OB

Question 1

Approx how much does a women’s weight increase during pregnancy and how much does the uterus, amniotic fluid, Fetus/placenta, blood volume/fluid, and fat/protein makeup of that weight increase?

Answer 1

• 17% mean increase; 12kg
• Uterus 1kg
• Amniotic fluid 1kg
• Fetus and placenta 4kg
• Blood volume and interstitial fluid 4kg
• fat and protein 4kg

Question 2

What changes take place in the respiratory system during pregnancy?

Answer 2

-Respiratory System Changes
Thoracic cage circumference increase (5-7cm); increase in AP diameter
-Relaxin (relaxation of the ligamentous attachments of the ribs)
-Elevation of the diaphragm

Question 3

What happens to Vt, RV, ERV, FRC, closing volumes during pregnancy?

Answer 3

• Vt (450 to 600) and closing volumes increase
• Residual volume (1000 to 800), Exp reserve vol (700 to 550), Func residual cap (1700 to 1350) all decrease. Supine position exaggerates effects (FRC 70% of pre-prego volume)

Question 4

What happens to minute ventilation (MV) during pregnancy?

Answer 4

(increased Vt, increased CO2 production) 30% over pre-prego

Question 5

Increase alveolar ventilation leads to what during pregnancy?

Answer 5

Alkalosis

Question 6

How does progesterone affect ventilation and oxygenation during pregnancy?

Answer 6

Progesterone stimulates respiration; leftward shift of CO2 response curve= More sensitive to CO2

Question 7

What is the predominate anesthetic for C/S up to date?

Answer 7

Regional

Question 8

What does every women get before having a C/S?

Answer 8

Bicitra (at risk for aspiration)

Question 9

What risks does obesity increase during pregnancy?

Answer 9

Adverse effects and C/S rate. (can be as high as 50%)

Question 10

What is the 1st thing you should always do when entering OR with pregnant pt?

Answer 10

Put on O2 and pre oxygenate.

Question 11

What happens to O2 uptake during pregnancy?

Answer 11

Increased O2 uptake; 20% at rest, 60% with labor

Question 12

What happens to the oxy/hgb curve and O2 carrying capacity during pregnancy?

Answer 12

• Oxy/Hgb curve shifted to R (30.2mmHg = more given off to baby)
• Oxygen carrying capacity decreases
• Increased metabolism
• Vulnerable to hypoxia

Question 13

What happens to the Oxy/Hgb curve during preeclampsia?

Answer 13

Shifts Left may be harmful to baby and tissue not receiving O2

Question 14

What changes take place to the airway during pregnancy?

Answer 14

Capillary engorgement of nasal mucosa, resp tract, oropharynx, nasopharynx, trachea, vc

Question 15

What are some safety tips when evaluating and manipulating prego airways?

Answer 15

• Care with manipulation (more prone to bleed)
• Early upper airway obstruction
• Smaller tube size (always have #6 avail)
• Reevaluate frequently during labor (mallampati can change during course of labor)