancy?

A

Sluggish & Gallstones d/t decreased CCK

61
Q

How is the Liver affected by Pregnancy?

A

20% Decrease in Pseudocholinesterase

A simultaneous increase in volume of distribution counters any clinically significant prolongation of NMB with succinylcholine.

(succs can still be used w no problem)

62
Q

How does Pregnancy affect Blood Glucose?

A

Insulin Resistance = ↑Blood Glucose transfer to Fetus

63
Q

What are the methods of transfer across the Placenta?

A

Diffusion

Bulk Flow

Active Transport

Pinocytosis

Breaks

64
Q

How long can the Fetus live without Oxygen?

65
Q

What is the transfer of Oxygen to the Fetus dependent on?

A

Maternal Uterine Blood Flow vs. Fetal Umbilical Blood Flow

66
Q

Pregnant women should not lay supine after ___ wks

67
Q

Maternal vascular capacitance is _____ at the time of delivery.

68
Q

How much Oxygen is stored and consumed by the Fetus?

A

Stored O2: 42 mL

Consumed O2: 21 mL/min

69
Q

How does the Fetus compensate for the Placental PaO2 of 40 mmHg?

A

Mom: Right HgbO2 Shift

Fetus: Left HgbO2 Shift & More Hgb

70
Q

How is CO2 transferred across the Placenta?

A

Simple Diffusion

Fetal Hgb has lower CO2 affinity than Mom

71
Q

Normal Uterine blood flow is 50 mL/min. How much is that increased during Pregnancy?

A

600-700 mL/min (10% of Cardiac Output)

80% of that goes to Placenta; the rest to Myometrium

72
Q

The placenta must provide ____ml O2/min/kg for fetal body weight for fetal growth and development while adults require ____ml O2/min/kg at rest

73
Q

What factors affect Uterine Blood Flow (UBF)?

A

systemic BP

Uterine Vasoconstriction

Uterine Contractions

74
Q

What anesthetic agents and drugs can decrease Uterine Blood flow?

A

Thiopental

Propofol

Gases > 1 MAC

(d/t HoTN)

75
Q

How does Ketamine, Opioids, and N2O affect Uterine Blood Flow?

A

Little to No Effect

76
Q

How does high serum Local Anesthetics affect the Uterus?

A

Uterine Vasoconstriction, but Neuraxial Analgesia can reduce Vasoconstriction

77
Q

Increased uterine blood flow is a result of:

A

Pain relief
Decreased sympathetic activity
Decreased maternal hyperventilation

78
Q

Decreased uterine blood flow is a result of:

A

HoTN
IV injection of LAs/Epi
Absorbed locals

decreased uterine arterial pressure
increased uterine venous pressure
increased uterine vascular resistance

79
Q

What happens to infant’s heart & lungs at birth?

A

Oxygen filling lungs ↓Pulm. Vascular Resistance

↑LAP closes Foramen Ovale

↑Oxygen Tension closes Ductus

80
Q

What can happen if the Ductus remains open w/ Hypoxia or Acidosis?

A

Downward Spiral of Hypoxia & Acidosis d/t increase R-to-L Shunt

81
Q

When does normal Labor begin?

A

40 +/- 2 weeks after LMP

82
Q

What happens in the 1st Stage of Labor?

A

Latent Phase: Minor Dilation 2-4cm & Infrequent Contractions

Active Phase: Progressive Dilation to 10cm & Regular Contractions q3-5 min

83
Q

When is the 2nd Stage of Labor?

A

From Complete Dilation to Delivery

84
Q

What is the 3rd Stage of Labor?

A

From Infant Delivery to Placenta Delivery

85
Q

Airway resistance in pregnancy is ___ (increased/decreased)

86
Q

Why does PVR drop in pregnancy?

A

Increased progesterone relaxes venous smooth muscle

87
Q

What factors modulate the maintenance and regulation of uteroplacental blood flow?

A

altered responses to vasoconstrictors, increases in endothelium-derived vasodilators, and the effects of steroid hormones and shear stress

88
Q

_____is the method most commonly used clinically to assess uteroplacental blood flow in humans.

A

Doppler ultrasonography

89
Q

Fetal blood flow is characterized by three anatomic communications between the left and right circulations:

A

the ductus venosus
the foramen ovale
the ductus arteriosus

90
Q

uterine blood flow during non pregnant state:

91
Q

Uterine blood flow does NOT autoregulate, therefore it is dependent on:

A

MAP
CO
Uterine vascular resistance

92
Q

uterine blood flow equation:

A

uterine artery pressure-uterine venous pressure/uterine vascular resistance

93
Q

Is ephedrine or phenylephrine better to use in pregnancy

A

phenylephrine= less fetal acidosis

94
Q

Drug characteristics that favor placental transfer

A

Low molecular wt <600 daltons (most anesthetic drugs)

High lipid solubility

Non-ionized

Non-polar

95
Q

Drugs w no placental transfer:

A

NMB
glycopyrrolate
Heparin
Insulin

96
Q

Drugs w significant placental transfer

A

Local anesthetics (except chloroprocaine d/t rapid metabolism

Volatile anesthetics

opioids

benzodiazpines

atropine

beta-blockers

Magnesium (non lipophilic bit it’s small)

97
Q

FRC=

98
Q

The parturient is at a higher risk of difficult:

A

mask ventilation
laryngoscopy
intubation

99
Q

Factors that make airway management more complicated include:

A

increased Mallampati score
upper airway vascular engorgement
narrowing of glottic opening (use smaller ETT -6.0-7.0)

100
Q

Functional residual capacity falls below ____ ____

A

Closing capacity which causes airway closure during tidal breathing

101
Q

_____ increased MV up to 50%

A

progesterone (respiratory stimulant)

102
Q

airway edema is made worse by:

A

preeclampsia
tocolytics
prolonged trendelenburg

103
Q

What hormones contribute to vascular engorgement and hyperemia in pregnancy

A

Progesterone
Estrogen
Relaxin

104
Q

What type of laryngoscope handle is recommended for large-breasted women?

A

a short-handed laryngoscope (datta handle)

105
Q

While MAP and SBP remain stable throughout pregnancy ____, ___ and ___ decrease

106
Q

Plasma volume expansion outpaces new RBC production leading to:

A

dilution anemia

107
Q

CO returns to pre-labor values in:

108
Q

CO returns to pre-pregnancy values in:

109
Q

twins cause CO to increase ____% above a single fetus

110
Q

Cardiac axis:

A

left deviation

gradid uterus pushed diaphragm cephalad = heart pushed up and left

111
Q

Progesterone:

A

increases RAAS activity
vascular muscle relaxation
Increased MV

112
Q

Renal increases

A

GFR
Creatinine clearance
Glucose in urine

113
Q

creatinine and BUN

114
Q

uterine blood flow is: (select all that apply)

20% of CO
700mL/min
not autoregulated
reduced by phenylephrine

A

700mL/min
not autoregulated

115
Q

what stage of labor begins w the onset of perineal pain?

latent phase
active stage
first stage
second stage

A

second stage

116
Q

a laboring mother is always considered:

A

a FULL STOMACH

117
Q

According to the ASA practice guidelines, the laboring mother who is healthy may:

A

drink a moderate amount of clear liquids throughout labor

eat solid food up to the point a neuraxial block is placed

118
Q

which of the following parameters normally decreases during pregnancy (select 4)

platelet count
oxygen consumption
GFR
HR
Peripheral vascular resistance
Hemoglobin content in g/dL
Blood volume
Functional residual capacity

A

Platelet count
Peripheral vascular resistance
Hemoglobin content in g/dL
Functional residual capacity

119
Q

Which characteristic will increase the likelihood that a maternally-administered drug will cross the placenta?

A.) a molecular wt greater than 1000 daltons
B.) increased drug ionization
C.) increased drug polarity
D.) increased lipid solubility

A

increased lipid solubility

120
Q

Which of the following lab values tends to be decreased in full-term parturients?

serum albumin
lactate dehydrogenase
alkaline phosphatase
alanine aminotransferase

A

serum albumin

121
Q

Select two physiologic characteristics that you would expect to be increased in an obstetric patient at term

Minute ventilation
Functional residual capacity
Oxygen consumption
Minimum alveolar concentration

A

Minute ventialtion
Oxygen consumption

122
Q

Which of the following statements concerning placental perfusion is correct?

A. Placental perfusion is autoregulated

B. Placental perfusion is directly related to maternal blood pressure

C. The intervillous space receives blood from the quadratic arteries

D. The placenta receives 50% of the maternal cardiac output

A

B. Placental perfusion is directly related to maternal blood pressure

123
Q

What is the suggested block height for patients undergoing cesarean section?

A. L1
B. T10
C. T6
D. T4

124
Q

Which of the following drugs would most likely exhibit an appreciable increase in its circulating free fraction in a full-term parturient?

A. a highly protein-bound drug
B. a drug metabolized by cholinesterases
C. a highly water-soluble drug
D. chiral drugs

A

A. a highly protein-bound drug

125
Q

Which of the following parameters increases with pregnancy?

A. PaO2
B. PaCO2
C. HCO3
D. Total lung capacity

126
Q

Which of the following statements is true of a full-term parturient?

A. Basal oxygen consumption is increased by 33 percent
B. The partial pressure of arterial carbon dioxide is increased
C. The partial pressure of arterial oxygen is decreased
D. Plasma bicarbonate increases 10 percent

A

A. Basal oxygen consumption is increased by 33 percent

127
Q

During the third trimester of pregnancy, the cardiac output

A. increases primarily due to an increase in stroke volume
B. increases primarily due to an increase in heart rate
C. decreases primarily due to a decrease in stroke volume
D. decreases primarily due to a decrease in heart rate

A

A. increases primarily due to an increase in stroke volume

128
Q

Rapid sequence induction, cricoid pressure, and a cuffed endotracheal tube are recommended for pregnant women receiving general anesthesia from ____ weeks on even if no symptoms of reflux are present.

A. 12
B. 15
C. 18
D. 20
129
Q

Which of the following statements regarding the hematology studies of a full-term parturient is correct?

A. The total blood volume decreases
B. The average platelet count is about 50,000
C. A relative polycythemia is present during pregnancy
D. The red blood cell mass increases

A

D. The red blood cell mass increases

130
Q

Which of the following decreases with pregnancy? (select two)

A. renal blood flow
B. alkaline phosphatase levels
C. serum creatinine
D. plasma cholinesterase activity
A

C. serum creatinine
D. plasma cholinesterase activity

131
Q

Which of the following parameters decreases during pregnancy?

A. Systemic vascular resistance
B. Total blood volume
C. Heart rate
D. Stroke volume
A

A. Systemic vascular resistance

132
Q

Pregnancy typically produces

A. an increase in the glomerular filtration rate
B. an increase in the serum creatinine level
C. an increase in the blood urea nitrogen level
D. a decrease in renal blood flow

A

A. an increase in the glomerular filtration rate

133
Q

The second stage of labor occurs when

A. regular uterine contractions begin
B. the cervix begins to dilate
C. the cervix is fully dilated
D. the fetus crowns

A

C. the cervix is fully dilated

134
Q

How long after delivery does the cardiac output of the mother remain elevated?

A. 12 hours
B. 2 days
C. 7 days
D. 14 days
A

D. 14 days ( 2 weeks)

135
Q

Which of the following drugs does NOT pass the placenta easily?

A.) etomidate
B.) ephedrine
C.) Atropine
D.) glycopyrrolate

A

D.) glycopyrrolate

136
Q

What is the P50 of fetal hemoglobin at term?

A.) 12
B.) 18
C.) 24
D.) 30

137
Q

Cardiac output increases dramatically during pregnancy and delivery. The cardiac output returns to nonpregnant values by how long postpartum?

A.) 12 hrs
B.) 1 day
C.) 2 weeks
D.) 6 months

A

C.) 2 weeks

138
Q

Uterine blood flow at term pregnancy typically increases to about

A.) 100mL/min
B.) 250 mL/min
C.) 500 mL/min
D.) 750 mL/min

A

D.) 750 mL/min

139
Q

Which of the following cardiovascular parameters is decreased at term?

A.) CVP
B.) PCWP
C.) SVR
D.) LVESV

140
Q

Cardiac output is the GREATEST
A.) during first trimester
B.) during the 3rd trimester
C.) during labor
D.) immediately after delivery of the newborn

A

D.) immediately after delivery of the newborn

141
Q

Which of the following respiratory parameters is NOT increased in the parturient?

A.) Minute ventilation
B.) Tidal volume
C.) Arterial PaO2
D.) serum bicarbonate

A

D.) serum bicarbonate

142
Q

Which of the following lung volumes or capacities change the LEAST during pregnancy?

A.) Tidal volume
B.) Functional residual capacity (FRC)
C.) Expiratory reserve volume (ERV)
D.) Vital Capacity

A

D.) Vital Capacity

143
Q

Which of the following properties of epidurally administered local anesthetics determines the extent to which epi will prolong the duration of blockade?

A.) Molecular weight
B.) Lipid solubility
C.) pKa
D.) concentration

A

B.) Lipid solubility

144
Q

Which of the following is NOT increased during pregnancy?

A.) Renal plasma flow
B.) creatinine clearance
C.) Blood urea nitrogen (BUN)
D.) glucose excretion

A

C.) Blood urea nitrogen (BUN)

145
Q

Passive diffusion of substances across the placenta is enhanced by all of the following EXCEPT

A.) Low molecular wt of the substance
B.) High water solubility of the substance
C.) Low degree of ionization of the substance
D.) Large concentration gradient of the drug

A

B.) High water solubility of the substance

146
Q

Which of the following statements is CORRECT in describing differences between fetal and maternal blood during labor?

A.) Fetal blood has a lower hemoglobin concentration than does maternal blood

B.) Fetal placental blood flow is twice maternal placental blood flow

C.) Fetal hemoglobin has a greater affinity for O2 than does maternal hemoglobin

D.) The fetal oxyhemoglobin dissociation cure is shifted to the right of the maternal oxyhemoglobin dissociation curve

A

C.) Fetal hemoglobin has a greater affinity for O2 than does maternal hemoglobin

147
Q

Aortocaval compression starts to become significant in a normal pregnancy at how many weeks EGA?

A.) 10 weeks
B.) 15 weeks
C.) 20 weeks
D.) 25 weeks

A

C.) 20 weeks

148
Q

Adverse effects (on the mother) associated with aorto-caval compression by the gravid uterus include

A.) nausea and vomiting
B.) changes in cerebration
C.) fetal distress
D.) all of the above

A

D.) all of the above

OB (8 decks)

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