Physiologic changes of pregnancy

Question 1

What happens to Cardiac output in pregnancy and why? when will it be normal again?

Answer 1

Increases secondary to an increase in SV and HR. Will return to normal over 12 weeks postpartum

Question 2

What happens to BP, PVR, and SVR during preggo?

Answer 2

They all decrease

Question 3

What happens to CVP, EF, and PAP during preggo

Answer 3

They stay the same

Question 4

Which kind of EKG changes can you see with preggo?

Answer 4

Left axis deviation, sinus tachy, inverted or flattened t waves, Q waves in lead 3

Question 5

Explain the anemia of preggo:

Is O2 transport affected? Why or why not?

Answer 5

Physiologic. Plasma vol increases by a higher percentage compared to cell volume which will decrease HCT. O2 transport NOT affected due to increase in CO and increased partial pressure of O2 and rightward shift of oxyhemoglobin dissociation curve

Question 6

Explain hypercoaguable state in preggo:

What happens to albumin levels and colloid oncotic pressure?

Answer 6

increased levels of most coagulation factors: 7, 9, 10, 12 with the largest increase in factor 7 and fibrinogen
Albumn and colloid oncotic pressure decrease

Acquired resistance to protein C

Question 7

Respiratory system and preggo-pulmvonary blood volume? minute ventilation?

Answer 7

increase in TV with constant respiratory rate (increased MV)
increased pulmonary blood flow with increased pulmonary capillary blood volume which can lead to pulmonary edema

Question 8

Is there (in preggo) a change in resp rate? closing capacity? vital capacity? FEV1?

Answer 8

No change in any of those

Question 9

Is there a change in preggo of FRC/closing capacity ratio?

Answer 9

Yes, decreased resulting in faster small airway closure when lung volume is reduced

Question 10

Nasal intubations and preggo? why or why not? what makes pregnant people more difficult to intubate?

Answer 10

Don’t do it. Capillary engorgement of mucosa due to increased blood volume, edema of oropharynx, larynx and trachea. Use a smaller tube!

Question 11

What 5 things does progesterone do to pregnant women as far as GI issues are concerned?

Answer 11

1. Relaxes smooth muscle
2. Impairs esophageal motility
3. Reduces lower esophageal sphincter tone
4. Increases production of gastrin (increases gastric acidity)
5. Delayed gastric emptying/increased emesis

Question 12

Does epidural analgesia with local anesthetics and opioids affect patient’s gastric emptying? Which liver lab values are increased/decreased in preggo?

Answer 12

NO. Increased alk phos, decreased transaminase and bilirubin levels

Question 13

Never forget-even with preggo, the number one contraindication to regional is:
Renal system: plasma creatinine and urea are:

Answer 13

patient refusal

Plasma creatinine and urea are decreased