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Principles II- Josh > Pregnancy A&P ppt > Flashcards

Pregnancy A&P ppt Flashcards

Josh's guide to the A&P of OB

1
Q

Parturients are rarely in _________ condition

A

optimal

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2
Q

Parturients are always considered what?

A

A “full stomach”

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3
Q

average weight gain of the Parturient

A

17%

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4
Q

2 basic reasons you have cardiovascular changes in pregnancy

A

the developing fetus

labor and delivery events with mom

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5
Q

CV physiological changes
IVF
volume/constituents
CO

A

IVF- increased
volume/constituents- diluted
CO- increased

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6
Q

CV system
Increased IVF volume and constituents begins when?
at full term can be how much? (mLs)

A

1st trimester

1500mL

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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

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8
Q

CV system

do to the extra IVF what will develope?

A

dilutional anemia

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9
Q

CV system

EBL- vaginal? c-section?

A

300-500 mL

800-1000mL

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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%)

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11
Q

CV system
Stroke volume increases what %?

A

30%

thus leading to increased CO

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12
Q

CV system
Heart rate increases what %?

A

15-25%

thus eading to increased CO

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13
Q

CV system

what happens to SVR??? and to what %

A

decreases 20%

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14
Q

CV system

what happens to SBP since SVR decreases?

A

nothing stays about the same

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15
Q

CV system

what happens to DPB since SVR decreases?

A

decreases 15%

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16
Q

CV system

PVR decreases by how much

A

35%

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17
Q

CV system

what happens to CVP?

A

No changes

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18
Q

CV system

when does Supine Hypotension Syndrome (SHS) occur

A

near term

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19
Q

CV system

s/s of SHS

A

diaphoresis
N/V
changes in cerebration

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20
Q

CV system

what is SHS

A

compression of the IVC by the gravid uterus, while in supine position

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21
Q

CV system

how does SHS work?

A

decreased venous return
leads to decreased CO
leads to decline in systemic BP

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22
Q

CV system

what happens with aortocaval compression

A

decreased SBP

decreased in uterine and placental blood flow

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23
Q

CV system

when a prego gets nauseated what do you do?

A

give ephedrine

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24
Q

CV system

what can help with SHS or aortocaval compression

A

LUD or RUD

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25
Q

CV system
what is the BEST treatment for SHS or Aortocaval compression

A

LUD with 15 degree right hip elevation

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26
Q

CV system

what is the prefered treatment for SHS or aortocaval compression

A

prevention

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27
Q

CV system
normal fetal HR
Fatal tachycardia?
Fetal bradycardia

A

Normal- 110-160
tachy- >160
brady-< 100

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28
Q

CV system

patho of SHS (of mechanism in how it actually causes hypotension)

A

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

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29
Q

CV system

what is the normal compensitory response to SHS?

A

increased SVR

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30
Q

CV system

what is the sympathetic response to regional anesthesia?

A

vasodilation
Hypotension
decreased uterine and placental blood flow (fetal acidosis)

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31
Q

CV system
pregnant women are much more dependent on the ____ - _____ _____ for maintenance of BP (supports MAP)

A

renin-angiotensin system

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32
Q

CV system

by the 3rd trimester serum renin levels are __x’s the non-pregnant level

A

3x’s

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33
Q

Pulmonary system Upper airway

what happens to the cappillary membranes

A

engorgment

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34
Q

Pulmonary system Upper airway

what happens to the vocal cords and arytenoids

A

edematous

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35
Q

Pulmonary system Minute Ventilation
MV is increased what % during 1st trimester?
what % TV and RR

A

50%
TV 40%
RR 10%

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36
Q

Pulmonary system Minute Ventilation
What is the stimulus for increased MV?
what else does it do?

A

Progesterone

sedation

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37
Q

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?

A

decreased PaCO2
from 40 mmHg to 30 mmHg
No changes in pH

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38
Q

Pulmonary system Lung Volumes

what happens to the diaphragm by the 3rd trimester

A

moves cephalad

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39
Q

Pulmonary system Lung Volumes
sense the diaphragm moves cephalad the FRC decreases by ___% by term.

A

20%

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40
Q

Pulmonary system Lung Volumes

The decreased FRC causes greater ______ ______ which ultimatly leads to _______

A

closing capacity

atelectasis

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41
Q

Pulmonary system Lung Volumes
what are the anesthestic considerations in relation to MV increase?

A

increased MV and decreased FRC => increased alveolar concentrations of inhaled anesthestics.
basically gas uptake is faster!!!

42
Q

Pulmonary system Arterial Oxygenation
what happens in early pregnancy to PaO2?
what happens later in pregnancy to PaO2?

A

early- above 100 mmHg

later- normal or slghtly decreases (airway closure)

43
Q

Pulmonary system Arterial Oxygenation

there is marked decrease in PaO2 with apnea. mainly due to what 3 things

A

decreased FRC
Decreased CO r/t aortocaval compression
Increased oxygen consumption

44
Q

Pulmonary system Physiologic changes

what to want to do with the OETT

A

select a smaller cuffed ETT (6.0-7.0)

45
Q

Pulmonary system Physiologic changes

what airway do u always want to avoid? and why?

A

nasal airways

vascular congestion

46
Q

Pulmonary system Physiologic changes

what are some reasons that make these individuals difficult airways?

A

short neck
weight gain
large breast

47
Q

Pulmonary system Physiologic changes
as stated before decreased FRC and increased MV will cause what?

A

rapid alveolar consentration of IA

48
Q

Pulmonary system Physiologic changes

rapid _________ with apnea

A

desaturation

49
Q

Pulmonary system Physiologic changes

always _________ for 5 minutes with GA, and ______ during regional anesthesia

A

preoxygenate

oxygenate

50
Q

Nervous System CNS

why are is there a decreased anesthetic requirement?

A

MAC lower VA
progesterone produced sedation
Increased inhation agent r/t pulm changes

51
Q

what is ALWAYS contraindicated in a prego?

A

LMA

52
Q

Nervous System CNS

CNS depression leads to what and why during intubation?

A

increased risk for aspiration

due to impaired upper airway reflexes

53
Q

Nervous System CNS
due to the increased risk for aspiration due to impaired upper airway reflexes what typed of intubation tech should be used

A

RSI

Cricoid pressure

54
Q

prohesterone may produce what?

A

sedation

55
Q

Nervous System Physiological changes

what 3 things change in the nervous system (mainly in r/t the spinal cord)

A

engorgement of epidural veins
decreased epidural space
decreased volume in CSF

56
Q

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?

A
  • exaggerated spread of LA

- Decreased in dose requirement by 30-50%

57
Q

Renal system

the renal system changes usually start to occur when?

A

3rd month of pregnancy

58
Q

Renal system
there is a ____ to _____% increase in RBF and GFR

A

50-60

59
Q

Renal system

there is a 50% decrease in the upper normal limits of what labs? and what are their values

A

BUN-8 mg/dL

Creatinine-0.5 mg/dL

60
Q

uterine blood flow is up to how much mL/min

A

500-700 mL/min

61
Q

Is the uterus autoregulated

A

no, it depends on the mothers BP

62
Q

the placental circulation is ______ proportional to the mean perfusion pressure across the uterus and ______ proportional to uterine vascular resistance

A

directly

inversely

63
Q

what causes decreases in uterine blood flow?

A

mothers hypotension

64
Q

do epidurals or spinal anesthesia alter uterine blood flow?

A

not if maternal hypotension is avoided

65
Q

what do contractions do to uterine blood flow?

A

decreases it

66
Q

what increases uterine vascular resistance in response to maternal stress and pain?

A

endogenous release of catecholamines

67
Q

An Anesthetic consideration is that which pressor is NOT associated with significant decreases in uterine blood flow?

A

ephedrine

68
Q

Placental exchange occurs primarily by what?

A

diffusion

69
Q

palcental diffusion depends on what 5 things

A 
maternal to fetal concentration gradients
maternal protein binding
molecular weight
lipid solubility
degree of ionization
70
Q

fetal circulation

A

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
Q

ductus venosus

A

shunts blood from the umbilical vein to inferior vena cava (bypassing liver)

72
Q

Foramen Ovale

A

Shunts blood from the RA to LA

73
Q

ductus arteriousus

A

shunts blood from pulmonary artery to descending aorta. (bypassing lungs)

74
Q

the brain and upper body receive what type of blood?

A

well oxygenated

75
Q

the abdomen and lower body receive what type os blood?

A

less well oxygenated blood

76
Q

Stages of labor

A

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
Q 
**************
1st stage Pain
what type of pain?
what causes the pain?
what type of nerve fibers?
where to the fibers origionate?
pain characteristics?
A

-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
Q 
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?
A
  • 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
Q

Hepatic system

why may succinylcholine last longer in the prego r/t hepatic

A

25% in plasma cholinesterases activity

80
Q

Hepatic system

why is the prego at increased risk for DVTs

A

hypercoaguble

81
Q

Hepatic system

which coag factors are increased

A

all

82
Q

Hepatic system

what happens to LDH, AST/SGOT, ALT/SGPT

A

increase

83
Q

Hepatic system

what are anesthetic considerations r/t the Hepatic system

A

succinycholine and mivacurium may have prolonged effect due to increased liver enzymes

84
Q

GI system

what aides in the retarding gastric emptying

A

the upward and backward displacement of the pylorus

85
Q

GI system

the decreased gastric motility is r/t _________ thus causing increased gastric fluid volume

A

Progesterone

86
Q

GI system

_________ stimulates gastric H+ ion secretion resulting in a lower pH of gastric fluid

A

Gastrin

87
Q

GI system
what is the name for the aspiration Pneumonitis that occurs with volumes >25 mL and a pH < 2.5

A

mendelson’s syndrome

88
Q

GI system
anesthetic considerations
all pregos are considered what?

A

full stomachs

89
Q

what is the treatment for aspiration prophylaxis for all pregnant women? give doses and route!

A

Reglan 10mg IV
Zantac 50mg IV
Bicitra 30 mL PO

90
Q

what is the main thing you must avoid with regional anesthesia (MOST IMPORTANT)

A

HYPOTENSION

91
Q

which anesthetic techniques decreases the likelihood of fetal drug depression and maternal pulmonary aspiration?

A

Regional

92
Q

does regional anesthesia influance the progress of labor or the ability to bear doen during the second stage of labor?

A

nope it shouldn’t

93
Q

90% of deliveries are ________ presentation in either occiput transverse or occiput anterior position

A

cephalic

normal or abnormal?????

94
Q

what are 2 abnormal presentations?

A

persistant occiput posterior

breech presentation

95
Q

you should consider _______ and ______ presentation with multiple gestations and ussually consider a ______ _______

A

prematurity
breech
cesarean section

96
Q

what is Beat to beat variability?
Is it normal?
what does it indicate?

A

FHR that varies 5-20 BPM
yes (completly normal)
nothing no worries

97
Q

what is early decelerations?
is it normal?
what does it indicate?

A
  • 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
Q 
******************
what is a late deceleration 
is it normal?
 what does it indicate?
what test is recomended?
A
  • slowing of FHF that begins 10-30 seconds after the onset of uteine contractions.
  • nope never
  • fetal distress
  • fetal scalp pH
99
Q 
***************************
what are variable decelerations?
they are generally characterized by what?
thought to be caused by what?
are the bad?
how can you fix it?
A
  • 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
Q

after birth of baby what is the first thing you suction and why

A

the babies nose- b/c it causes the first breath

101
Q

in the newborn how do you evaluate and treat hypolovolmia

A

via the umbilical vein

102
Q

for vascular resuscitation an ______ ______ ______ may be inserted. can be used for ABGs

A

umbilical arterial catheter

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