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6903 > OB > Flashcards

OB Flashcards

1
Q

Term pregnancy is a pregnancy greater than ___ how many weeks?

A

37

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2
Q

Pre term labor occurs when?

A

between week 20 and 37

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3
Q

What do tocolytics do?

A

stop labor if rupture of mem has not occurred, they are smooth muscle relaxers

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4
Q

3 ex of tocolytics?

A

mag, nifedipine, indomethacin

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5
Q

5 causes of uteroplacental insufficiency?

A

smoking, insulin dep diabetes, HTN, drug abuse, alcohol consumption

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6
Q

Blood volume increases by what % during pregnancy?

A

45%

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7
Q

CO increases by what % in pregnancy?

A

40%

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8
Q

HR increases up to what % in pregnancy?

A

20%

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9
Q

Do SV and HR increase?

A

yes

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10
Q

SVR decreases what % in pregnancy and is the result of what?

A

10-15% (says 21% too) due to decrease in overall vascular tone (decrease resistance in uteroplacental, pulmonary, renal, and cutaneous vascular beds)

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11
Q

What is another pregnancy induced CV change that is r/t muscle?

A

hypertrophy

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12
Q

Why does dilutional anemia occur in pregnancy?

A

increase in plasma volume in excess of rbc

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13
Q

Usual Hg during pregnancy?

A

11

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14
Q

What offsets the decrease in Hg (2)?

A

right shift of the oxyhg curve and increase in CO

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15
Q

What is responsible for decreasing DBP and SBP? When does this occur?

A

SVR, 2nd trimester

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16
Q

At term, blood volume is increased how much?

A

1000-1500 mL

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17
Q

Total BV at term is what/kg?

A

90mL/kg

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18
Q

When does BV return to normal after pregnancy?

A

1-2 weeks after delivery

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19
Q

HR and SV increase about how much?

A

HR 20-30% SV 20-50%

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20
Q

What happens to the cardiac chambers during pregnancy?

A

they enlarge

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21
Q

When do the cardiac effects during pregnancy start to be seen on echo?

A

1st and 2nd trimester

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22
Q

Greatest increase in CO in pregnant person is seen when?

A

in labor and right after delivery

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23
Q

When does CO return to normal after delivery?

A

2 weeks after delivery

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24
Q

CV changes begin as early as how many weeks pregnant?

A

4 weeks

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25
Q

Increase in HR begins when and peaks when?

A

begins 1st trimester and peaks 32 week

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26
Q

Beginning in what week does the CO increase by 40%?

A

5th week

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27
Q

Why does CO increase during uterine contractions?

A

autotransfusion from contracting uterus to central circulation

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28
Q

Immediately after delivery, CO increases by what % and why?

A

80%; d/t aortocaval decompression and increase in central volume from the uterus

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29
Q

Why does the heart appear enlarged on xray?

A

diaphgram displaces heart up and to the left

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30
Q

What heart sounds are normal during pregnancy?

A

grade 1 or 2 systolic murmur or 3rd heart sound

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31
Q

What heart sounds are not normal during pregnancy?

A

systolic murmur > grade 3 or accompanied by chest pain or syncope

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32
Q

Diastolic and cardiac enlargement are pathologic. T/F?

A

true

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33
Q

Plasma volume increases by what % whereas rbc increase by what %?

A

40-50%; 20%

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34
Q

Why does the plasma volume increase?

A

increased progesterone and estrogen resulting in RAAS

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35
Q

Vag birth EBL and c section EBL?

A

500 mL; 800-1000 mL

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36
Q

In labor, each contraction moves how many mL of blood from the contracting uterus to the central circulation?

A

300-500 mL

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37
Q

Why does maternal HR decrease during contractions?

A

adequate neuraxial anesthesa/little SNS stim + transient increase in preload

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38
Q

Why does the SBP not change much during pregnancy?

A

increased blood volume but decreased SVR

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39
Q

DBP decreases about how much so what happens to the MAP?

A

15 mm Hg; decreases

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40
Q

At term, the uterus gets how much (%) CO?

A

20%

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41
Q

In the supine position, what is compressed, which leads to?

A

IVC leading to decreased venous return/SV and hypotension

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42
Q

Normal maternal response to aortocaval decompression?

A

tachycardia and vasoconstriction in lower extremities

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43
Q

Respiratory maternal changes evident after how many weeks gestation?

A

12 weeks

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44
Q

What does cephalaud displacement of the diaphragm do to respiratory volumes?

A

decreased FRC, ER, and RV

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45
Q

Rapid desat in apneic pregnant pt d/t?

A

increased O2 consumption, decreased FRC

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46
Q

3 conditions which exaggerate the already rapid desaturation in pregnant women?

A

labor, morbid obesity, sepsis

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47
Q

What happen to TLC, VC, and IC and why?

A

they’re unchanged d/t subcostal widening and enlarging of thoracic AP diameter

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48
Q

O2 consumption at rest w term pregnancy?

A

increased 33%

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49
Q

O2 consumption increases by what % at labor and why??

A

100% or more; d/t increase in alveolar vent

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50
Q

When during the pregnancy does the diaphragm elevate?

A

3rd trimester

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51
Q

Elevation of diaphragm results in a what % decrease in FRC?

A

20% that mimics restrictive lung disease

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52
Q

During labor, pain can cause MV to increase how much and may cause CO2 to drop to what level?

A

300%; 15

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53
Q

What are some airway changes that occur during pregnancy?

A

edema from cap engorgement, friable tissues, narrowing of glottic opening from edema

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54
Q

Is a nasal intubation a good idea in pregnant pts?

A

no

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55
Q

Most common GA complication post op in pregnant pts?

A

aspiration

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56
Q

2 problems from gestational diabetes as far as the placenta is concerned?

A

decreased placental perfusion (35-40%), impaired oxygen transport

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57
Q

Why is the baby of a gestational diabetes mother at risk for hypoglycemia?

A

increased glu in mother= increased insulin in baby

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58
Q

Glucose challenge is done at how many weeks unless had gest diabetes previously and then it’s done at this many weeks?

A

24-28 weeks gestation; 13 weeks

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59
Q

Mom w gestational diabetes has an increased risk of?

A

c section d/t high birth wt

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60
Q

________, __________, and ____ metabolism is altered during pregnancy?

A

carb, fat, protein bc it favors fetal growth and development

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61
Q

Metabolic changes resemble a what state? Why?

A

starving; glu and AA are low while FFA, ketones, and TGL are high

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62
Q

T/F: pregnancy is a diabetogenic state?

A

true

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63
Q

What happens to insulin level during pregnancy?

A

they steadily rise

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64
Q

Insulin resistance during pregnancy is probably d/t?

A

secretion of human placental lactogen, human chorionic somatomammotropin

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65
Q

What occurs in response to an increased demand for insulin secretion?

A

pancreatic beta cell hyperplasia

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66
Q

What promotes hypertrophy of the thyroid gland?

A

HCG and estrogens

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67
Q

What happens to thyroid binding globulin, T3 and T4 levels? What about free T3 and free T4 and thyrotropin?

A

thyroid binding globulin is increased d/t hypertrophy of the thyroid gland, T3 and T4 elevated but free levels normal, thyrotropin normal

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68
Q

What happens to the kidneys size during pregnancy?

A

increase in size and weight

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69
Q

When do kidneys return back to normal?

A

6 months post partum

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70
Q

What happens to the renal pelvis and ureters? when does that begin and why?

A

dilate; 1st trimester, progesterone

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71
Q

Ureters hold how many times their normal volume during pregnancy?

A

25 times

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72
Q

2 consequences of kidney changes during pregnancy?

A

increased UTIs and decreased bladder tone

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73
Q

GFR increases how much during pregnancy?

A

50%

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74
Q

When does increase GFR peak?

A

9-16 weeks gestation

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75
Q

What happens to GFR as term approaches?

A

it falls

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76
Q

Are proteinuria and glycosuria pathologic in pregnant person?

A

no

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77
Q

GFR returns to normal after how many weeks postpartum?

A

3 weeks

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78
Q

Increased filtering and therefore excretion of?

A

AA, glucose, proteins, lytes, drugs, vitamins

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79
Q

Why does serum albumin level decrease?

A

expanded plasma vol

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80
Q

What happens to pseudocholinesterase activity at term? What drugs does that affect? When does it return to normal?

A

25-30% decrease in it; suxxs, ester anesthetics, 2-6 weeks post partum

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81
Q

Why is there poor emptying of the gall bladder?

A

high progesterone levels inhibit release of cholecystokinin

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82
Q

What 2 things does poor emptying of the gall bladder result in?

A

altered bile composition and gallstone formation

83
Q

What clotting factors are increased during pregnancy?

A

fibrinogen/factor I, factor VII, platelets

84
Q

What clotting factors are increased during pregnancy?

A

fibrinogen/factor I, factor VII-X, XII, platelets

85
Q

Increased clotting levels coupled w what puts pt at increased risk for DVT?

A

venous pooling

86
Q

One of leading causes of maternal mortality?

A

thromboembolic events

87
Q

Which clotting factor may be decreased?

A

XI

88
Q

Fibrinogen levels in pregnant state?

A

400-650

89
Q

What happens to wbc count in pregnancy?

A

it rises, may be as high as 20-30K during labor

90
Q

Upward displacement of stomach results in what 2 things?

A

poss decreased emptying and decreased sphincter tone

91
Q

What causes increased acid levels in pregnancy?

A

increased levels of gastrin excreted by placenta

92
Q

How long is woman at increased aspiration risk after delivery?

A

6 weeks in to postpartum period

93
Q

All pregnant women are a full stomach from when to when?

A

8 weeks of pregnancy to 6 weeks after

94
Q

What is Mendelson’s syndrome?

A

chemical pneumonitis caused by aspiration during GA

95
Q

pH ___ can result in aspiration pneumonitis? What is this in most pregnant people?

A

2.5, 25; same values

96
Q

This neutralizes stomach aciditiy

A

bicitra

97
Q

When do you give H2 receptor agonists and what are ex?

A

night before surgery; cimetidine, ranitidine

98
Q

When do you give PPIs?

A

night before surgery

99
Q

What do PPIs do?

A

increase lower esophageal sphincter tone and increase gastric emptying

100
Q

What muskuloskeletal hormone increases in pregnancy?

A

relaxin

101
Q

Fetal gas exchange is completely dependent on?

A

maternal uterine perfusion pressure

102
Q

Uterine blood flow in mL/min?

A

700 mL/min

103
Q

Uterine blood flow in nonpregnant uterus?

A

50 mL/min

104
Q

Can uterine vasculature further dilate?

A

no, it is maximally dilated. autoregulation is absent

105
Q

Uterine blood flow is determined by this relationship?

A

uterine arterial pressure - uterine venous pressure / uterine vascular resistance

106
Q

This ABG value can reduce uterine blood flow and cause fetal hypoxia and acidosis?

A

PaCO2

107
Q

3 events that decrease uterine blood flow?

A

hypotension, uterine vasoconstriction, contractions

108
Q

2 things that can cause uterine vasoconstriction?

A

stress induced release of catecholamines during labor and any drug w alpha adrenergic activity (phenyl)

109
Q

How do you contractions decrease blood flow to the uterus?

A

elevating uterine venous pressure

110
Q

A medication that can critically compromise uterine blood flow?

A

pitocin

111
Q

Aortocaval compression occurs after what week in pregnancy when mom is supine?

A

28th week

112
Q

Aortocaval compression corrected by what position?

A

left uterine displacement

113
Q

The enlarged uterus inhibits what 2 things in supine position?

A

venous return which results in decreased uterine arterial flow

114
Q

The enlarged uterus inhibits venous return which results in what in the supine position?

A

venous return which results in decreased uterine arterial flow

115
Q

The fetus relies on the placenta for what 3 functions?

A

resp gas exchange, nutrition, waste elimination

116
Q

What do the umbilical arteries do? How many are there?

A

sends oxygen poor blood to the placenta/mom to be oxygenated; 2

117
Q

What does the umbilical vein do?

A

fetus receives oxygen rich blood from the mom/placenta

118
Q

How do resp gasses and small ions move across the placenta? Is energy needed for this process?

A

diffusion; no

119
Q

What is the typical size of anesthetic gasses and what does that mean for placental crossing?

A

small:

120
Q

How does water move across the placenta?

A

bulk flow/osmotic/hydrostatic gradient

121
Q

AA, vitamins, and some ions use what method to cross the placenta?

A

active transport

122
Q

What is primary active transport?

A

goes against a gradient w a protein carrier

123
Q

What is secondary active transport?

A

moving down a concen gradient by a protein carrier

124
Q

Large molecules (immunoglobulins) move across the placenta by this method?

A

pinocytosis (binding of specific receptor on a cell surface and then it is enclosed on the plasma mem)

125
Q

What is likely responsible for Rh sensitization?

A

breaks in the placental mem and mixing of maternal and fetal blood

126
Q

First stage of labor consists of?

A

regular contractions until fully dilated (10 cm)

127
Q

2 stages of the first stage of labor?

A

latent: progressive cervical effacement and minor dilation (2-3 cm); active: more frequent contractions (3-5 min) and progressive cervical dilation up to 10 cm

128
Q

Second stage of labor consists of?

A

10 cm dilated until baby is complete (pushing stage)

129
Q

What is the third stage of labor?

A

delivery of baby until placenta is delivered

130
Q

First stage of labor, pain is at what level?

A

T10-L1

131
Q

First stage of labor, nociceptor stimulation is mediated by?

A

C fibers (small, unmyelinated, nerves)

132
Q

What nerves do pain travel along in the first stage of labor?

A

visceral afferents accompanying sympathetic nerves

133
Q

Second stage of labor pain travels through what nerves?

A

pudendeal

134
Q

Second stage pain nerves enter spinal cord where?

A

S2-S4

135
Q

Anesthesia for second stage of labor must cover which levels?

A

T10-S4

136
Q

What is the regional anesthetic preferred over other techniques?

A

continuous epidural

137
Q

Is the incidence of inadvertent IV injection during epidural high in pregnant women?

A

yes

138
Q

Look at indications for c sec?

A

previous classic c sec, previous vaginal reconstruction, transverse, oblique breech presentation, genital herpes w ruptured mem impending maternal death

139
Q

What are the parameters for pregnancy induced hypertension?

A

SBP > 140; DBP > 90

140
Q

What are the parameters for preexisting HTN in pregnant person?

A

SBP > 30 above baseline, DBP > 15 above baseline

141
Q

PIH more accurately describes 1 of what 3 syndromes?

A

preeclampsia, eclampsia, HELLP

142
Q

What is preeclampsia?

A

HTN, proteinuria, peripheral edema

143
Q

What is eclampsia?

A

preeclampsia sx + seizures

144
Q

What is HELLP?

A

hemolysis, elevated liver enzymes, low platelets

145
Q

Preeclampsia usually occurs after how many weeks gestation?

A

24

146
Q

Preeclampsia has a higher incidence in what 4 types of women?

A

african american, DM, extremes of age, multiple gestation

147
Q

20% of preeclamptic women also have what symptom?

A

decrease in clotting factors

148
Q

Mild preeclampsia is what SBP, DBP, protein in urine, and edema?

A

SBP 140-160, DBP 90-110, 1 + edema, trace proteinuria

149
Q

Severe preeclampsia is what SBP, DBP, protein in urine, and edema?

A

SBP 160 +, DBP 110+, 2 + edema, > 5 g proteinuria in 24 hours

150
Q

Definitive treatment of preeclampsia?

A

delivery of fetus

151
Q

Leading cause of maternal mortality?

A

preeclampsia

152
Q

Management for preeclampsia?

A

Mgsulfate, antiHTN (hydralazine, beta blockers ok too)

153
Q

During GA with the preeclampic woman, be prepared for what?

A

extreme HTN response to intubation

154
Q

Whats the priority for eclampsia?

A

secure airway and stop seizure

155
Q

3 meds to stop seizure?

A

thiopental, benzos, magnesium

156
Q

Only treatment for eclampsia?

A

delivery of fetus

157
Q

HELLP usually occurs after what gestation?

A

36 weeks

158
Q

Sx of HELLP?

A

malaise, HA, N/V, epigastric pain

159
Q

HELLP can progress in to?

A

DIC

160
Q

Rupture of what organ possible with HELLP?

A

hepatic

161
Q

This occurs when the placenta obstructs fetal presentation?

A

placenta previa

162
Q

Symptom of placenta previa?

A

painless vaginal bleeding

163
Q

Be prepared for what w placenta previa?

A

lots of bleeding, must be c section

164
Q

What is placenta accreta?

A

abnormally adheres to the surface of myometrium (muscle layer)

165
Q

What is placenta increta?

A

invades myometrium

166
Q

What is placenta percreta?

A

erodes myometrium, can invade bowel, bladder, etc…probable hysterectomy

167
Q

Be prepared for what 2 things with placenta accreta, increta, and percreta?

A

massive blood loss and venous embolus

168
Q

The outermost layer that covers the uterus?

A

perimetrium

169
Q

The middle part of the uterus that contains the thick muscle layers

A

myometrium

170
Q

The innermost layer of the uterus that responds to hormonal variations during the menstrual cycle?

A

endometrium

171
Q

The chorionic villi that attach to the uterine wall penetrate this portion of the uterus?

A

endometrium

172
Q

This is separation of the placenta after 20 weeks?

A

placenta abruptae

173
Q

At what grade of placentae abruptae do you start seeing fetal distress?

A

2

174
Q

Signs of amniotic fluid embolus?

A

sudden tachypnea, pul HTN, hypoxia, CV collapse, coagulopathy

175
Q

What is the mortality rate of amniotic fluid embolus in the first hour?

A

50%

176
Q

DIC occurs in what % of pts with amniotic fluid embolus in the first hour?

A

80%

177
Q

Amniotic fluid embolus usually occurs when?

A

labor and delivery or 30 min of delivery

178
Q

What lines do you want for amniotic fluid embolus treatment?

A

PAC, a line, 2 large bore IVs

179
Q

Uterine rupture is most likely to occur when?

A

after VBAC and uterine manipulation (version)

180
Q

What do you prepare for w uterine rupture?

A

emergent laparatomy with GA

181
Q

2 possibles with uterine rupture?

A

blood loss and hysterectomy

182
Q

Continued bleeding after delivery may be? Treatment?

A

retained placenta; D&C often w regional

183
Q

2 anesthetic considerations for retained placenta?

A

follow hg closely, may be hypovolemic

184
Q

This happens when the umbilical cord protrudes out of the cervix and ahead of the fetus and is an emergency!

A

prolapsed cord

185
Q

Multiple gestation: what happens to FRC?

A

may be reduced further, decreased compliance

186
Q

Why might someone w multiple gestations require higher ITC doses?

A

increased CSF

187
Q

Is the blood volume increased with multiple gestation over the usual BV in a pregnant person?

A

yes

188
Q

3 negative affects of multiple gestation on the mother?

A

higher incidence of thrombocytopenia, increased incidence of dilutional anemia, all rates of complications greatly increased

189
Q

Good regional technique for multiple gestation?

A

epidural

190
Q

In asthmatic or hypovolemic pts, what induction drug do you want to use?

A

ketamine 1 mg/kg

191
Q

This sedative med is more likely to produce maternal hypotension and neonatal depression?

A

versed

192
Q

C section under GA: surgery is only begun when?

A

ETT placement confirmed by ETCO2

193
Q

Avoid what resp issue in C section under GA and why?

A

hypervent bc it may reduce uterine blood flow and has been associated w fetal acidosis

194
Q

Good gas to use for c section under GA and why?

A

50% nitrous w 0.75 MAC bc low volatile agent will decrease likelihood of uterine relaxation

195
Q

Do you want a muscle relaxant for c section under GA/

A

yes roc

196
Q

If uterus does not contract readily, what should you do?

A

switch to balanced technique

197
Q

Dose of methergine and side effect?

A

0.2 mg IM, increase arterial BP

198
Q

Dose of hemabate?

A

0.25 mg IM

199
Q

Good GI consideration for C sec under GA?

A

OGT to empty stomach contents

200
Q

Sensory level for spinal for C section must reach what level?

A

T4: level of pt’s nipples

201
Q

Common cause of maternal mortality during c section that can occur spontaneously?

A

hemmorrhage

202
Q

2 negatives ab spinal?

A

less control than epidural and more drop in BP

203
Q

in GA, whose life takes over precedence w failed intubation?

A

mother

6903 (12 decks)

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