Random Flashcards
How does Progesterone affect minute ventilation?
It increases Vt by 40% and rate by 10%
Is progesterone a respiratory stimulant or depressant?
Stimulate (want more O2 for baby)
How does the body compensate for the mild respiratory alkalosis mom is in?
Renal compensation eliminates the bicarb to normalize moms pH
During pregnancy which was does the oxyhemoglobin shift? Why?
Shifts R to offload O2 to baby
How does pregnancy affect FRC? ERV or RV more?
Decreases FRC with a greater reduction to ERV than RV
What stage of labor receives the most CO?
3rd stage - 80% increase
When does CO return to normal pre labor levels? Pre pregnancy days
?
Pre labor - two days
Pre pregnancy - 2 weeks
How does SVR? BP? and blood volume change in pregnancy ?
Increase in blood volume
Decrease in DBP
= No change in BP
Who is at risk for aortocaval compression? Which trimesters?
Supine mom in the 2nd and 3rd trimester
How is aortocaval compression treated?
Turn mom left by elevating the right torso by 15 degrees
How does intravascular volume change in pregnancy? Plasma volume? RBC?
Increases by 35%
Plasma volume increases by 45%
RBC increases by 20%
Which clotting factors increase during pregnancy? Which decrease?
Increase - 1,7,8,9,10,12
Decrease - 11,13
How much does MAC change during pregnancy ? Why?
Decreases by 40% due to progesterone
Why does gastric volume and gastric pH increase during pregnancy ?
Due to increased Gastrin secretion
When does gastric emptying become slowed in pregnancy ?
At the onset of labor
How much blood flow does the uterus get in the non pregnant state?
100mL a minute
How much blood flow does the uterus get in the pregnant state?
700mL
Does uterine blood flow auto regulate?
No
Maternal hypotension, hemorrhage, aortocaval compression are examples of?
Decreased perfusion to the uterus
Uterine contraction, hypertensive conditions are examples of?
Increased resistance in the uterus
Which law is an example of why drugs pass through the placenta?
Ficks law of diffusion?
Characteristics of drugs that cross placenta?
Nonionized
Nonpolar
Low weight < 500 Daltons
High lipid solubility
Beginning of regular contractions to full dilation is what stage of labor?
stage 1
Delivery of the placenta is what stage of labor?
stage 3
How does maternal hyperventilation affect mom and baby?
Causes a left shift on the oxyHgb curve thus reducing O2 to baby
How does uncontrolled pain affect mom and baby?
Increased catecholamines caused HTN and reduce blood flow to the baby
Full dilation to delivery of baby is what stage of labor?
Stage 2
Where is the pain in the first stage of labor? How is this treated?
Lower uterus and cervix
T10 - L1
Neuraxial
Paravertebral block
Paracervical block
Where is pain in the second stage of labor? How is it treated?
Adds in vagina, perineum, and pelvic floor
S2-S4 roots
Neuraxial
Pudendal nerve block
Bupivacaine or ropivacaine, which has less risk of CV toxicity ?
Ropivacaine (S enantiomer have less risk compared to R enantiomers)
What is a risk factor with chloroprocaine?
Arachnoiditis
When is chloroprocaine useful in pregnancy? Why?
Emergency C section when epidural is in place.
Very fast on/off due to pseudocholinesterase
What is the treatment for a high spinal?
Supportive, left uterine displacement, and intubation
What is bradycardia and tachycardia in a fetus?
Brayd < 110
Tachy > 160
How is premature delivery defined?
Before 37 weeks
What is used to stop labor?
Tocolytic agents
Mag
Beta 2 (terbutaline, ritodrine)
Side effects of Beta 2? K? Glucose?
Hypokalemia from shifting K into the cell
Hyperglycemia
Do Beta 2 drugs cross the placenta?
Yes - risk for increased HR
Treatment for hypermagnesemia?
Diuretics and IV calcium
What 3 drugs are given for aspiration prophylaxis ?
Sodium citrate
H2 - ranitidine
Gastrokinetic - Reglan
Why is sodium citrate given? What does it do? When should it be given?
Neutralizes gastric acid - aspiration prophylaxis
15-30 mL / 15-30 minutes before
Why is ranitidine given? What does it do? When should it be given?
H2 receptor antagonist reduces gastric secretions
aspiration prophylaxis
1 hour before
Why is Reglan given? What does it do? When should it be given?
Gastrokinetic agent to increase gastric emptying and increase LES tone
1 hour before
When are pregnant patients considered a full stomach ?
20 weeks
When should NSAIDS be avoided? What might happen?
After the first trimester
May close ductus arteriosus
What is the triad signs of preeclampsia?
HTN after 20 weeks
Protein in urine
Generalized edema but not used anymore
What is the root cause of preeclampsia ?
Imbalance of prostacyclin and thromboxane
(more thromboxane)
What does thromboxane do?
Increases platelet aggregation
Vasoconstricts
Increases uterine activity
What does prostacyclin do?
Decreases platelet aggregation
Vasodilation
Decreases uterine activity
Most S&S are present in severe preeclampsia and not mild preeclampsia. Which S&S is present in both?
Generalized edema?
What happens to GFR and UO in severe preeclampsia vs mild preeclampsia?
Severe - has GF destruction thus having low urine output (<500mL) per day AND having protein in urine (>5g in a day)
What is the definitive treatment of preeclampsia?
Delivery
What is given to protect against seizures in preeclampsia? Dose?
Magnesium - load of 4g over 10 minutes
1g infusion per hour after
Is neuraxial anesthesia okay in preeclampsia?
Yes
How does magnesium affect NMB?
Increased sensitivity to them
Will preeclamptic patients exhibit airway swelling?
Yes - higher risk for difficult intubation
What is the definitive treatment for HELLP?
Delivery of baby
What is HELLP?
Hemolysis
Elevated liver enzymes
Low platelets
Classic S&S of HELLP?
Epigastric pain and upper abdominal tenderness
What is placenta accreta?
Attaches to myometrium
What is placenta percreta?
Extends beyond uterus
What is placenta increta?
Invades myometrium
What is placenta previa?
Attaches to the lower uterine segment
What is the number one symptom and biggest concern of placenta previa?
Painless vaginal bleeding
Covers the cervical os and increases chance for hemorrhage
What places mom at risk for increased chance of placenta previa?
Previous c sections and multiple births
If an epidural is in place and mom has sudden breakthrough pain, what could be happening?
Placental abruption
What is the most common cause of postpartum hemorrhage in pregnancy ?
Uterine atony
Best drug for retained placental fragments?
IV nitroglycerine
Best treatment for uterine atony?
Uterine massage
Oxytocin
Ergot alkaloids
Intrauterine balloon
What is a normal Apgar score?
8-10
What is a moderate distress Apgar score?
4-7
What is impending distress Apgar score?
0-3
When is the Apgar score calculated?
1 and 5 minutes after delivery
What does the 1-minute Apgar score indicate?
Baby acid-base levels
What does the 5-minute Apgar score indicate?
Predictive to neurologic outcomes
Baby has no heart rate, what is the Apgar score?
0
Baby has a heart rate of less than 100, what is the Apgar score?
1
What is the Apgar score if baby has a heart rate over 100?
2
Apgar score for Respiratory effort?
Absent - 0
Slow and irregular - 1
Normal and crying - 2
Apgar score for muscle tone?
Limp - 0
Some flexion - 1
Active - 2
Apgar score for Reflex?
Absent - 0
Grimace - 1
Cough,sneeze,cry - 2
Apgar score for color?
Pale/blue - 0
Body pink but blue extrem - 1
Pink - 2
Best indicator of ventilation during neonatal resuscitation?
Resolution of bradycardia
What size tube and handle should be used?
Downsize the tube - 6.0 to 7.0
Short handle is recommended ( data handle)
What happens to the nasal passages and airway during pregnancy ?
Due to increased volume, relaxin, progesterone, and estrogen these areas become engorged and swollen
