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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
How does maternal hyperventilation affect mom and baby?
Causes a left shift on the oxyHgb curve thus reducing O2 to baby
25
How does uncontrolled pain affect mom and baby?
Increased catecholamines caused HTN and reduce blood flow to the baby
25
Full dilation to delivery of baby is what stage of labor?
Stage 2
26
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
27
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
28
Bupivacaine or ropivacaine, which has less risk of CV toxicity ?
Ropivacaine (S enantiomer have less risk compared to R enantiomers)
29
What is a risk factor with chloroprocaine?
Arachnoiditis
30
When is chloroprocaine useful in pregnancy? Why?
Emergency C section when epidural is in place. Very fast on/off due to pseudocholinesterase
31
What is the treatment for a high spinal?
Supportive, left uterine displacement, and intubation
32
What is bradycardia and tachycardia in a fetus?
Brayd < 110 Tachy > 160
33
How is premature delivery defined?
Before 37 weeks
34
What is used to stop labor?
Tocolytic agents Mag Beta 2 (terbutaline, ritodrine)
35
Side effects of Beta 2? K? Glucose?
Hypokalemia from shifting K into the cell Hyperglycemia
36
Do Beta 2 drugs cross the placenta?
Yes - risk for increased HR
37
Treatment for hypermagnesemia?
Diuretics and IV calcium
38
What 3 drugs are given for aspiration prophylaxis ?
Sodium citrate H2 - ranitidine Gastrokinetic - Reglan
39
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
40
Why is ranitidine given? What does it do? When should it be given?
H2 receptor antagonist reduces gastric secretions aspiration prophylaxis 1 hour before
41
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
42
When are pregnant patients considered a full stomach ?
20 weeks
43
When should NSAIDS be avoided? What might happen?
After the first trimester May close ductus arteriosus
44
What is the triad signs of preeclampsia?
HTN after 20 weeks Protein in urine Generalized edema but not used anymore
45
What is the root cause of preeclampsia ?
Imbalance of prostacyclin and thromboxane (more thromboxane)
46
What does thromboxane do?
Increases platelet aggregation Vasoconstricts Increases uterine activity
47
What does prostacyclin do?
Decreases platelet aggregation Vasodilation Decreases uterine activity
48
Most S&S are present in severe preeclampsia and not mild preeclampsia. Which S&S is present in both?
Generalized edema?
49
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)
50
What is the definitive treatment of preeclampsia?
Delivery
51
What is given to protect against seizures in preeclampsia? Dose?
Magnesium - load of 4g over 10 minutes 1g infusion per hour after
52
Is neuraxial anesthesia okay in preeclampsia?
Yes
53
How does magnesium affect NMB?
Increased sensitivity to them
54
Will preeclamptic patients exhibit airway swelling?
Yes - higher risk for difficult intubation
55
What is the definitive treatment for HELLP?
Delivery of baby
56
What is HELLP?
Hemolysis Elevated liver enzymes Low platelets
57
Classic S&S of HELLP?
Epigastric pain and upper abdominal tenderness
58
What is placenta accreta?
Attaches to myometrium
59
What is placenta percreta?
Extends beyond uterus
60
What is placenta increta?
Invades myometrium
61
What is placenta previa?
Attaches to the lower uterine segment
62
What is the number one symptom and biggest concern of placenta previa?
Painless vaginal bleeding Covers the cervical os and increases chance for hemorrhage
63
What places mom at risk for increased chance of placenta previa?
Previous c sections and multiple births
64
If an epidural is in place and mom has sudden breakthrough pain, what could be happening?
Placental abruption
65
What is the most common cause of postpartum hemorrhage in pregnancy ?
Uterine atony
66
Best drug for retained placental fragments?
IV nitroglycerine
67
Best treatment for uterine atony?
Uterine massage Oxytocin Ergot alkaloids Intrauterine balloon
68
What is a normal Apgar score?
8-10
69
What is a moderate distress Apgar score?
4-7
70
What is impending distress Apgar score?
0-3
71
When is the Apgar score calculated?
1 and 5 minutes after delivery
72
What does the 1-minute Apgar score indicate?
Baby acid-base levels
73
What does the 5-minute Apgar score indicate?
Predictive to neurologic outcomes
74
Baby has no heart rate, what is the Apgar score?
0
75
Baby has a heart rate of less than 100, what is the Apgar score?
1
76
What is the Apgar score if baby has a heart rate over 100?
2
77
Apgar score for Respiratory effort?
Absent - 0 Slow and irregular - 1 Normal and crying - 2
78
Apgar score for muscle tone?
Limp - 0 Some flexion - 1 Active - 2
79
Apgar score for Reflex?
Absent - 0 Grimace - 1 Cough,sneeze,cry - 2
80
Apgar score for color?
Pale/blue - 0 Body pink but blue extrem - 1 Pink - 2
81
Best indicator of ventilation during neonatal resuscitation?
Resolution of bradycardia
82
What size tube and handle should be used?
Downsize the tube - 6.0 to 7.0 Short handle is recommended ( data handle)
83
What happens to the nasal passages and airway during pregnancy ?
Due to increased volume, relaxin, progesterone, and estrogen these areas become engorged and swollen

Lifespan (11 decks)

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