Notes from OB review day Flashcards
Josh's guide to mastering the pregos effects on her body systems (taken from review day)
Coags/Hem system
Plasma volumes increase how much during pregnancy
1000-1500ml
Coags/Hem system
what happens to albumin
decrease amounts
Coags/Hem system
drugs that are protein bound like propofol, will have what occur as a result of pregnancy
An increased amount of free drug.
decreased amounts of albumin
Coags/Hem system
what happens to
Hct
Plasma coag factors
Hct- decreases (dilutional)
Coags- increased amount of coag factors
Coags/Hem system
what happens to platelets
up and down
* not much change*
********************** Coags/Hem system in recap what occurs to the following RBC Plasma Hct Hgb Coags
RBC-- increase 20% Plasma-- increase 40-50% Hct- decrease Hgb- decrease Coags- increases
Pulmonary system MV TV RR PCO2
MV- increased (up to 50%
TV- increased (up to 40%)
RR- increased (up to 10%)
PCO2- decreased
Pulmonary system
what type of OETT do you want to use with the prego
a smaller one!!
Pulmonary system
what type of airway don’t you want to use in the prego?
Nasal trumpets
Pulmonary system
how long must you preoxygenate the prego
a full 5 min
Pulmonary system
what are the prego’s prone to doing during intubation
desaturation quickly
Pulmonary system
what happens to FRC
decreases 20%
Pulmonary system what happens to the FEV VC and closing capacity
no changes
Pulmonary system
what occure to lung compliance
Nothing really (very minimal changes)
Pulmonary system
what is the first thing we do to the prego on the OR table? what next? then what?
LUD
then O2
then other equipment
GI system
what happens to the anatomical location of the stomach during pregnancy
pushed up (towards head) and a 45 degree twist
GI system
why is the prego at an increased risk for aspiration
decreased LES tone
decreased gastric motility
GI system
what is the incidence of GERD in the prego
30-50%
GI system
what bad syndrome can the prego get from aspiration? and what are it’s characteristics?
Mendelson’s syndrome
low Ph
High gastric volume
is chemical pneumonitis caused by aspiration during anaesthesia, especially during pregnancy.
GI system
what is given to prevent aspiration in the prego
Zantac (ranitidine) H2 antagonist
Reglan (Metoclopramide)
Bicitra (non-particulate antacid)
GI system
most common sugery with prego
Appendectomy
Cholecystectomy
GI system
all prego’s are an aspiration risk what 3 things must we always do in regard to intubating these women
prophylaxis (aspiration)
RSI
Sellickic’s maneuver (BURP) (don’t say cricord pressure use your big boy words)
Hepatic System
what happens to LFTs, bilirubin, alk phos with pregnancy
no to minimal changes
Hepatic System
what is a good test to asses for cholecystitis
bile acids
Hepatic System
what happens to AST and ALT
increased (pathological causes)
Hepatic System
HELLP means what?
Hemolysis (RBC)
Elevated LFTs
Low Platelets
Hepatic System
are the prego’s hypercoagable
yes
Stages!!
what are the stages of ppregnancy
1st- contractions to 10cm
2nd- full dilation to delivery of baby
3rd- delivery of baby to delivery of placenta
Visceral pain comes from where?
contractions and dilation of cervix
somatic pain comes from where?
what nerves
stretching of vagina and perineum
perenodel nerves
when is the appropriate time for an epidural
4-6 cm dilated
why is an epidural better than a spinal for the prego
b/c we want the mom to push (we want her to participate in birth)
epidural allows participation
spinal doesn’t allow participation
CV system
fetal bradycardia
<120 bpm
CV system
fatal tachycardia
> 160
CV system
normal fetal HR
110 (120)-160
CV system
beat to beat variation
normal fetal HR
CV system
early decel
occurs before each contraction
normal fetal movement
CV system
late decel
after contraction
r/t low blood flow or utero placental deficiency
CV system
CO increases up to __% by week 10 and __ to __% post delivery
10%
60-80%
CV system
what happens to diastolic b/p
systolic?
dys- decreases
sys- no changes
CV system
2 main complications
Anemia
supine hypotension syndrome
CV system
if a prego says they have nausea what should you do?
treat b/p
LUD
CV system
what may the heart look like on an xray with the prego
enlarged
CV system
what type of effusions are common in the prego
pericardial effusion
CV system
what may be auscultated in the prego
low grade murmur
this is due to extra fluid and is NORMAL
CV system
what occurs due to spinal and epidural? how is this treated
vasodilation and hypotension
bolus with fluids
CNS System
what hormone causes sedation?
progesterone
CNS System
with pregnancy MAC is decreased how much?
40%
CNS System
there may be an exaggerated effect to what meds inparticular in the prego (so you will always use smaller doses than in the general population)
Local anesthestics
CNS System
what happens to endorphins
increased
CNS System
the CSF pressure increases with what?
contractions (do spinals between them)
Blood flow in relation to palcenta
how much blood flow is going through it?
500-700 ml
Blood flow in relation to palcenta
does the placenta have autoregulation?
nope, relies solely on moms circulation
Blood flow in relation to palcenta
decreased BF can occur when what 4 things happen
1) hypotension
2) stress
3) supine
4) hypoventilation
Blood flow in relation to palcenta
decreased blood flow can lead to what?
maternal hypoxia
hypercabia
Blood flow in relation to palcenta
what is needed for best placental perfusion
hypocarbia hypercarbia normocarbia
normocarbia
Ephedrine indirect or direct
indirect
phenylephrine direct or indirect
direct
APGAR how many categories? what is the scoring in each category? normal scores? when is it done?
5
0-1-2
8-10 (rarely ever a 10)
1 min and 5 min
APGAR
what is the 1 min assessment for?
what is the 5 min assessment for?
1 min- babies response to birth process?
5 min- babies own response (or response to living on own)
what is EBL for a c-section and what must you remember about it?
1-2 liters
it is normal and ok
how much time do you have to start neonate recessatation? what is it called?
60 seconds
“the golden minute”
Renal System
what happens to GFR in weeks 16-26?
what about 3rd trimester?
16-26- 80% increase
3rd trimester- 50-60% decrease
Renal System
what happens to BUN and Creatinine?
why does this occur
decrease up to 50%
BUN 8
Creat 0.5
occurs due to dilution
