obstetrics Flashcards
physiology of upper airway swelling in the parturient
increased progesterone, estrogen, and relaxin cause vascular engorgement and hyperemia. also larger ECF volume- all lead to upper aw swelling. this affects nasal passages, oropharynx, epiglottis, larynx, trachea
what size ett for parturient
6-7 ETT r/t narrowed glottic opening
what’s the name for a short handled laryngoscope
Datta handle
should you do an NPA in a parturient
no, try to avoid. all of her is engorged ok, including the nasal passages
aw edema is made worse by what?
pre eclampsia, tocolytics, prolonged trendelenburg
FRC in relation to closing capacity for parturient
FRC falls below closing capacity in parturient, leading to aw closure during tidal breathing
what would you expect the ABG of a parturient to look like
pH: no change
PaO2: increased to 104-108mmHg (d/t hyperventilation)
PaCO2 decreased to 28-32
HCO3- decreased to 20mmoL
P50 in a parturient shifts to
right or is increased, increased O2 to fetus this way
mom p50: 30mmHg
fetus P50: 19mmHg (left, decreased)
how much does O2 consumption increase during pregnancy
20%
changes in HR and SV for parturient
both increase, 15 and 30% respectively
percent increase in CO during labor stages
1st stage: 20%
2nd stage: 50%
3rd stage: 80%
SVR and PVR changes during pregnancy
decrease in SVR because progesterone produces NO which causes vasodilation and decrease in PVR in response to angiotensin and NE
overall effect of progesterone on parturient
cardiac axis deviation during pregnnacy
left axis deviation due to diaphragm being pushed cephalad so heard is pushed up and left
left displacement of uterus should be used during which trimesters
both second and third
clotting factors that increase in a parturient include
1, 7, 8, 9, 10, 12. (pregnancy causes hyper coagulable state- DVT is 6 times higher risk in parturients
anticoagulants that decrease during pregnancy include
antithrombin and protein s
fibrinolytic system in parturient
increase in fibrin breakdown but decrease in factors 11 and 13- mom makes more clot but also breaks it down faster
how much does PT/PTT decrease in a parturient
20%
PT: 9.6-12.9 seconds
PTT: 25-35 seconds
how does platelet count change in a parturient
remains unchanged or decreases up to 10% (due to hemodilution and consumption)
do filling pressures (CVP and PAOP) change during pregnancy?
no
why does creatinine clearance increase in a parturient
r/t increased intravascular volume and CO- more creatinine delivered to the kidney per unit of time
what happens to creatinine and BUN in parturient
decreased
why does urine glucose increase in parturient
increased GFR and reduced reabsorption in peritubular capillaries