OB (1/10) Flashcards
what are the different hormones involved in changes to mom with pregnancy
- relaxin
- progesterone
- cortisone
- estrogen
- endorphins
- prostaglandins
during pregnancy the heart moves _______ and to the _____________
up; left
what is normal CO during pregnancy
6-12 L/min
during pregnancy CO increases by ___________%
50
HR during pregnancy increases by about _____%
25
BP during pregnancy may decrease except with _________________
htn
SVR is decreased by _________ % during pregnancy
20
what hormones are responsible for the decrease in SVR during pregnancy
- prostacyclines
- estrogen
- progesterone
during pregnancy what CV parameters increase?
- CO
- HR
- contractility
- blood volume
- SV
T/F: pregnancy causes a high vascular resistance system
false; low vascular resistance system
why does SVR decrease during pregnancy
due to low vascular resistance system 2/2 vasodilation that gets blood to the utuerus for adequate blood flow.
normal blood volume of 150 lb, non-pregnant pt = ___________
blood volume in this pt who is pregnant at term will ___________ by 1-1.5L
4.7; increase
T/F: hgb decreases with increased blood volume in pregnancy
false; RBC/hgb increases by 30% but the plasma volume increases by 50% and that why you may see dilutional anemia
CO during pregnancy starts to increase at ____________ weeks
5
when is CO the greatest during pregnancy
right at delivery, CO increases up to 80%
CO reaches 50% increase mark in the ___________ trimester, and is due to increased _________ stimulated by __________
2nd; SV; estrogen
LV mass of the heart increases by ______% between the 1st and 3rd trimesters
23
there is a ______________ shift in the oxyhgb dissocation curve with pregnancy
right
during labor, CO increases by _____% in the first stage of labor; _____% in the late first stage of labor, and ____% in the second stage of labor
10; 25; 40
T/F: giving a pregnant pt an epidural will suppress the SNS stimulation and increase in CO during labor
true
during a uterine contraction __________ mL of blood is displaced from the intervillous space of the placenta to maternal central circulation = _______________
300-500; autotransfusion
a woman is in labor laying in the supine position, you come in and she is c/o N/V & dizziness, she looks pale, diaphoretic, and pallor, & hypotensive what do you think is going on/what is the intervention?
aortal/inferior vena caval compression; compression of vessels –> transient decrease in CO from decrease in venous return
fix: left uterine displacement (placing wedge under the right hip)
when is a mom particularly sensitive to aortal/inferior vena caval compression when close to labor?
after epidural block
pregnant mom goes into cardiac arrest while on the OR table; baby is still utero what position change should you do while doing compressions
left uterine displacement (wedge under right hip)
mom is term and is sitting up in the bed; what vessel is a risk of occlusion
femoral
if mom is term and sitting up –> s/sx of hypotension, diaphoresis, N/V how do you intervene
she is possibly occluded femorally, put head down and do left uterine displacement
TV & Mv during pregnancy increases by _______%
45
what hormone causes an increase in minute ventilation during pregnancy
progesterone
FRC is _________ by 20% during pregnancy
decreased
O2 consumption increases by _________% during pregnancy
50
why do pregnant women drop their O2 saturation so fast during pregnancy?
decrease FRC and increased O2 consumption
progesterone causes what respiratory changes during pregnancy
- bronchodilation
- increased minute ventilation
hypoxic ventilatory response during pregnancy is _______x the normal level
2 (this is a protective mechanism in the pregnant pt)
what respiratory parameters are increased during pregnancy
- inspiratory reserve volume
- Tidal volume
- inspiratory capacity
- dead space
- minute ventilation
- alveolar ventilation
what respiratory parameters decrease during pregnancy
- expiratory reserve volume
- residual volume
- functional residual capacity
- total lung capacity
T/F: the pregnant pt in surgery, the EtCO2 is assumed to be about 5 < than PaCO2
false; during pregnancy EtCO2 is assumed to = PaCO2
what parameter during surgery of the pregnant pt predicts the degree of maternal hyperventilation and an be used to avoid uterine vasoconstriction induced by hypocarbia
EtCO2
if you have to intubate a pregnant woman at term, what are the risks
- trauma
- bleeding
- obstruction
- difficult DL (d/t arytenoid and VC edema)
T/F: you should avoid nasal airways in the pregnant pt at term
true - increased risk of bleeding
pregnant women are in a mild state of _________________ (respiratory or metabolic acidosis or alkalosis)
respiratory alkalosis (d/t increased Mv –> more CO2 blown off by mom)
what hormone drives the change in CO2 in the pregnant pt
progesterone
changes to Mv in stages of labor:
1st stage = ___________
2nd stage = ____________
- 1st stage = 70-140% increase Mv
- second stage of labor Mv increases 120-200%
during labor PaO2 may ___________ by _______ mmHg
decrease; 10 - 15
in the first stage of labor O2 consumption increases by _____% and increases by _____% in the second stage of labor
40; 75
T/F: during labor maternal aerobic requirement for Oxygen > oxygen consumption
true
what helps with the respiratory changes (increased Mv, decreased PaO2, increased O2 consumption) during labor?
epidural and adequate pain control
FRC ___________ after delivery, but remains ___________ pre-pregnancy level for _______ weeks
increases; lower; 1-2
O2 consumption, Tv, and Mv remain elevated after birth for ___________ weeks
6-8
what two factors cause physiologic anemia for pregnancy
- maternal plasma volume increases 50% by 34 weeks
- increase in maternal plasma volume exceeds RBC volume increase
plasma volume increases from 49 mL/kg up to __________ mL/kg during pregnancy
67
