Normal Pregnancy Flashcards

1
Q

What are the first 3 steps in newborn resuscitation after delivery?

A
  1. warm and dry infant - also stimulates breathing
  2. ABC’s, grasp umbilical cord to check HR
  3. Evaluate infant for color and signs of resp. distress such as grunting, nasal flaring, chest retractions, tachypnea
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2
Q

What are the 5 parameters used to give an infant an apgar score?

A
HR
Respiratory effort
Muscle tone
Skin color
Response to stimulation
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3
Q

When are apgar scores given?

A

1, 5, and 10 minutes of life

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4
Q

What is the primary cause of cardiac arrest in neonates and infants?

A

hypoxemia

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5
Q

What are indications for bag mask ventilation in an infant?

A

apnea

HR

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6
Q

What is the ventilatory rate for a newborn?

A

40-60 bpm

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7
Q

What airway pressures can you use for the first breath after delivery?

A

30-40 cm H2O

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8
Q

What is the airway pressure you can use for an infant after a normal delivery?

A

15-20 cm H2O

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9
Q

What is the airway pressure you can use on an infant with diseased lungs after delivery?

A

20-40 cm H2O

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10
Q

What are indications for intubation of a newborn?

A
  • prolonged bag and mask ventilation
  • ineffective bag and mask ventilation
  • tracheal suctioning
  • severe prematurity
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11
Q

What would be the ETT size for a 6.5 lb (>3000 gms) infant?

A

4.0

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12
Q

What would be the ETT size for a 4.5-6.5 lb (2000-3000 gms) infant?

A

3.5

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13
Q

What would be the ETT size for a 2-4.5 lb (1000-2000 gms) infant?

A

3.0

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14
Q

What would be the ETT size for a 2 lb (

A

2.5

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15
Q

What should you do to optimize intubating position in an infant?

A

shoulder roll

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16
Q

When should you start chest compressions on an infant?

A

if after 15-30 secs of positive pressure with 100% FiO2 and HR is

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17
Q

How many inches should you compress the chest when doing CPR on an infant?

A

1/2-3/4

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18
Q

What is the compression ratio to breaths in an infant?

A

5:1

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19
Q

What should you do if you see meconium during delivery?

A

prevent stimulation to limit/prevent crying and decrease chance of meconium aspiration, infant immediately intubated and suctioned, suction while withdrawing ETT and may be repeated prn

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20
Q

Which phase of pregnancy does your CO increase the most?

A

first 13 weeks

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21
Q

How much does your CO increase with pregnancy?

A

40%

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22
Q

What causes the increase in CO with pregnancy?

A

increased HR by about 15 bpm

increased stroke volume by 25-30%

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23
Q

Why does CO/blood flow increase during pregnancy?

A

blood flow increases to uterus, breasts, and kidneys

24
Q

When does uterine blood flow increase the most during pregnancy?

A

from week 32-40

25
Q

What happens do the vasculature during pregnancy?

A

veins distend/dilate 150%

26
Q

What happens to the epidural space during pregnancy?

A

veins are distended and engorged which decreases LA requirements

27
Q

What EKG changes would you see with pregnancy?

A

left axis deviation, ST and T wave changes in lead III due to heart size increasing by 12% and heart displaced up and left and rotated laterally

28
Q

What are hematologic changes with pregnancy?

A

hemodilution (40-50% increase in plasma volume and 20-30% increase in red cell mass)
increased fibrinogen and clotting factors
increased platelets
increased WBC in 3rd trimester and during labor

29
Q

What is aortocaval compression?

A

pregnant uterus compresses the aorta and IVC in the supine position

30
Q

What is supine hypotension syndrome?

A

fetus compresses aorta and IVC causing decrease in CO up to 24%, decreased uterine blood flow, fetal acidosis

31
Q

What are symptoms of supine hypotension syndrome?

A

N/V
diaphoresis
possible changes in cerebration
fetal bradycardia

32
Q

What is the treatment for supine hypotension syndrome?

A

wedge under right hip
tilting OR table 15-30 degrees to the left
using a mechanical uterine displacing table

33
Q

What changes occur to the respiratory tract during pregnancy?

A
  • vascular engorgement of nasopharynx, larynx, trachea, bronchi (vocal changes and difficulty breathing through nose can occur)
  • progesterone-mediated relaxation of bronchial musculature (decreases airway resistance)
34
Q

What changes occur to the lung volumes during pregnancy?

A

decreased FRC
increased TV
same TLC

35
Q

What changes occur with gas exchange during pregnancy?

A
50% increase in minute ventilation
decreased PaCO2 (avg. 32 mmHg)
increased PaO2 (avg. 105 mmHg)
compensatory decrease in bicarb
O2 consumption increases 20%, 60% in labor
36
Q

What are anesthesia implications regarding the pulmonary changes with pregnancy?

A
  • smaller size ETT (6.0 or 6.5)
  • avoid NG tubes
  • beware of “Afrin addicts” - rebound effect
  • rapid maternal desaturation occurs with apnea
  • preoxygenation is key
  • inhalation induction faster
37
Q

What are mechanical GI changes that occur with pregnancy?

A
  • small and intestines displaced cephalad (increased intragastric pressure)
  • stomach is more vertically positioned
  • angle of GE junction is changed
38
Q

What are physiologic GI changes that occur with pregnancy?

A
  • relaxation of the lower esophageal sphincter
  • delayed gastric emptying
  • delayed intestinal mobility
  • gastric pH decreases
  • increased incidence of heartburn
39
Q

What are anesthetic implications regarding GI changes with pregnancy?

A
  • all pregnant women considered full stomach >14 weeks
  • aspiration risk increases
  • avoid + pressure ventilation with mask anesthesia
  • use RSI with GETA
  • Consider use of Bicitra 30 mL PO, Reglan 10 mg IV, IV H2 blocker
40
Q

What happens to serum cholinesterase levels during pregnancy and what does this mean regarding some of our drugs?

A

serum cholinesterase levels decrease which means we would give less drug (Ex: succ and ester LA)

41
Q

What happens to the MAC during pregnancy?

A

decreases by 25-40%

42
Q

What happens to the elimination half-life of most of our drugs during pregnancy?

A

longer elimination half-life due to increased volume of distribution

43
Q

When do altered drug responses from pregnancy return to normal?

A

about 3 months post-partum

44
Q

What is important regarding blood flow to the placenta?

A

not autoregulated, directly dependent on uterine perfusion pressure and number and size of spiral arteries

45
Q

What are factors that decrease uterine blood flow?

A
uterine contractions
uterine hypertonus
maternal hypotension or hypertension
aortocaval compression
drug induced hypotension or hypertension
46
Q

What are the mechanisms of placental transfer or drugs/substances?

A

passive diffusion (O2, CO2, drugs, electrolytes)
active transport (amino acid, H2O soluble vitamins)
facilitated diffusion (glucose)
filtration (water, some solids)
pinocytosis (immunoglobulins, proteins, macromolecules)

47
Q

What are factors that determine drug concentrations in the uterine artery?

A
drug dosage
route of administration
maternal metabolism and excretion
maternal protein binding
maternal pH and drug pKa
48
Q

What are drug properties that affect the rate of placental transfer?

A

lipid solubility

molecular weight

49
Q

Do ionized substances cross the placenta?

A

No

50
Q

Can you give benzos during pregnancy?

A

No, transfers to baby and can cause cleft lip and palate

51
Q

When is the optimal time for elective surgery during pregnancy?

A

2nd trimester

52
Q

What does gravida mean?

A

number of pregnancies

53
Q

What do the numbers after parity mean?

A

1st number = term pregnancies
2nd number = pre-term pregnancies (20-37 weeks)
3rd number = spontaneous and elective abortions (

54
Q

What causes variable decelerations?

A

cord compression

55
Q

What causes early decelerations?

A

head compression

56
Q

What causes accelerations?

A

normal physiological response to sympathetic stimulation

57
Q

What causes late declerations?

A

placental insufficiency