OB (2/10) Flashcards
Total blood volume during pregnancy increases from 76 mL/kg to ____________ mL/kg
94
why is there a prominent increase in blood volume in the parturient?
- helps transports nutrients to the fetus better ( d/t: low SVR & thinner blood)
- protects the mother from the amount of blood loss with delivery
average blood loss with vaginal delivery
400-600 mL
average blood loss with C - section
800-1000 mL
estrogen and progesterone are increased __________ fold in pregnancy
100
T/F: pregnancy is a hypercoagulable state
true
pregnancy is associated with what coagulation changes
- enhanced plt turnover (i.e. greater plt consumption)
- clotting
- fibrinolysis
what coagulation factors are INCREASED in concentration at term pregnancy
- factor I (fibrinogen)
- Factor VII (procovertin)
- Factor VIII (antihemophilic factor)
- Factor IX (christmas factor)
- Factor X (stuart power factor)
- Factor XII (hageman factor)
what coagulation factors are decreased at term pregnancy
Factor XI (thromboplastin) & XIII (fibrin-stabilizing factor)
which coagulation factors are UNCHANGED at term pregnancy
Factor II (prothrombin) and Factor V (proaccelerin)
change in PT and PTT at term pregnancy
shortened by 20%
TEG changes at term pregnancy
hypercoagulable
Fibrinopeptide A, Fibrin degradation products, plasminogen are all ____________ at term pregnancy
increased
changes to bleeding time and plt count at term pregnancy
no change
change to antithrombin III at term pregnancy
decreased
what is more important in pregnancy: plt count or plt fx?
plt function
what is gestational thrombocytopenia
low plt count, but no bleeding or bruising.
if pt has this, they will have it every subsequent pregnancy
T/F: it is a contraindication to give pt with gestational thrombocytopenia and epidural
false; typically still do epidurals in theses pts.
during a C-section, the first 300-400 mL that ends up in the suction canister is __________________
amniotic fluid
changes to hematology/coagulation with delivery and first day post-partum
- rapid decrease in plt count, fibrinogen, factor VIII, and plasminogen
- increase in antifibrinolytic activity
- clotting times remain shortened
- hypercoagulable state continues
when does coagulation profile return to pre-pregnancy state?
by 2 weeks post delivery
what are the changes to the position of the stomach with pregnancy
it is displaced up to the left and rotated 45 degrees (which leads to GERD)
changes to the GI system with pregnancy
- stomach moves up to the left and rotated 45 degrees
- decreases lower esophageal tone
- esophageal peristalsis and intestinal transient are slowed (but emptying is not effected) –> constipation
what is the biggest change to the GI system that is a concern to anesthesia in the pregnant pt
the decreased lower esophageal tone –> GERD & aspiration risk
T/F: gastric emptying of food and liquid is unaltered during pregnancy
true (but have decreased gastric emptying with labor)
what hormone causes further relaxation of the lower esophageal sphincter in pregnancy increasing risk of GERD/aspiration
progesterone
T/F: there is no change in gastric acid secretion btwn pregnant and non pregnant
true
changes to the GI system during LABOR
- decreased gastric emptying
hepatic changes in the pregnant pt
- liver displacement upward and posteriorly
- increased bilirubin and liver enzymes
- increased risk of biliary dz
what is THE most common surgery done on a pregnant woman
cholecystectomy
what causes the need for cholecystectomy in pregnant woman
- increased secretion of bile / biliary stasis
- hypomotility with cholesterol
what hormone inhibits contractility of GI smooth muscle which causes gallbladder hypomotility in the pregnant pt
progesterone
a completely healthy pregnant woman is a ASA class _________
II
ASA class of pregnant woman with a condition?
III or IV
what is the most common GU issues with pregnancy
frequent UTIs
which organ system changes are the earliest and most dramatic seen in pregnancy
renal changes
GFR in pregnancy increases by _________% and does not return to normal until ________ months post-partum
50; 3
renal vascular volume ____________ by 30% during pregnancy
increases
Renal plasma flow _____________ during pregnancy
increases
Cr clearance ___________ during pregnancy
increases
BUN/Cr ____________ during pregnancy
decreases
total protein excretion and urinary albumin excretion ______________ during pregnancy
increase
glucose excretion ______________ during pregnancy
doubles
the renal changes that occur with pregnancy occur to compensate for __________________
mild respiratory alkalosis the pt has
endocrine changes with pregnancy
- thyroid gland enlarges
- increased T3/T4
- insulin resistance
- 200% increase in cortisol at term
insulin resistance in the mother during pregnancy is caused by what?
hormones from the placenta
what are the primary sources of increased release of relaxin during pregnancy
- corpus luteum
- placenta
what is the purpose of increased relaxin during pregnancy
increases mobility of sacroiliac, sacrococcygeal, and pubic joints to prepare pelvis for passage of placenta
what hormone causes carpal tunnel syndrome in pregnant pts (that goes away after delivery)
relaxin
____________ is a polypeptide hormone that remodels collagen fibers and pelvic connective tissue
relaxin
