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Boards: Pregnancy, Neonatology > Pregnancy > Flashcards

Pregnancy Flashcards

1
Q

Dogs, Cats - gestation, placental types

A

Gestation ~60d - dogs 58-68d, cats 64-67d

Zonary placenta, endothelial Attachment

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2
Q

Horses - gestation, placental types

A

11mo - 335-342d
Diffuse/microcotylendonary placenta with epitheliochorial attachment

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3
Q

Sheep, Dogs - gestation, placenta type

A

~150d, cotyledonary, epitheliochorial attachment

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4
Q

Bovids - gestation, placenta type

A

280-290d

Cotyledonary, epithelial attachment

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5
Q

Pigs - gestation, placenta type

A

3mo, 3wk, 3d - ~115d

Diffuse, epitheliochorial

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6
Q

Epitheliochorial Placental Barrier

A

least invasive, three layers of tissue btw maternal and fetal blood

LA: pigs, cows, horses, SR

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7
Q

Endotheliochorial Placental Barrier

A

– partially invasive, only endothelial wall of mom’s blood vessels and interstitial tissue between maternal and fetal blood

Dogs, cats

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8
Q

Hemochorial Placental Barrier

A

– trophoblast cells line maternal vasculature in placenta, maternal blood in direct contact with placental chorion

Humans

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9
Q

Changes in Circulating Blood Volume, etc In Pregnancy

A

–Blood vol increases by ~40%, PCV drops DT increase in plasma volume
–Increase in HR, SV –> CO increases by 30-50%
–Progesterones: increase venous capacitance, decrease SVR; SAP, DAP normal DT increased CO
–BP decreases by 20% - increases to meet non-pregnant values to term

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10
Q

Effect of Pregnancy: PCV

A

–Decreases PCV DT 50% increase in plasma volume at gestation
–PCV nadir at second trimester - PCV in healthy dogs at term similar to non-pregnant dogs

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11
Q

Changes During Labor

A

–CO increases another 10-25%
–MOA: uterine contraction, increased SV; loss of uterus/decreased SVR, release of aortovenous compression
–SAP increases by 10-30mm Hg
–CVP increases slightly with labor (4-6mmHg), increases drastically during painful fetal extraction (up to 50cmH2O)

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12
Q

Perfusion to the Uterus

A

NO AUTOREGULATION, completely dependent on BP for perfusion

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13
Q

Compression of VC, aorta by uterus in dorsal recumbency

A

decreases VR, CO –> Subsequent decreases in uterine BF, RBF

Positional marked decrease in BP DT aortovenous compression
* At term: almost complete inferior VC compression (dorsal)
* Increased risk of thromboembolism
* Compensatory response: increased sympathetic tone – eliminated via LA epidural or GA

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14
Q

Other Cardiac Changes Associated with Pregnancy

A

Increased cardiac work, decreased cardiac reserves
Workload = ventricular pressure x volume *area within PV loop
* Increased cardiac oxygen demand DT increased cardiac workload

Decreased reserve – not able to compensate, hypotension fairly fluid responsive
* Patient with heart dz can become decompensated

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15
Q

Ecbolic Drugs

A
  • Oxytocin: vasodilation, hypotension
  • Ergot (to control uterine bleeding): VC, hypertension
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16
Q

How does the O2 Curve Shift in mom?

A

TO THE RIGHT

Increased 2,3 DPG - ensures oxygen has a lower affinity for hgb so will offload to fetus

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17
Q

What pulmonary factors generally decrease throughout pregnancy?

A

Residual Vol
FRC
TLC (LJ: no change)
High Affinity for Oxygen

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18
Q

What pulmonary factors generally increase throughout pregnancy?

A

VT
Minute ventilation: DT increased myocardial O2 consumption, causes respiratory alkalosis - pH normalized via renal compensation

19
Q

Changes with PaCO2 During Pregnancy

A

Increased serum progesterone increases respiratory center CO2 sensitivity, minute ventilation increases (40-50%)
 PaCO2 decreases during gestation (~30mmHg around parturition)
 Renal compensation leads to normal pH

Oxygen consumption increases 20%
* Due to developing fetus, placenta, uterine muscle, mammary tissue

20
Q

Capacities Changes During Pregnancy

A

–FRC reduced DT cranial displacement of diaphragm: normally, FRC&raquo_space;> CC
–Closing capacity unchanged: FRC reduction matches closing capacity, leading to atelectasis = prone to hypoxemia, hypoventilation induces hypoxemia more easily

21
Q

Airway Changes During Pregnancy

A

Airway conductance increased, pulmonary resistance decreased by progesterone induced bronchodilation

22
Q

FRC Changes During Labor

A

FRC reduces further DT increased pulmonary blood volume
* Small airway closure develops at end exhalation in 1/3 of humans
* Normally: FRC&raquo_space;> CC
* Closing capacity remains unchanged: FRC reduction matches closing capacity, leading to atelectasis = prone to hypoxemia

23
Q

Which capacities are unaltered during pregnancy?

A

TLC, VC, PaO2

24
Q

Consequence of inhalant induction in pregnant patients?

A

Induction with inhalation agent more rapid DT decreased FRC, progesterone and endorphin levels in CNS reduce MAC
* MAC of isoflurane by up to 40%
* Greater CO, more drug taken up by blood, slower rise in [alveolar]

25
Q

Pregnancy GI Effects: Decreased function?

A

–Delayed gastric emptying (displacement of stomach by uterus)
–Decreased motility (progesterone)
–Decreased LES: progesterone

26
Q

Pregnancy GI Effects: Increased?

A

–Intragastric pressure, altered stomach position DT gravid uterus
–Increased gastrin production, more gastric acid secretions - progesterone

27
Q

Consequences of GI Effects in Pregnancy?

A

High risk for regurgitation, aspiration
 May present to ER with full stomachs
 Risk of vomiting increased by hypotension, hypoxia, toxic reactions to LAs
 Antiemetics: metoclopramide, H2 blocker, cerenia
 Rapid airway control, cuffed ETT

28
Q

Hepatic Changes with Pregnancy

A

–Minor alterations to function - normal biotransformation of drugs
–Total plasma protein increased DT increased blood vol, even though plasma protein concentrations slightly decreased
–ALP, ALT mildly increased
–PChE decreased - prolonged DOA sux
–Increased HBF

29
Q

Renal Changes with Pregnancy

A

–Increased GFR, RBF - 50-60% by third trimester, remains so until 3mo post partum
–BUN/creatinine may be lower than normal - can be more difficult to determine renal dz
–Na, H2O balance unchanged
–Elsewhere: activation of RAAS - significant water, Na retention; decreased plasma osmolality

30
Q

Causes of Decreased Uterine Blood Flow?

A

 Maternal hypovolemia, hypotension
 Uterine ctx
 Caval compression
 Anesthesia induced CV depression
 Sympathetic blockade (LAs), increased SNS tone
 Hypocapnia

Result: placental hypoperfusion, fetal hypoxia, acidosis, fetal distress

31
Q

Uterine Blood Flow

A

Directly proportional to systemic perfusion pressure, inversely proportional total vascular resistance

Uterine BF entirely dependent on maternal CO, uterine perfusion pressure
o Increases dramatically in pregnancy, up to 10% of CO at end of pregnancy
o Uterine vascular resistance increased by contractions

32
Q

Coagulation Changes with Pregnancy

A

hypercoagulable state (progesterone)

Increased plasma levels of VII, VIII, IX, X, XII, fibrinogen, vWF

33
Q

Blood Work Changes Assoc with Pregnancy

A

Thrombocytopenia: increased platelet turnover, hemodilution

Leukocytosis (neutrophilia)

Decreased plasma proteins including albumin – hemodilution

Increased ALP – placental production

34
Q

Specific Drug Metabolism Changes with Pregnancy

A

● Barbiturate biotransformation reduced in pregnancy
● Succinylcholine, procaine metabolism reduced DT PChE decreases
● Increased RBF, GFR increase excretion
● MAC reduced

35
Q

MOA transfer of drugs across placenta?

A

DIFFUSION

▪ Low MW(<500Da), low protein binding, high lipid solubility, non-ionized diffuse quickest
● Most anesthetics diffuse quickly

Placental thickness decreases as gestation progresses: increase drug diffusion into fetus

36
Q

Weak Acids

A

less ionized as pH decreases (barbiturates)

37
Q

Weak Bases

A

more highly ionized at pH values less than pKa (opioids, LAs)

38
Q

Drug Concentrations in the Fetus

A

Drug concentrations in umbilical vein greater than in fetal organs
o Up to 85% of umbilical blood initially passes through fetal liver

Drugs may get metabolized, sequestered in liver

Umbilical venous blood mixes with inferior vena cava - buffering drug concentration changes initially

39
Q

Fetus Drug Metabolism

A

o Fetal microsomal enzymes not as active (longer drug half-lives)
o Fetal drug toxicity enhanced by fetal or maternal metabolism into toxic metabolites

Dog fetal liver: no fetal liver

40
Q

Risks Assoc with Ax during the first trimester?

A

fetal teratogenesis, spontaneous abortion, fetal death

41
Q

Risks Assoc with Anesthesia During Middle Trimester?

A

generally considered safest; spontaneous abortion, fetal death reported

42
Q

Risks Assoc Anesthesia during Third Trimester?

A

carries risk of premature labor, fetal death

43
Q

Which species lack fetal hgb?

A

Pigs, guinea pigs, rats, chickens, horses, cats, dogs, rabbits

Boards: Pregnancy, Neonatology (5 decks)

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