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Principles II- Josh > Notes from OB review day > Flashcards

Notes from OB review day Flashcards

Josh's guide to mastering the pregos effects on her body systems (taken from review day)

1
Q

Coags/Hem system
Plasma volumes increase how much during pregnancy

A

1000-1500ml

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2
Q

Coags/Hem system

what happens to albumin

A

decrease amounts

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3
Q

Coags/Hem system

drugs that are protein bound like propofol, will have what occur as a result of pregnancy

A

An increased amount of free drug.

decreased amounts of albumin

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4
Q

Coags/Hem system
what happens to
Hct
Plasma coag factors

A

Hct- decreases (dilutional)

Coags- increased amount of coag factors

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5
Q

Coags/Hem system
what happens to platelets

A

up and down

* not much change*

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6
Q 
**********************
Coags/Hem system
in recap what occurs to the following
RBC
Plasma
Hct
Hgb
Coags
A 
RBC-- increase 20%
Plasma-- increase 40-50%
Hct- decrease
Hgb- decrease
Coags- increases
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7
Q 
Pulmonary system
MV
TV
RR
PCO2
A

MV- increased (up to 50%
TV- increased (up to 40%)
RR- increased (up to 10%)
PCO2- decreased

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8
Q

Pulmonary system

what type of OETT do you want to use with the prego

A

a smaller one!!

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9
Q

Pulmonary system

what type of airway don’t you want to use in the prego?

A

Nasal trumpets

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10
Q

Pulmonary system

how long must you preoxygenate the prego

A

a full 5 min

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11
Q

Pulmonary system

what are the prego’s prone to doing during intubation

A

desaturation quickly

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12
Q

Pulmonary system

what happens to FRC

A

decreases 20%

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13
Q 
Pulmonary system
what happens to the
FEV
VC
and closing capacity
A

no changes

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14
Q

Pulmonary system
what occure to lung compliance

A

Nothing really (very minimal changes)

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15
Q

Pulmonary system
what is the first thing we do to the prego on the OR table? what next? then what?

A

LUD
then O2
then other equipment

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16
Q

GI system

what happens to the anatomical location of the stomach during pregnancy

A

pushed up (towards head) and a 45 degree twist

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17
Q

GI system
why is the prego at an increased risk for aspiration

A

decreased LES tone

decreased gastric motility

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18
Q

GI system

what is the incidence of GERD in the prego

A

30-50%

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19
Q

GI system
what bad syndrome can the prego get from aspiration? and what are it’s characteristics?

A

Mendelson’s syndrome
low Ph
High gastric volume

is chemical pneumonitis caused by aspiration during anaesthesia, especially during pregnancy.

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20
Q

GI system
what is given to prevent aspiration in the prego

A

Zantac (ranitidine) H2 antagonist
Reglan (Metoclopramide)
Bicitra (non-particulate antacid)

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21
Q

GI system
most common sugery with prego

A

Appendectomy

Cholecystectomy

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22
Q

GI system

all prego’s are an aspiration risk what 3 things must we always do in regard to intubating these women

A

prophylaxis (aspiration)
RSI
Sellickic’s maneuver (BURP) (don’t say cricord pressure use your big boy words)

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23
Q

Hepatic System

what happens to LFTs, bilirubin, alk phos with pregnancy

A

no to minimal changes

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24
Q

Hepatic System

what is a good test to asses for cholecystitis

A

bile acids

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25
Q

Hepatic System

what happens to AST and ALT

A

increased (pathological causes)

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26
Q

Hepatic System

HELLP means what?

A

Hemolysis (RBC)
Elevated LFTs
Low Platelets

27
Q

Hepatic System

are the prego’s hypercoagable

A

yes

28
Q

Stages!!

what are the stages of ppregnancy

A

1st- contractions to 10cm
2nd- full dilation to delivery of baby
3rd- delivery of baby to delivery of placenta

29
Q

Visceral pain comes from where?

A

contractions and dilation of cervix

30
Q

somatic pain comes from where?
what nerves

A

stretching of vagina and perineum

perenodel nerves

31
Q

when is the appropriate time for an epidural

A

4-6 cm dilated

32
Q

why is an epidural better than a spinal for the prego

A

b/c we want the mom to push (we want her to participate in birth)
epidural allows participation
spinal doesn’t allow participation

33
Q

CV system
fetal bradycardia

A

<120 bpm

34
Q

CV system
fatal tachycardia

A

> 160

35
Q

CV system

normal fetal HR

A

110 (120)-160

36
Q

CV system

beat to beat variation

A

normal fetal HR

37
Q

CV system

early decel

A

occurs before each contraction

normal fetal movement

38
Q

CV system

late decel

A

after contraction

r/t low blood flow or utero placental deficiency

39
Q

CV system

CO increases up to __% by week 10 and __ to __% post delivery

A

10%

60-80%

40
Q

CV system
what happens to diastolic b/p
systolic?

A

dys- decreases

sys- no changes

41
Q

CV system

2 main complications

A

Anemia

supine hypotension syndrome

42
Q

CV system

if a prego says they have nausea what should you do?

A

treat b/p

LUD

43
Q

CV system
what may the heart look like on an xray with the prego

A

enlarged

44
Q

CV system
what type of effusions are common in the prego

A

pericardial effusion

45
Q

CV system
what may be auscultated in the prego

A

low grade murmur

this is due to extra fluid and is NORMAL

46
Q

CV system

what occurs due to spinal and epidural? how is this treated

A

vasodilation and hypotension

bolus with fluids

47
Q

CNS System

what hormone causes sedation?

A

progesterone

48
Q

CNS System

with pregnancy MAC is decreased how much?

A

40%

49
Q

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)

A

Local anesthestics

50
Q

CNS System

what happens to endorphins

A

increased

51
Q

CNS System
the CSF pressure increases with what?

A

contractions (do spinals between them)

52
Q

Blood flow in relation to palcenta

how much blood flow is going through it?

A

500-700 ml

53
Q

Blood flow in relation to palcenta

does the placenta have autoregulation?

A

nope, relies solely on moms circulation

54
Q

Blood flow in relation to palcenta

decreased BF can occur when what 4 things happen

A

1) hypotension
2) stress
3) supine
4) hypoventilation

55
Q

Blood flow in relation to palcenta

decreased blood flow can lead to what?

A

maternal hypoxia

hypercabia

56
Q

Blood flow in relation to palcenta
what is needed for best placental perfusion
hypocarbia hypercarbia normocarbia

A

normocarbia

57
Q

Ephedrine indirect or direct

A

indirect

58
Q

phenylephrine direct or indirect

A

direct

59
Q 
APGAR
how many categories?
what is the scoring in each category?
normal scores?
when is it done?
A

5
0-1-2
8-10 (rarely ever a 10)
1 min and 5 min

60
Q

APGAR
what is the 1 min assessment for?
what is the 5 min assessment for?

A

1 min- babies response to birth process?

5 min- babies own response (or response to living on own)

61
Q

what is EBL for a c-section and what must you remember about it?

A

1-2 liters

it is normal and ok

62
Q

how much time do you have to start neonate recessatation? what is it called?

A

60 seconds

“the golden minute”

63
Q

Renal System
what happens to GFR in weeks 16-26?
what about 3rd trimester?

A

16-26- 80% increase

3rd trimester- 50-60% decrease

64
Q

Renal System
what happens to BUN and Creatinine?
why does this occur

A

decrease up to 50%
BUN 8
Creat 0.5
occurs due to dilution

Principles II- Josh (17 decks)

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