OB

Question 1

FRC in preggo?

Answer 1

It decreases

Question 2

Heart in preggo-where does it move and what happens with S1? Changes on EKG? CXR?

Answer 2

Moves anteriorly and to the left-from 4th IC to mid clavicular line
LVH on EKG by 12 weeks
CXR-increase in Kung markings may resemble CHF
4 cm elevation of diaphragm and increase in transverse cardiac diameter

Question 3

Most of increase in CO is due to an increase in

Answer 3

SV primarily, but HR contributes also

Question 4

Aortocaval compression starts:

Supine hypotension syndrome:

Answer 4

Starts at 13-16 weeks.

Supine hypotensive syndrome happens when-hypotension from decreased venous return becomes symptomatic

Question 5

Why is there a decrease in Hct?

Answer 5

Increase by 55% in plasma volume and only 30% increase in RBC volume

Question 6

Factors that decrease in preggo-

WBC in preggo

Answer 6

11,13, AT3

WBC 9-11 term, 13 with preggo

Question 7

Does gastric emptying change during labor?
LES tone with preggo?
When do preggo women go back to normal as far as gastric emptying, pH and volume?

Answer 7

No, but volume increases and oH decreases with labor
LES tone is decreased during preggo
Normal by post op day 1-3

Question 8

Pseudocholinesterase activity decreases by 25% during preggo-does this affect drug metabolism?
Plasma proteins do what in preggo?

Answer 8

Not significantly

Plasma proteins decrease

Question 9

Renal stuff (RBF and GFR) in preggo? 
Glucosurua? Proteinuria?

Answer 9

RBF increased 75-85% and GFR increases 50%, so creatinine and BUN decrease
Glucosuria due to increased GFR and proteinuria very slightly elevated.

Question 10

Why are preggos more sensitive to DM? Thyroid in pregnancy?

S3 in preggo-are you worried?

Answer 10

Increased tissue sensitivity to insulin
Thyroid-size increases due to follicular hyperplasia and vascularity. Free t3 and t4 are unchanged. Regular is increased
S3-no worries here

Question 11

In lateral position, collateral venous return happens how?

Answer 11

via vertebral venous plexus and paradoxical veins, drain into the azygous-preserving venous return

Question 12

What is the term for what makes the epidural space smaller in preggo?

Answer 12

Venous plexus compression of epidural and intrathecal spaces

Question 13

Normal term ABG

Answer 13

7.44/30/103

Question 14

What accounts for increase in MV during preggo?

Answer 14

MV= TV x RR. Primarily increase in TV, RR increases 15%. Progesterone May mediate increased respiratory sensitivity

Question 15

EKG changes in pregnancy

Answer 15

Mid systolic murmur at left sternal border. Sinus tachycardia and LVH okay. Shortened PR and QT interval okay. Depressed ST segment can happen, and mild cardiomegaly with increased lung markings

Question 16

Normal hemoglobin at term:

Answer 16

11 weeks

Question 17

Why are parturients full stomachs?

Answer 17

Upward displacement of stomach-impairs GE mechanism of GR junction. Gastric em out yong May be prolonged, ph

Question 18

Are you concerned about liver function in preggo?

Answer 18

Total protein, albumin, and colloid oncotic pressure are reduced. But it’s questionable if these significantly increase free fraction of drugs.

Question 19

Physiologic changes if preggo start when?

Answer 19

Start in first trimester. Increase in MV by 6-7 weeks. Decrease in FRC by 5 mos