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Methods of Anesthesia II > Maternal and Fetal Physiology > Flashcards

Maternal and Fetal Physiology Flashcards

1
Q

blood travels from the mothers uterine artery to?

A

the placenta

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2
Q

from the placenta where does the blood go?

A

through the umbilical vein into the fetal right atrium

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3
Q

how is blood shunted around the liver in a fetus?

A

ductus venosus

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4
Q

what are the two pathways that blood can travel after being in the fetal right atrium?

A

50% blood shunt through foramen ovale to left atrium

50% blood goes through right ventricle

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5
Q

when blood makes it to the right ventricle what two ways can it go?

A

90% to pulm artery and is shunted to aorta via the ductus arteriosus
10% to the fetal lungs for perfusion

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6
Q

why does most of the blood shunt away from the fetal lungs (other than they aren’t breathing)

A

they have hypoxic vasoconstriction and that decreases the amount of blood that is able to flow through the lungs

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7
Q

how does blood return to the placenta?

A

umbillical artery

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8
Q

foramen ovale

A

hole between RA and LA

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9
Q

what % of the population have a patent foramen ovale?

A

10-25%

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10
Q

how quickly does functional closure of the foramen ovale take after birth?

A

rapidly after first breath

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11
Q

how quickly does anatomic closing of the foramen ovale take after birth?

A

3-12months

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12
Q

ductus arteriosus

A

connection between the pulmonary artery and the aorta

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13
Q

how quickly does functional closure of the ductus arteriosus take after birth?

A

10-15hr

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14
Q

how quickly does complete closure of the ductus arteriosus take after birth?

A

4-6wk

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15
Q

what % of the population has a patent ductus arteriosus?

A

10%

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16
Q

what drug keep the ductus arteriosus open?

A

prostaglandins PGE1

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17
Q

indomethacin

A

promotes ductus arteriosus closure

treats PDA after birth

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18
Q

NSAIDS and ductus arteriosus

A

promotes closure of ductus arteriosus

contraindicated in third trimester pregnancy

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19
Q

what are the fetal circulation changes at birth?

A

1- hypoxic pulm HTN resolves because neonate breathes
2- flow to pulm artery and left atrium increase
3- increased left atrial pressure closes foramen ovale
4- increased aortic pressure closes ductus arteriosus

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20
Q

how much plasma ultrafiltrate do fetal lungs have?

A

90mL

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21
Q

how does the ultrafiltrate get removed from fetal lungs?

A

during SVD it is squeezed out by mothers pelvic muscles

the rest absorbed by pulm capillaries and lymphatics

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22
Q

which are more likely to have problems with respiration after birth? SVD or C-section

A

C-section, no squeeze of ultrafiltrate out

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23
Q

P50

A

PaO2 that will cause SaO2 of 50%

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24
Q

P50 normal adult hemoglobin

A

27mmHg

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25
P50 pregnant mother at term
30mmHg
26
P50 fetal hemoglobin
19mmHg
27
which is more affinitive for oxygen? fetal or maternal hemoglobin?
fetal
28
Aortocaval compression
pregnant patient lays supine it compresses aorta and SVC decrease CO decrease uterine artery blood flow (fetal hypoxia)
29
fetal hypoxia etiologies 2
1 decrease in uterine blood flow | 2 left shift of mothers oxygen Hb curve
30
what can cause decrease in uterine blood flow? 4
hypotension uterine artery vasoconstriction uterine contractions aortocaval compression
31
what can cause unterine artery vasoconstriction?
hypocapnea (hypervent) | vasoconstrictors
32
symptoms of aortocaval compression
maternal hypotension decreased maternal cardiac output/uterine blood flow engorged epidural venous plexus
33
supine hypotensive syndrome
when a pregnant mother is supine and gets hypotensive
34
when is left uterine displacement considered mandatory?
patient is more than 20 weeks along
35
stage 1 labor
onset of labor to full 10cm dilation
36
where is the pain during the latent phase of stage 1?
abdominal area t10-L1
37
where is the pain during the active phase of stage 1? why?
perineal pain S2-S4 (pudendal nerve) | fetal head press against pelvis
38
stage 2 labor
time of max dilation to delivery of fetus
39
where is the pain during stage 2 labor?
perineal area
40
what can heavy respirations lead to?
hypocarbia | fetal alkalosis
41
stage 3 labor
delivery of fetus to delivery of placenta
42
CNS changes for pregnant patient 2
1. decreased MAC requirements (up to 40%) | 2. Decreased neuraxial dosing requirements
43
Cardiovascular changes for pregnant patient 6
1. increased blood volume 2. increased cardiac output 3. increased clotting factor concentration 4. decreased SVR 5. ECG changes (left axis deviation 6. Iron anemia
44
respiratory changes for pregnant patient 3
1. hyperventilation 2. rapid oxygen desaturation 3. significant airway edema
45
GI changes for a pregnant patient 3
1. decreased lower esophageal sphincter tone 2. increased production of gastric acid 3. decreased gastric motility
46
ABG changes for a pregnant patient 3
increase in PaO2 increase in pH decrease in HCO3-
47
Renal changes for a pregnant patient 2
GFR increases | mild glycosuria/proteinuria is common
48
why is there decreased MAC requirements for pregnant women?
endogenous opiods increased | progesterone levels are 20x normal (sedative)
49
why is the neuraxial dosing requirements decreased? 3
1. fetus compresses the IVC 2. epidural venous engorgement decreases the CSF 3. spinal and epidural medications have increased cephalad spread
50
what is the approximate blood loss for SVD?
400-500mL
51
what is the approximate blood loss for a c-section?
800-1000mL
52
what problems does increased blood volume cause?
dilutional anemia | edema
53
is there a greater increase in plasma or RBCs?
plasma- thats why there is dilutional anemia
54
what causes the edema?
plasma dilutes the albumin and decreases oncotic pressure
55
what are the two reasons why cardiac output increases?
decrease in afterload (decrease in SVR) | increase in blood volume
56
why could cardiac output decrease for a pregnant patient?
aortocaval compression from laying supine
57
when does the greatest increase in cardiac output occur?
immediately after delivery of baby because no more aortocaval compression
58
why is there increased clotting factors?
prepares mother for blood loss
59
what risk is increased in the hypercoaguable state?
DVT risk (up to 6-12 weeks post partum)
60
what are the safe anticoagulants?
heparin | finbrinolytics
61
what is an unsafe anticoagulant?
coumadin
62
what causes the decreased SVR?
increase in estrogen and progesterone
63
what causes the left axis deviation of the heart?
diaphragm elevation shifts the heart
64
what causes iron anemia?
fetus consuming Fe | vitamin supplements can be recommended
65
why do pregnant women hyperventilate
because increased oxygen requirements= deeper TV
66
what stimulates the deep breaths besides increased O2 requirements?
progesterone relaxes bronchial smooth muscle
67
why do mothers have an right shift of the oxyhemoglobin curve?
increased 2,3 DPG levels
68
causes of the airway edema in pregnant mothers?
``` weight gain (larger tissues) decreased oncotic pressure intravasculatly ' progesterone ```
69
what type of intubation should you avoid in pregnant mothers?
nasal intubations
70
why does progesterone cause airway edema??
causes capillary engorgement in the upper airway
71
what causes a decreased LES tone?
increased progesterone | upward displacement of stomach
72
at what gestational age
full stomach after 16-20 weeks gestational age
73
why is there an increase in PaO2?
increased MV
74
why is there an increase in pH
respiratory alkalosis
75
why is there a decrease in HCO3-?
compensation for resp alk

Methods of Anesthesia II (13 decks)

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