Pregnancy A&P ppt Flashcards
Josh's guide to the A&P of OB
1
Q
Parturients are rarely in _________ condition
A
optimal
2
Q
Parturients are always considered what?
A
A “full stomach”
3
Q
average weight gain of the Parturient
A
17%
4
Q
2 basic reasons you have cardiovascular changes in pregnancy
A
the developing fetus
labor and delivery events with mom
5
Q
CV physiological changes
IVF
volume/constituents
CO
A
IVF- increased
volume/constituents- diluted
CO- increased
6
Q
CV system
Increased IVF volume and constituents begins when?
at full term can be how much? (mLs)
A
1st trimester
1500mL
7
Q
CV system
plasma volume increases what %
erythrocyte volume increases what %
what happenes to albumin (plasma protein)
A
plasma volume- 45% (40-50%)
erythrocyte volume- 20%
albumin (plasma protein)- decreases
8
Q
CV system
do to the extra IVF what will develope?
A
dilutional anemia
9
Q
CV system
EBL- vaginal? c-section?
A
300-500 mL
800-1000mL
10
Q
CV system CO increases by what % in the following: 10th week of gestation? 3rd trimester post delivery
A
10th week- 10%
3rd trimester- 40-50%
post delivery- 60-80% (up to 180%)
11
Q
CV system
Stroke volume increases what %?
A
30%
thus leading to increased CO
12
Q
CV system
Heart rate increases what %?
A
15-25%
thus eading to increased CO
13
Q
CV system
what happens to SVR??? and to what %
A
decreases 20%
14
Q
CV system
what happens to SBP since SVR decreases?
A
nothing stays about the same
15
Q
CV system
what happens to DPB since SVR decreases?
A
decreases 15%
16
Q
CV system
PVR decreases by how much
A
35%
17
Q
CV system
what happens to CVP?
A
No changes
18
Q
CV system
when does Supine Hypotension Syndrome (SHS) occur
A
near term
19
Q
CV system
s/s of SHS
A
diaphoresis
N/V
changes in cerebration
20
Q
CV system
what is SHS
A
compression of the IVC by the gravid uterus, while in supine position
21
Q
CV system
how does SHS work?
A
decreased venous return
leads to decreased CO
leads to decline in systemic BP
22
Q
CV system
what happens with aortocaval compression
A
decreased SBP
decreased in uterine and placental blood flow
23
Q
CV system
when a prego gets nauseated what do you do?
A
give ephedrine
24
Q
CV system
what can help with SHS or aortocaval compression
A
LUD or RUD
25
******************
CV system
what is the BEST treatment for SHS or Aortocaval compression
LUD with 15 degree right hip elevation
26
CV system
| what is the prefered treatment for SHS or aortocaval compression
prevention
27
CV system
normal fetal HR
Fatal tachycardia?
Fetal bradycardia
Normal- 110-160
tachy- >160
brady-< 100
28
CV system
| patho of SHS (of mechanism in how it actually causes hypotension)
a compensitory response
- paravertebral venous plexuses => azygos vein=> SVC
- reflex increases peripheral SNS => increases SVR, maintains SBP despite decreased CO
Uncompensated
- Decreased SBP < 100mmHg
=> fetal acidosis
=> bradycardia
29
CV system
| what is the normal compensitory response to SHS?
increased SVR
30
CV system
| what is the sympathetic response to regional anesthesia?
vasodilation
Hypotension
decreased uterine and placental blood flow (fetal acidosis)
31
*****************
CV system
pregnant women are much more dependent on the ____ - _____ _____ for maintenance of BP (supports MAP)
renin-angiotensin system
32
CV system
| by the 3rd trimester serum renin levels are __x's the non-pregnant level
3x's
33
Pulmonary system Upper airway
| what happens to the cappillary membranes
engorgment
34
Pulmonary system Upper airway
| what happens to the vocal cords and arytenoids
edematous
35
*************
Pulmonary system Minute Ventilation
MV is increased what % during 1st trimester?
what % TV and RR
50%
TV 40%
RR 10%
36
******************
Pulmonary system Minute Ventilation
What is the stimulus for increased MV?
what else does it do?
Progesterone
| sedation
37
Pulmonary system Minute Ventilation
the 50% increase in MV will cause what problem?
what is the decrease from what to what?
any changes in pH?
decreased PaCO2
from 40 mmHg to 30 mmHg
No changes in pH
38
Pulmonary system Lung Volumes
| what happens to the diaphragm by the 3rd trimester
moves cephalad
39
*********************
Pulmonary system Lung Volumes
sense the diaphragm moves cephalad the FRC decreases by ___% by term.
20%
40
Pulmonary system Lung Volumes
| The decreased FRC causes greater ______ ______ which ultimatly leads to _______
closing capacity
| atelectasis
41
***************************************
Pulmonary system Lung Volumes
what are the anesthestic considerations in relation to MV increase?
increased MV and decreased FRC => increased alveolar concentrations of inhaled anesthestics.
basically gas uptake is faster!!!
42
Pulmonary system Arterial Oxygenation
what happens in early pregnancy to PaO2?
what happens later in pregnancy to PaO2?
early- above 100 mmHg
| later- normal or slghtly decreases (airway closure)
43
Pulmonary system Arterial Oxygenation
| there is marked decrease in PaO2 with apnea. mainly due to what 3 things
decreased FRC
Decreased CO r/t aortocaval compression
Increased oxygen consumption
44
Pulmonary system Physiologic changes
| what to want to do with the OETT
select a smaller cuffed ETT (6.0-7.0)
45
Pulmonary system Physiologic changes
| what airway do u always want to avoid? and why?
nasal airways
| vascular congestion
46
Pulmonary system Physiologic changes
| what are some reasons that make these individuals difficult airways?
short neck
weight gain
large breast
47
*****************************
Pulmonary system Physiologic changes
as stated before decreased FRC and increased MV will cause what?
rapid alveolar consentration of IA
48
Pulmonary system Physiologic changes
| rapid _________ with apnea
desaturation
49
Pulmonary system Physiologic changes
| always _________ for 5 minutes with GA, and ______ during regional anesthesia
preoxygenate
| oxygenate
50
Nervous System CNS
| why are is there a decreased anesthetic requirement?
MAC lower VA
progesterone produced sedation
Increased inhation agent r/t pulm changes
51
**********************
| what is ALWAYS contraindicated in a prego?
LMA
52
Nervous System CNS
| CNS depression leads to what and why during intubation?
increased risk for aspiration
| due to impaired upper airway reflexes
53
Nervous System CNS
due to the increased risk for aspiration due to impaired upper airway reflexes what typed of intubation tech should be used
RSI
| Cricoid pressure
54
*************************
| prohesterone may produce what?
sedation
55
Nervous System Physiological changes
| what 3 things change in the nervous system (mainly in r/t the spinal cord)
engorgement of epidural veins
decreased epidural space
decreased volume in CSF
56
************************
Nervous System Physiological changes
due to the engorgement of epidural veins, the decreased epidural space, and decreased volume of CSF what are 2 important anesthestic considerations?
- exaggerated spread of LA
| - Decreased in dose requirement by 30-50%
57
Renal system
| the renal system changes usually start to occur when?
3rd month of pregnancy
58
*************
Renal system
there is a ____ to _____% increase in RBF and GFR
50-60
59
Renal system
| there is a 50% decrease in the upper normal limits of what labs? and what are their values
BUN-8 mg/dL
| Creatinine-0.5 mg/dL
60
uterine blood flow is up to how much mL/min
500-700 mL/min
61
Is the uterus autoregulated
no, it depends on the mothers BP
62
the placental circulation is ______ proportional to the mean perfusion pressure across the uterus and ______ proportional to uterine vascular resistance
directly
| inversely
63
what causes decreases in uterine blood flow?
mothers hypotension
64
do epidurals or spinal anesthesia alter uterine blood flow?
not if maternal hypotension is avoided
65
what do contractions do to uterine blood flow?
decreases it
66
what increases uterine vascular resistance in response to maternal stress and pain?
endogenous release of catecholamines
67
An Anesthetic consideration is that which pressor is NOT associated with significant decreases in uterine blood flow?
ephedrine
68
Placental exchange occurs primarily by what?
diffusion
69
palcental diffusion depends on what 5 things
```
maternal to fetal concentration gradients
maternal protein binding
molecular weight
lipid solubility
degree of ionization
```
70
*************
| fetal circulation
1) well oxygenated blood enters fetus from the placenta via the UMBILICAL VEIN
2) IVF has 3 sources
3) blood enters the RA from the IVC; better saturated blood enters LA via the FORAMEN OVALE
4) blood enter the LV and is ejected into the ASCENDING AORTA
5) returns to the heart via the SUPERIOR VENA CAVA and combines with the blood in the RA
6) enters RV and is ejected into the PULMONARY ARTERY, small amounts goes to the LUNGS the remainde shunted across the ductus arteriousus.
71
*********************
| ductus venosus
shunts blood from the umbilical vein to inferior vena cava (bypassing liver)
72
*****************
| Foramen Ovale
Shunts blood from the RA to LA
73
******************
| ductus arteriousus
shunts blood from pulmonary artery to descending aorta. (bypassing lungs)
74
the brain and upper body receive what type of blood?
well oxygenated
75
the abdomen and lower body receive what type os blood?
less well oxygenated blood
76
******************
| Stages of labor
1st- onset of regular contractions(latent and active stages) ends with full cervical dilation (10 cm at term)
2nd stage- begins with full dilation of the cervix, ends with delivery of baby
3rd stage- delivery of infant untill placenta is expelled
77
```
**************
1st stage Pain
what type of pain?
what causes the pain?
what type of nerve fibers?
where to the fibers origionate?
pain characteristics?
```
-VISCERAL
-caused by uterine contractions an ddilation of cervix
-Autonomic C fibers
-enter the dorsal horn of the spinal cord T10-L1
-dull- aching pain
(how to remember For Jake)
know the C
visCeral pain
caused by Contractions and dilation Cervix
autonomic C fibers
78
```
2nd stage Pain
what type of pain?
what causes the pain?
what type of nerve fibers?
name of the nerves?
where to the fibers origionate?
```
- SOMATIC
- caused by the stretching of the vagina and perineum by desecent of the fetus
- A-Delta
- pudendal nerves
- enter spinal cord at posterior roots S2-4
(how to remember Somatic Seecond stage remember the S)
79
Hepatic system
| why may succinylcholine last longer in the prego r/t hepatic
25% in plasma cholinesterases activity
80
Hepatic system
| why is the prego at increased risk for DVTs
hypercoaguble
81
Hepatic system
| which coag factors are increased
all
82
Hepatic system
| what happens to LDH, AST/SGOT, ALT/SGPT
increase
83
Hepatic system
| what are anesthetic considerations r/t the Hepatic system
succinycholine and mivacurium may have prolonged effect due to increased liver enzymes
84
GI system
| what aides in the retarding gastric emptying
the upward and backward displacement of the pylorus
85
GI system
| the decreased gastric motility is r/t _________ thus causing increased gastric fluid volume
Progesterone
86
GI system
| _________ stimulates gastric H+ ion secretion resulting in a lower pH of gastric fluid
Gastrin
87
**********************
GI system
what is the name for the aspiration Pneumonitis that occurs with volumes >25 mL and a pH < 2.5
mendelson's syndrome
88
****************************
GI system
anesthetic considerations
all pregos are considered what?
full stomachs
89
***********************
| what is the treatment for aspiration prophylaxis for all pregnant women? give doses and route!
Reglan 10mg IV
Zantac 50mg IV
Bicitra 30 mL PO
90
what is the main thing you must avoid with regional anesthesia (MOST IMPORTANT)
HYPOTENSION
91
which anesthetic techniques decreases the likelihood of fetal drug depression and maternal pulmonary aspiration?
Regional
92
does regional anesthesia influance the progress of labor or the ability to bear doen during the second stage of labor?
nope it shouldn't
93
90% of deliveries are ________ presentation in either occiput transverse or occiput anterior position
cephalic
| normal or abnormal?????
94
what are 2 abnormal presentations?
persistant occiput posterior
| breech presentation
95
you should consider _______ and ______ presentation with multiple gestations and ussually consider a ______ _______
prematurity
breech
cesarean section
96
************************************
what is Beat to beat variability?
Is it normal?
what does it indicate?
FHR that varies 5-20 BPM
yes (completly normal)
nothing no worries
97
**********************
what is early decelerations?
is it normal?
what does it indicate?
- the slowing of the FHF that begins with the onset of uterine contraction
- yep (no worries no problems)
- nothing NOT indicative of fetal distress
98
```
******************
what is a late deceleration
is it normal?
what does it indicate?
what test is recomended?
```
- slowing of FHF that begins 10-30 seconds after the onset of uteine contractions.
- nope never
- fetal distress
- fetal scalp pH
99
```
***************************
what are variable decelerations?
they are generally characterized by what?
thought to be caused by what?
are the bad?
how can you fix it?
```
- variable in magnitude, duration and time of onset
- generally characterized by a steep descent of FHR
- umbilical cord compression
- unless prolonged, they are usually benign
- changing maternal position
100
after birth of baby what is the first thing you suction and why
the babies nose- b/c it causes the first breath
101
in the newborn how do you evaluate and treat hypolovolmia
via the umbilical vein
102
for vascular resuscitation an ______ ______ ______ may be inserted. can be used for ABGs
umbilical arterial catheter
