Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

(Spring 2025) Advanced Principles A > Maternal Physiology (Exam II) > Flashcards

Maternal Physiology (Exam II) Flashcards

1
Q

Gravida refers to what?

A

Number of pregnancies (not babies)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Para refers to what?

A
  • numbers of births (>20weeks)
  • live births or Stillbirths
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What is G0P0?

A

Nulligravida/Nulliparous

  • No pregnancies
  • No births
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What would G3P2 refer to?

A

Multigravida/ Multiparous

  • 3 pregnancies
  • 2 births
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

How long is a pregnancy? When is a gestation “term”?

A
  • 40 weeks
  • Term at 37 - 40 weeks
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What are the components that result in the 12kg weight gain typical of pregnancies?

A
  • Uterus & Amniotic Fluid = 1kg
  • Fetal/Placental Weight = 4kg
  • New Fat/Protein stores = 4kg
  • Blood volume increase = 2kg

lol this is 11kg…

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Do women of all BMI’s gain weight the same during pregnancies?

A

No

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

How much does total blood volume increase during pregnancy?

A

30 - 35% increase

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

When does the increase in total blood volume of the typical pregnant woman occur?

A

8 - 32 weeks (Majority by 24 weeks)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Does plasma volume or RBC volume increase more during pregnancy?

A

Both increase but plasma volume increases more.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Why does blood volume increase during pregnancy?

A

To counteract delivery blood loss (500 ml vaginal/800 ml C-section)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Approximately when does maternal blood volume return to normal post-delivery?

A

6 weeks

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Compare the blood volume of a pregnant patient and a non-pregnant patient in mL/kg.

A

Non = 65mL/kg
Pregnant= 85-90 mL/kg

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

CO will increase by ___% by term.

A

40%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

In regards to hemodynamics, by 6 weeks there will be an increase in maternal _____ ____ and by 8 - 10 weeks there will be an increase in _____ _____.

A

Heart Rate : Stroke Volume

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What is the mechanism for increased Stroke Volume in the pregnant patient?

A

↑ Plasma Renin = ↑aldosterone = ↑ Preload = ↑ SV

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

How much does uterine blood flow increase during pregancy?

A

Baseline = 50 mL/min
Term = 700 mL/min

20x increase!

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

What is the cause of the pregnancy symptoms of warm skin, flushing, and itching?

A

3-4x increase in skin blood flow

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

What changes in SVR occur in pregnancy?

A

20% lower

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

What hormones are responsible for maternal vasodilation?

A
  • Progesterone
  • Prostacyclin
  • Relaxin
  • Estrogen
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Pregnancy is a ____ flow, _____ resistance state.

A

High flow : low resistance

↑ CO and ↓ SVR

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Do the following increase or decrease during pregnancy?

  • Blood volume
  • Cardiac Output
  • SVR
  • Heart rate
A
  • ↑ Blood volume
  • ↑ Cardiac Output
  • ↓ SVR
  • ↑ Heart rate
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

What changes are seen in a maternal heart size due to pregnancy?

A

Eccentric Hypertrophy (as much as 50%)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

How does the heart shift due to pregnancy?
Why does this occur?

A
  • Heart shifts anterior and leftward due to diaphragmatic elevation cause by a gravid uterus.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

Where does the point of maximal impulse for auscultation shift in a pregnant patient?

A

4th ICS mid-clavicular line (normally found fifth intercostal space at the midclavicular line)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

What EKG changes are seen in a pregnant patient?

A
  • Left Axis shift in 3rd trimester
  • Lead III T-wave inversion
  • PR interval shortened (sympathetic activity in 3rd tri accelerates AV node conduction)
  • ST segment depressed
  • QT interval increased (Still WNL)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

What are the most common EKG abnormalities in pregnant patients and why?

A

Tachydysrhythmias (Sinus tach, PAC, PVC)

  • cardiac ion channel conduction changers
  • increase cardiac size
  • autonomic tone changes
  • hormones
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

What valvular changes are typical of pregnancy?

A
  • Tricuspid & Pulmonic regurgitation (>90% pts)
  • Mitral regurgitation (~25-30% of pts)

These typically reverse postpartum.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

What heart sound is often heard in the 3rd trimester?
What causes this?

A

Ventricular Gallop/3rd heart sound

Due to inrush of large blood volume into very compliant left ventricle after MV opens.

(Shortly after S2, the S3 heart sounds is caused by the rapid deceleration of blood flow into the ventricles during early diastole. As the ventricles fill, their walls vibrate, producing a low-pitched, soft sound)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

What heart sound disappears at term?

A

4th heart sound

An S4 sound occurs when the atria contract forcefully against a stiff ventricle, creating a turbulent blood flow sound just before the first heart sound (S1), late diastole.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

What murmur can occur due to cardiac enlargement?
Where is this best heard?

A
  • Grade II SEM (systolic ejection murmur)
  • Heard right side of heart, near sternal border
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

What occurs in the supine position of a pregnant woman?

A

Aortocaval compression

Uterus compresses great vessels.

Occurs as early as 13-16 weeks.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

What exacerbates aortocaval compression?

A

Anesthesia due to vasodilation.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

What are the s/s of aortocaval compression?

A
  • Fetal Distress
  • Tachycardia → bradycardia
  • N/V
  • Pallor
  • Syncope
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

What is the treatment for aortocaval compression?

A

LUD (Left Uterine Displacement)

Done by tilting the patient to the left.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
36
Q

What cardiovascular changes occur during the first stage of labor?

A
  • CO increases before & during contractions
  • HR increases
  • Autotransfusion of 300-500mls from uterus to general circulation w/ each contraction.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
37
Q

What cardiovascular changes occur during the second stage of labor?

A

CO increases by 50% due to:

  • Pushing effort
  • ↑ SV & HR
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
38
Q

What cardiovascular changes occur during the second stage of labor?

A

CO increases by 60 - 80% due to

  • Relief from vena cava obstruction
  • Uterine contracts blood into circulation
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
39
Q

When does CO return to normal post-delivery?

A
  • begins to decline within 10 minutes of delivery
  • 24 hours back to normal
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
40
Q

What happens to the airway in obstetric patients?

A
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
41
Q

What are the anesthetic implications of edematous airways?

A
  • Smaller ETT necessary (6.0-6.5)
  • Avoid NGT/Nasal trumpets (bloody nose)
  • Mallampati class may worsen during labor
  • Airway obstruction risk increases
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
42
Q

How does the hormone estrogen effect the obstetric patient’s pulmonary system?

A

Estrogen will ↑ number and sensitivity of progesterone receptors in the respiratory center of the brain.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
43
Q

How does the hormone Progesterone effect the obstetric patient’s pulmonary system?

A
  • ↑ respiratory center sensitivity to CO₂
  • Bronchodilates
  • Causes edematous airways
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
44
Q

How does the hormone Relaxin effect the obstetric patient’s pulmonary system?

A

Causes ligamentous attachments to lower ribs to relax.

  • subcostal angle increases
  • widened AP & transverse diameter of chest wall.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
45
Q

Is Total Lung Capacity reduced or preserved during pregnancy?

A

Preserved.

Chest height is shortened but A-P dimension increases with barrel shape due to relaxin.

46
Q

What is FRC?

A

Volume of air that prevents complete emptying of lungs and keeps small airways open.

47
Q

What is ERV?

A

Volume of air that can be expired with maximum effort at the end of normal expiration.

48
Q

What is RV?

A

Residual Volume = Volume of air in the lungs after ERV is expired

49
Q

Uterine elevation of the diaphragm results in a _____% decrease in FRC.

A

20% ↓ in FRC at term! (Both ERV and RV are decreased).

50
Q

What causes the earlier closure of small airways in the obstetric patient?

A

Elevated Diaphragm → more negative pleural pressure = small airway closure

51
Q

What position results in a more profound decrease in FRC?

A

Supine (30% in FRC)

52
Q

What happens if closing capacity exceeds FRC?

A

Small airway closure & V/Q mismatch leading to
O₂ desaturation.

53
Q

What respiratory volumes are increased during pregnancy?

A
  • VT ( increased CO₂ production = increased respiratory drive related to progesterone lvl)
  • IC (Inspiratory Capacity = VT + IRV)
54
Q

What respiratory volumes are unchanged by pregnancy?

A
  • TLC (all lung volumes)
  • VC (IRV + VT + ERV)
55
Q

How can pre-oxygenation be achieved?

A
  • 3 - 5 VC breathes with tight face mask w/ 100% O₂
  • 8 deep breaths at O₂ flow rate 10L/min over 1 min.
56
Q

What FeO₂ (fraction of expired O₂) is desirable?

A

0.9 or greater

57
Q

What positioning is helpful for preoxygenation?

A

20° Reverse Trendelenburg

58
Q

How much does O₂ consumption increase by at term?

A

20%

Due to increased metabolism of mom & baby, increased work of breathing, and increased cardiac workload.

59
Q

How do minute ventilation and alveolar ventilation change in pregnancy?

A

Both Increase.

RR increases by 1-2 breaths per minute, mediated by hormonal changes.

60
Q

How do ABG’s change during pregnancy?
What does this result in?

A

PaCO₂ decreases by 8-10 mmHg
PaO₂ increases by 5 mmHg

Respiratory Alkalosis is normal in healthy pregnancies.

61
Q

Compare and contrast a typical ABG vs an obstetric ABG.

62
Q

What pulmonary change occurs during the first stage of labor?

A

Minute ventilation increases by up to 140%.

63
Q

What pulmonary change(s) occurs during the second stage of labor?

A
  • V̇T goes up by 200%
  • Maternal CO₂ decreases by 10 - 15
  • O₂ consumption increases
  • Aerobic requirement increases
  • Maternal lactate increases

Supplemental O₂ might be necessary.

64
Q

What hematologic changes occur during pregnancy?

A
  • Plasma volume increases more than RBC mass resulting in dilutional anemia.
  • Hgb drops by 2.5 g/dL
  • HCT decreases by 6.5%
65
Q

What Hgb range do we like for maternal patients?

A

11 - 13 g/dL

  • Less than 11 is abnormal
  • > 13 means you need to watch for pre-eclampsia.
66
Q

What changes occur with platelets during pregnancy?

A
  • Normal 165 - 415
  • No change or moderate decrease is typically seen with pregnancy.
67
Q

Why do we care about platelets in obstetric patients?

A

Risk for epidural hematoma from neuraxial techniques.

68
Q

Pregnancy produces a hypercoagulable or hypocoagulable state?

A

Hypercoagulable.

69
Q

What coagulation factors increase due to pregnancy?

A

All of them, except II, V, XI, and XIII.

70
Q

What coagulation factor has the most significant increase during pregnancy?

A

Factor 1 (Fibrinogen)

71
Q

What is hyperfibrinogenemia?

A

Fibrinogen (Factor I) > 400mg/dL at term

  • Increased clotting efficiency
  • Impaired fibrinolysis
72
Q

What factors are increased at term gestation?

Will be on test

A
  • I (Fibrinogen)
  • VII (proconvertin)
  • VIII (Antihemophilic factor)
  • IX (Christmas factor)
  • X (Stuart-Prower factor)
  • XII (Hageman factor)
73
Q

What factors are unchanged at term gestation?

Will be on test

A
  • II (Prothrombin)
  • V (Proaccelerin)
74
Q

What factors are decreased at term gestation?

Will be on test

A
  • XI (Thromboplastin antecedent)
  • XIII (Fibrin-stabilizing factor)
  • PT & PTT ↓ by 20%
  • Fibrinolytic activity overall decreases in 3rd trimester
75
Q

What occurs with WBC’s during pregnancy?

A
  • Increase steadily to 9 - 10 throughout pregnancy
  • Spike up to 34 during labor
76
Q

How does immune function change during pregnancy?

A
  • Leukocyte function is impaired
  • Antibody titers can decrease
77
Q

All parturient patients are considered to be _____ stomach.

78
Q

How does lower esophageal sphincter tone change throughout pregnancy?

A
  • Tone decreases throughout pregnancy with the lowest tone occurring at term.
  • LES tone normalizes at 4 weeks post-partum.
79
Q

What is Mendelson’s Syndrome?

A

Aspiration pneumonitis & inflammatory response of lung parenchyma

80
Q

What puts one at greater risk of Mendelson’s syndrome?

A
  • pH < 2.5
  • > 25mL gastric volume
81
Q

Uterus takes ____ weeks to return to normal size.

82
Q

What changes occur in the liver during pregnancy?

A

↑ risk of esophageal varices due to increased portal vein pressure.

↑ Liver enzymes and cholesterol

83
Q

What occurs with serum albumin during pregnancy?

A

serum albumin decreases

84
Q

What occurs with pseudocholinesterase levels during pregnancy?

A

pseudocholinesterase decreases by 25 - 33% during the peri-delivery timeframe.

*Usually still okay to give Sux**.

85
Q

When can cholestasis occur to parturient patients?

A

3rd trimester

86
Q

What are the s/s of cholestasis?

A
  • Pruritis
  • ↑ bilirubin
  • ↑ LFTs
87
Q

What are the consequences of cholestasis in obstetric patients?

A
  • ↑ risk of cholelithiasis
  • ↑ risk of cholecystectomy
  • ↑ risk of cholestasis in subsequent pregnancies
88
Q

During pregnancy the kidneys see a _____ increase in renal blood flow.

89
Q

What are the results of increased renal blood flow during pregnancy?

A
  • ↑ GFR
  • ↑ Creatinine clearance
  • ↓ Creatinine
  • ↓ BUN
90
Q

What BUN/Creatinine levels are typical of pregnant patients?

A
  • BUN: 8 - 9 mg/dL at term
  • Ct: 0.5 - 0.6 mg/dL at term
91
Q

What changes in the urine can occur during pregnancy?

A
  • Glycosuria common (Glucose reabsorption can’t keep up with ↑ GFR)
  • Proteinuria
92
Q

What would a finding of proteinuria possibly indicate in a parturient patient?

A

preeclampsia

93
Q

What would the following labs in a parturient patient suggest?

  • BUN > 15mg/dL
  • Creatinine > 1.0 mg/dL
  • Creatinine Clearance < 100 mL/min
A

Abnormal renal function

Further evaluation required.

94
Q

What occurs with the thyroid during pregnancy?

A

Enlargement by 50 - 70%

Hypothyroidism may occur and require levothyroxine to prevent fetal issues.

95
Q

Insulin resistance during pregnancy is the result of what hormone?

A

Human placental lactogen

Hormone that prepares the body for breastfeeding.

96
Q

How does adrenal function change in the parturient patient?

A
  • ↑ cortisol (200% by term)
  • ↑ plasma endorphins
97
Q

How does the anterior pituitary change during pregnancy?

A
  • 300% increase in size
  • ↑ Prolactin secretion
98
Q

What causes increased acne seen in pregnancy?

A

↑ Prolactin secretion by adenophypophysis hyperplasia.

99
Q

How does the posterior pituitary change during pregnancy?

A

Oxytocin secretion increases by 30% by term

  • Stimulates contractions
  • Breast milk letdown
  • “Bonding hormone”
100
Q

What hormone is responsible for breast milk letdown and is known as the “bonding” hormone?

101
Q

What nerve pains are common with pregnancy?

A
  • Sciatic
  • Meralgia paresthetica
102
Q

What is meralgia paresthetica?

A
  • Compression of lateral femoral cutaneous nerve at exit site of pelvis)

Tingling, numbness, and burning on lateral aspect of the thigh.

103
Q

What is the reason for lots of pelvic pain during pregnancy?

A

Lumbar lordosis w/ anterior pelvic tilt and narrowing of intervertebral spaces.

104
Q

What CNS changes occur during pregnancy?

A
  • ↑ CBF
  • ↑ BBB permeability
  • ↑ pain threshold
105
Q

What is the mechanism for increased pain threshold for parturient patients?

A
  • Progesterone activates κ-opioid receptors
  • ↑ plasma endorphins
106
Q

What occurs with the epidural space in pregnant women?

A
  • ↑ Venous plexus volume
  • ↓ CSF volume
107
Q

What is the result of increased venous plexus volume?

A

Engorged epidural veins and a higher risk of venous puncture during epidural placement.

108
Q

What is the result of decreased CSF volume on local anesthetic spread?

A

↑ spread of LA

109
Q

T/F. A higher total dose of local anesthetic is necessary to produce the same level of neuraxial block in parturient patients.

A

False. A lower total dose of LA is necessary.

110
Q

Parturient patients have an increased sensitivity to _______ neuromuscular blockers.

A

Non-depolarizing.

Roc & Vec

111
Q

What can happen with succinylcholine administration in a pregnant patient?

A

Prolonged paralysis due to ↓ pseudocholinesterase activity.

(Spring 2025) Advanced Principles A (11 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2025 Bold Learning Solutions. Terms and Conditions