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1
Q

How does Progesterone affect minute ventilation?

A

It increases Vt by 40% and rate by 10%

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2
Q

Is progesterone a respiratory stimulant or depressant?

A

Stimulate (want more O2 for baby)

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3
Q

How does the body compensate for the mild respiratory alkalosis mom is in?

A

Renal compensation eliminates the bicarb to normalize moms pH

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4
Q

During pregnancy which was does the oxyhemoglobin shift? Why?

A

Shifts R to offload O2 to baby

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5
Q

How does pregnancy affect FRC? ERV or RV more?

A

Decreases FRC with a greater reduction to ERV than RV

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6
Q

What stage of labor receives the most CO?

A

3rd stage - 80% increase

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7
Q

When does CO return to normal pre labor levels? Pre pregnancy days
?

A

Pre labor - two days

Pre pregnancy - 2 weeks

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8
Q

How does SVR? BP? and blood volume change in pregnancy ?

A

Increase in blood volume
Decrease in DBP

= No change in BP

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9
Q

Who is at risk for aortocaval compression? Which trimesters?

A

Supine mom in the 2nd and 3rd trimester

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10
Q

How is aortocaval compression treated?

A

Turn mom left by elevating the right torso by 15 degrees

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11
Q

How does intravascular volume change in pregnancy? Plasma volume? RBC?

A

Increases by 35%

Plasma volume increases by 45%

RBC increases by 20%

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12
Q

Which clotting factors increase during pregnancy? Which decrease?

A

Increase - 1,7,8,9,10,12
Decrease - 11,13

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13
Q

How much does MAC change during pregnancy ? Why?

A

Decreases by 40% due to progesterone

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14
Q

Why does gastric volume and gastric pH increase during pregnancy ?

A

Due to increased Gastrin secretion

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15
Q

When does gastric emptying become slowed in pregnancy ?

A

At the onset of labor

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16
Q

How much blood flow does the uterus get in the non pregnant state?

A

100mL a minute

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17
Q

How much blood flow does the uterus get in the pregnant state?

A

700mL

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18
Q

Does uterine blood flow auto regulate?

A

No

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19
Q

Maternal hypotension, hemorrhage, aortocaval compression are examples of?

A

Decreased perfusion to the uterus

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20
Q

Uterine contraction, hypertensive conditions are examples of?

A

Increased resistance in the uterus

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21
Q

Which law is an example of why drugs pass through the placenta?

A

Ficks law of diffusion?

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22
Q

Characteristics of drugs that cross placenta?

A

Nonionized
Nonpolar
Low weight < 500 Daltons
High lipid solubility

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23
Q

Beginning of regular contractions to full dilation is what stage of labor?

A

stage 1

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24
Q

Delivery of the placenta is what stage of labor?

A

stage 3

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25
Q

How does maternal hyperventilation affect mom and baby?

A

Causes a left shift on the oxyHgb curve thus reducing O2 to baby

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25
Q

How does uncontrolled pain affect mom and baby?

A

Increased catecholamines caused HTN and reduce blood flow to the baby

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25
Q

Full dilation to delivery of baby is what stage of labor?

A

Stage 2

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26
Q

Where is the pain in the first stage of labor? How is this treated?

A

Lower uterus and cervix
T10 - L1

Neuraxial
Paravertebral block
Paracervical block

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27
Q

Where is pain in the second stage of labor? How is it treated?

A

Adds in vagina, perineum, and pelvic floor
S2-S4 roots

Neuraxial
Pudendal nerve block

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28
Q

Bupivacaine or ropivacaine, which has less risk of CV toxicity ?

A

Ropivacaine (S enantiomer have less risk compared to R enantiomers)

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29
Q

What is a risk factor with chloroprocaine?

A

Arachnoiditis

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30
Q

When is chloroprocaine useful in pregnancy? Why?

A

Emergency C section when epidural is in place.

Very fast on/off due to pseudocholinesterase

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31
Q

What is the treatment for a high spinal?

A

Supportive, left uterine displacement, and intubation

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32
Q

What is bradycardia and tachycardia in a fetus?

A

Brayd < 110
Tachy > 160

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33
Q

How is premature delivery defined?

A

Before 37 weeks

34
Q

What is used to stop labor?

A

Tocolytic agents

Mag
Beta 2 (terbutaline, ritodrine)

35
Q

Side effects of Beta 2? K? Glucose?

A

Hypokalemia from shifting K into the cell

Hyperglycemia

36
Q

Do Beta 2 drugs cross the placenta?

A

Yes - risk for increased HR

37
Q

Treatment for hypermagnesemia?

A

Diuretics and IV calcium

38
Q

What 3 drugs are given for aspiration prophylaxis ?

A

Sodium citrate

H2 - ranitidine

Gastrokinetic - Reglan

39
Q

Why is sodium citrate given? What does it do? When should it be given?

A

Neutralizes gastric acid - aspiration prophylaxis

15-30 mL / 15-30 minutes before

40
Q

Why is ranitidine given? What does it do? When should it be given?

A

H2 receptor antagonist reduces gastric secretions

aspiration prophylaxis

1 hour before

41
Q

Why is Reglan given? What does it do? When should it be given?

A

Gastrokinetic agent to increase gastric emptying and increase LES tone

1 hour before

42
Q

When are pregnant patients considered a full stomach ?

43
Q

When should NSAIDS be avoided? What might happen?

A

After the first trimester

May close ductus arteriosus

44
Q

What is the triad signs of preeclampsia?

A

HTN after 20 weeks
Protein in urine

Generalized edema but not used anymore

45
Q

What is the root cause of preeclampsia ?

A

Imbalance of prostacyclin and thromboxane

(more thromboxane)

46
Q

What does thromboxane do?

A

Increases platelet aggregation
Vasoconstricts
Increases uterine activity

47
Q

What does prostacyclin do?

A

Decreases platelet aggregation
Vasodilation
Decreases uterine activity

48
Q

Most S&S are present in severe preeclampsia and not mild preeclampsia. Which S&S is present in both?

A

Generalized edema?

49
Q

What happens to GFR and UO in severe preeclampsia vs mild preeclampsia?

A

Severe - has GF destruction thus having low urine output (<500mL) per day AND having protein in urine (>5g in a day)

50
Q

What is the definitive treatment of preeclampsia?

51
Q

What is given to protect against seizures in preeclampsia? Dose?

A

Magnesium - load of 4g over 10 minutes

1g infusion per hour after

52
Q

Is neuraxial anesthesia okay in preeclampsia?

53
Q

How does magnesium affect NMB?

A

Increased sensitivity to them

54
Q

Will preeclamptic patients exhibit airway swelling?

A

Yes - higher risk for difficult intubation

55
Q

What is the definitive treatment for HELLP?

A

Delivery of baby

56
Q

What is HELLP?

A

Hemolysis
Elevated liver enzymes
Low platelets

57
Q

Classic S&S of HELLP?

A

Epigastric pain and upper abdominal tenderness

58
Q

What is placenta accreta?

A

Attaches to myometrium

59
Q

What is placenta percreta?

A

Extends beyond uterus

60
Q

What is placenta increta?

A

Invades myometrium

61
Q

What is placenta previa?

A

Attaches to the lower uterine segment

62
Q

What is the number one symptom and biggest concern of placenta previa?

A

Painless vaginal bleeding

Covers the cervical os and increases chance for hemorrhage

63
Q

What places mom at risk for increased chance of placenta previa?

A

Previous c sections and multiple births

64
Q

If an epidural is in place and mom has sudden breakthrough pain, what could be happening?

A

Placental abruption

65
Q

What is the most common cause of postpartum hemorrhage in pregnancy ?

A

Uterine atony

66
Q

Best drug for retained placental fragments?

A

IV nitroglycerine

67
Q

Best treatment for uterine atony?

A

Uterine massage
Oxytocin
Ergot alkaloids
Intrauterine balloon

68
Q

What is a normal Apgar score?

69
Q

What is a moderate distress Apgar score?

70
Q

What is impending distress Apgar score?

71
Q

When is the Apgar score calculated?

A

1 and 5 minutes after delivery

72
Q

What does the 1-minute Apgar score indicate?

A

Baby acid-base levels

73
Q

What does the 5-minute Apgar score indicate?

A

Predictive to neurologic outcomes

74
Q

Baby has no heart rate, what is the Apgar score?

75
Q

Baby has a heart rate of less than 100, what is the Apgar score?

76
Q

What is the Apgar score if baby has a heart rate over 100?

77
Q

Apgar score for Respiratory effort?

A

Absent - 0
Slow and irregular - 1
Normal and crying - 2

78
Q

Apgar score for muscle tone?

A

Limp - 0
Some flexion - 1
Active - 2

79
Q

Apgar score for Reflex?

A

Absent - 0
Grimace - 1
Cough,sneeze,cry - 2

80
Q

Apgar score for color?

A

Pale/blue - 0
Body pink but blue extrem - 1
Pink - 2

81
Q

Best indicator of ventilation during neonatal resuscitation?

A

Resolution of bradycardia

82
Q

What size tube and handle should be used?

A

Downsize the tube - 6.0 to 7.0

Short handle is recommended ( data handle)

83
Q

What happens to the nasal passages and airway during pregnancy ?

A

Due to increased volume, relaxin, progesterone, and estrogen these areas become engorged and swollen

Lifespan (11 decks)

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