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Advanced Principles A > Test 2: Maternal Physiology > Flashcards

Test 2: Maternal Physiology Flashcards

1
Q

How many weeks is a standard pregnancy?

A

40 weeks (divided into 3 trimesters)

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2
Q

When is Term Gestation?

A

Between 37 and 40 Weeks

Fetus is considered full term and can safely be born during this period

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3
Q

This word describes someone about to give birth or go into labor.

A

Parturient

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4
Q

Define Gravida

A

Gravida means the number of times a woman has been pregnant.

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5
Q

Define Para

A

Para means the number of times a woman has given birth greater than 20 weeks.

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6
Q

What is G0P0

A
  • Nulligravida/ Nulliparous
  • This woman has never been pregnant and never given birth
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7
Q

What is G1P0

A
  • Primigravida/ Nulliparous
  • This woman is pregnant for the first time and has not given birth yet
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8
Q

What is G3P2

A
  • Multigravid/ Multiparous
  • This woman is currently pregnant and has given birth twice OR she has been pregnant 3 times, given birth twice, and one miscarriage.

Need to look at these numbers in context with everything that is going on

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9
Q

Body habitus changes and weight gain is normal and healthy in pregnancy, what is the minimum expected weight gain?

A

12 kgs

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10
Q

The uterus and amniotic fluid make up how many kg of weight gain in pregnancy?

A

1 kg for the uterus
1 kg for the aminotic fluid

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11
Q

The Fetus/Placenta makes up how many kg of weight gain in pregnancy?

A

4 kg

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12
Q

New fat and protein stores make up how many kg of weight gain in pregnancy?

A

4 kg

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13
Q

Blood volume increase makes up how many kg of weight gain in pregnancy?

A

2 kg

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14
Q

Pre-pregnancy BMI: <18.5 (Underweight)
What will be the total weight gain?
What will be the rate of weight gain?

A

Total Weight Gain: 28-40 lbs
Rate of Weight Gain: 1 lb/wk

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15
Q

Pre-pregnancy BMI: <18.5-24 (Normal Weight)
What will be the total weight gain?
What will be the rate of weight gain?

A

Total Weight Gain: 25-35 lbs
Rate of Weight Gain: 1 lb/wk

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16
Q

Pre-pregnancy BMI: 25-29.9 (Overweight)
What will be the total weight gain?
What will be the rate of weight gain?

A

Total Weight Gain: 15-25 lbs
Rate of Weight Gain: 0.6 lb/wk

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17
Q

Pre-pregnancy BMI: >30 (Obese)
What will be the total weight gain?
What will be the rate of weight gain?

A

Total Weight Gain: 11-20 lbs
Rate of Weight Gain: 0.5 lb/wk

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18
Q

What is the % change in blood volume during pregnancy?

A

30-35% increase

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19
Q

Blood volume increases between what weeks of pregnancy?

A
  • 8 to 32 weeks
  • Majority of the blood volume increased by 24 weeks
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20
Q

What causes the blood volume to increase during pregnancy?

A
  • Expansion of both plasma and RBC volume
  • Plasma > RBC
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21
Q

What is the purpose of increasing blood volume during pregnancy?

A
  • Protective against blood loss during delivery
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22
Q

What is the EBL during vaginal delivery?

A

500 mL

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23
Q

What is the EBL during a C-section?

A

800 mL

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24
Q

When will blood volume return to pre-pregnancy levels?

A

Within six weeks after delivery

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25
Q

Non-pregnant blood volume:
Pregnant blood volume:

A

Non-pregnant blood volume: 65 mL/kg
Pregnant blood volume: 85-90 mL/kg

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26
Q

How much will cardiac output percentage be at term?

A

40% increase

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27
Q

When will there be an increase in maternal HR?

A

Maternal HR will increase by 6 weeks

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28
Q

When will there be an increase in maternal SV?

A

Maternal SV will increase by 8-10 weeks

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29
Q

What is the equation of Cardiac Output?

A

CO = SV x HR

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30
Q

The maternal increase in stroke volume is due to the reduction of _____________.

A

Systemic Vascular Resistance (SVR)

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31
Q

Renin will increase what hormone released from the adrenal cortex?

A

Aldosterone

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32
Q

Explain how increasing aldosterone concentration increases cardiac output.

A

↑ Aldosterone concentration
↑ Na+ reabsorption
↑ Water retention
↑ Plasma volume
↑ Preload
↑ SV
↑ CO

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33
Q

What hormone will cause an upregulation in angiotensinogen leading to aldosterone release?

A

Estrogen

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34
Q

How much does uterine blood flow (UBF) increase during pregnancy?

A

10-20x increase in UBF

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35
Q

What is the UBF for non-pregnant women?
What is the UBF for women at term gestation?

A

Non-pregnant: 50 mL/min
Term Gestation: 700 mL/min

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36
Q

How much does skin blood flow increase during pregnancy?

A

3-4x increase in Skin Blood Flow

Warmer skin temperature, Flushing, Itching

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37
Q

What is the % decrease in SVR during pregnancy?

A

20% decrease

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38
Q

What hormones are responsible for maternal vasodilation and a decrease in SVR?

A
  • Progesterone
  • Prostacyclin
  • Relaxin
  • Estrogen

There will also be vasodilation in the renal system which contributes to decrease SVR

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39
Q

When will maternal vasodilation occur?

A

As early as 5 weeks into pregnancy

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40
Q

A normal pregnancy will experience _________ flow and _______resistance

A

A normal pregnancy will experience HIGH flow and LOW resistance.

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41
Q

How does the size of the heart change with pregnancy?

A
  • 50% increase in LV mass by term gestation (Ventricular Hypertrophy)
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42
Q

What kind of ventricular hypertrophy is seen in normal pregnancy?

A
  • Eccentric Hypertrophy (Athlete’s Heart)
  • This type of hypertrophy will accommodate the increase in blood volume and preload.
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43
Q

How does the position of the maternal heart shift during pregnancy?

A

Maternal heart shifts ANTERIOR and LEFT

This shift is caused by diaphragmatic elevation and the heart may appear enlarged on CXR

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44
Q

How does the point of maximal impulse (PMI) change during pregnancy?

A
  • PMI shifts UP and to the LEFT
  • PMI will be at the 4th ICS, Mid Clavicular Line
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45
Q

EKG changes during pregnancy: QRS

A
  • QRS axis shift
  • Leftward in 3rd trimester
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46
Q

EKG changes during pregnancy: T-waves

A
  • T-wave inversion (Lead III)
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47
Q

EKG changes during pregnancy: ST-segments

A
  • ST-segment depression
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48
Q

EKG changes during pregnancy: PR intervals

A
  • PR interval shortened

This is caused by the increase in sympathetic activity in the 3rd trimester leading to acceleration of the AV node conduction velocity

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49
Q

EKG changes during pregnancy: QT intervals

A
  • QT-interval increases (but often still WNL)
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50
Q

Which EKG leads will have a positive deflection during pregnancy?

A
  • Leads I
  • Leads aVL
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51
Q

Which EKG leads will have a negative deflection during pregnancy?

A
  • Leads II
  • Leads aVF
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52
Q

What is the most common EKG abnormality during pregnancy?

A
  • Tachydysrhythmias
  • ST, PAC, PVC
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53
Q

What are the causes of tachydysrhythmias during pregnancy?

A
  • Changes in cardiac ion channel conduction
  • Increase in cardiac size
  • Changes in autonomic tone
  • Hormones
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54
Q

What are valvular changes seen during pregnancy?

A
  • Tricuspid and pulmonic regurgitation in >90% of pts.
  • Mitral valve regurgitation in 25-30% of pts.

These are reversible changes that will return to normal in postpartum period

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55
Q

During which trimester will a 3rd heart sound (ventricular gallop) be heard?

A

3rd trimester

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56
Q

When will the 4th heart sound disappear?

A

At term

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57
Q

Cardiac enlargement can result in a Grade II Systolic Ejection Murmur. Where can it best be heard?

A

Right side of the heart near the sternal border

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58
Q

What factors can affect maternal BP during pregnancy?

A
  • Positioning (Aortocaval Compression)
  • Gestational age
  • Maternal age
  • Parity
  • Pre-existing conditions
  • Pregnancy complication
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59
Q

What is aortocaval compression?

A

Compression of the inferior vena cava in the supine position caused by the gravid uterus.

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60
Q

What can exacerbate aortocaval compression?

A
  • Anesthetic drugs/ techniques that cause vasodilation
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61
Q

What weeks can aortocaval compression occur?

A

As early as 13-16 weeks gestation

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62
Q

Describe how aortocaval compression can decrease perfusion to the fetus.

A

Supine position
↓ Venous return to right atrium
↓ Cardiac Output
Hypotension
↓ Uterine Blood Flow
↓ Perfusion to Fetus

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63
Q

What are the symptoms of aortocaval compression?

A
  • Initial tachycardia
  • Followed by bradycardia
  • N/V (first notable symptom)
  • Pallor
  • Loss of consciousness
  • Fetal distress
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64
Q

What is the treatment for aortocaval compression?

A
  • Tilting the patient to the left
  • This will displace the uterus off the vena cava and aorta
  • LUD = Left Uterine Displacment
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65
Q

During the first stage of labor, how much blood will be auto-transfused from the uterus to the general circulation with each contraction?

A

300 to 500 mL

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66
Q

How much does CO increase during the second stage of labor?

A

50% increase in CO d/t pushing efforts

SV increases dramatically
HR increase

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67
Q

What happens to cardiac output immediately after delivery?

A
  • 60-80% increase in CO
  • Release of pressure on vena cava
  • Uterus continues to contract, releasing blood into the systemic circulation
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68
Q

How soon does CO decline after delivery?
When does CO return to normal?

A
  • Within 10 minutes of delivery
  • Returns to normal 24 hr postpartum
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69
Q

What are respiratory anatomical changes seen in pregnancy?

A

Vascular engorgement of airway structures

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70
Q

What are the results of vascular engorgement of airway structures?

A
  • Edema/ friable tissue
  • Difficult airways
  • Nosebleeds/ Rhinitis
71
Q

What are the anesthetic implications for parturients?

A
  • May need smaller ETT
  • Avoid nasal tube/ NGT (risk of nose bleed)
  • ↑ Risk for airway obstruction
  • Mallampati class may worsen
  • Unanticipated airway difficulties
72
Q

In terms of the pulmonary system, what is the role of estrogen during pregnancy?

A

Increases the number and sensitivity of progesterone receptors in the respiratory center in the brain

73
Q

In terms of the pulmonary system, what is the role of progesterone during pregnancy?

A
  • Increases respiratory center sensitivity of CO2
  • Bronchodilation
  • Hyperemia/edema of respiratory passages
74
Q

What is the role of relaxin during pregnancy?

A
  • Causes ligamentous attachments to lower ribs to relax
  • Subcostal angle increases
  • Widened AP and transverse diameter of chest wall
75
Q

What happens to chest height during pregnancy?
What happens to AP dimension during pregnancy?

A
  • Chest height is shortened (d/t elevated diaphragm)
  • AP diameter increased (barrel shape)
76
Q

What happens to total lung capacity during pregnancy?

A

TLC is preserved

77
Q

What is FRC?

A
  • Functional Residual Capacity
  • Volume of air that prevents complete emptying of lungs and keeps small airways open
78
Q

What is ERV?

A
  • Expiratory Reserve Volume
  • The extra volume of air that can be expired with max effort beyond the level reached at the end of a normal expiration
79
Q

What is RV?

A
  • Residual Volume
  • The volume of air that remains in the lungs after ERV is expired
80
Q

Name the components that make up the FRC.

A

FRC = ERV + RV

81
Q

What causes the 20% decrease in FRC at term?

A

Gravid uterus → Elevation of the uterus

Decrease FRC results from decrease RV and decrease ERV

82
Q

What does an elevated diaphragm do to the pleural pressure?

A

Increases pleural pressure (becomes less negative and more positive)

83
Q

What does a more negative pleural pressure do to small airways?

A
  • Earlier closure of small airways
  • ↓ RV
  • ↓ ERV
  • ↓ FRC
84
Q

How much does FRC decrease in a parturient when they are supine?

A
  • 30% decrease in FRC
  • Diaphragm is elevated more → increase alveolar atelectasis
85
Q

What happens when closing capacity exceeds FRC?

A

Small airway closure leading to V/Q mismatch resulting in decreased O2 saturation

86
Q

What respiratory volumes are decreased during pregnancy?

A
  • FRC
  • ERV
  • RV
87
Q

What respiratory volumes are increased during pregnancy?

A
  • Tidal Volume (Vt)
  • Inspiratory Capacity (IC)
88
Q

What causes the increase in Vt during pregnancy?

A

Increased metabolic CO2 production and respiratory drive related to high progesterone level

89
Q

What respiratory volumes will remain unchanged during pregnancy?

A
  • Total Lung Capacity (TLC)
  • Vital Capacity (VC)
90
Q

What is Vital Capacity?

A

The total volume that can be exhaled forcefully after a max inhalation

VC= IRV + Vt + ERV

91
Q

How are pregnant patients vulnerable to hypoxia?

A
  • Elevated diaphragm → Decreased FRC (especially supine)
  • Decrease O2 reserve
  • Will desaturate faster!
92
Q

For induction of anesthesia in pregnant patients undergoing surgery, what is the most vital thing to do?

A
  • Pre-oxygenation
93
Q

What are the goals of pre-oxygenation?

A
  • Bring O2 saturation as close to 100%
  • Denitrogenate the residual lung capacity
  • Maximize the storage of oxygen in the lungs
  • Denitrogenate and oxygenate the bloodstream to a maximal level
94
Q

What are the standards for adequate pre-oxygenation?

A

3-5 vital capacity breaths with a tight face mask seal delivering 100% O2

OR

8 deep breaths at an O2 flow rate of 10L/min within a time period of 60 seconds

95
Q

What device can be used to assist you in creating a tight mask seal on the patient?

A

Mask straps

96
Q

What is the ideal fraction of expired oxygen (FeO2) during pre-oxygenation?

97
Q

What position helps in pre-oxygenation?

A
  • 20 degrees in Reverse Tredelenburg
  • Helpful in morbidly obese patients
98
Q

What is the % increase of oxygen consumption by term gestation?

A

O2 consumption increase 20%

99
Q

What causes the increase in O2 consumption during pregnancy?

A
  • Increase metabolism (metabolic needs for the fetus, uterus, placenta)
  • Increase Work of Breathing
  • Increase Cardiac Workload
100
Q

During what trimester will the patient experience dyspnea?

A

1st trimester

101
Q

How does minute ventilation change during pregnancy?

A
  • Respiratory Rate increases 1-2 breaths/min
  • Hormone-mediated, increased neural drive to breathe

Alveolar ventilation also increases

102
Q

What changes are seen in ABG of pregnant patients?

A
  • Increase ventilation
  • PaCO2 decreases by 8-10 mmHg
  • PaO2 increases by 5 mmHg
  • Respiratory Alkalosis
103
Q

Expected ABG range of a pregnant patient
pH:
PaO2:
PaCO2:
HCO3:
Base Excess:

A

Expected ABG range of a pregnant patient
pH: 7.41-7.44
PaO2: 100-105 mmHg
PaCO2: 30-32 mmHg
HCO3: 20 mmHg
Base Excess: 2-3 mEq/L

Respiratory Alkalosis

104
Q

How much does minute ventilation change during the first stage of labor?

A

Minute ventilation is increased by 140%

105
Q

How much does minute ventilation change during the second stage of labor?

A

Minute ventilation is increased by 200%

106
Q

Describe what happens to the following during the second stages of labor:

Maternal CO2
O2 consumption
Aerobic requirements
Maternal Lactate Levels

A
  • Maternal CO2 decreases 10-15 mmHg
  • ↑ O2 consumption
  • ↑ Aerobic requirements
  • ↑ Maternal Lactate Levels

May need supplemental O2

107
Q

What happens to Hemoglobin and Hct levels during pregnancy?

A
  • 2.4 g/dL drop in Hgb
  • 6.5% decrease in Hct

This is a result of dilutional anemia d/t a greater increase in plasma volume than RBC volume

108
Q

Maternal Hemoglobin below this level is considered abnormal.

A

below 11 g/dL

109
Q

Maternal Hemoglobin above this level increases the risk of pre-eclampsia.

A

above 13 g/dL

110
Q

What is taken to treat anemia during pregnancy?

A

Iron Supplements

Iron is needed to make RBCs

111
Q

What is the range of a normal Plt count in non-pregnant pts?

A

165K to 415K

No change to moderate decrease seen in pregnancy

112
Q

At what platelet levels will someone be considered thrombocytopenic?

A

Less than 150K

113
Q

What can cause platelet numbers to be below 150K

A
  • Idiopathic
  • Hypertensive disorder of pregnancy
  • Gestational: <150K, no abnormal platelet function or bleeding seen
114
Q

Why do we care so much about platelet numbers during pregnancy?

A

Low platelet counts can lead to the inability to have an epidural during labor due to a risk of epidural hematoma, in which abnormal blood collection in the spine can cause spinal cord damage.

If it is an emergency and you have no labs. NO EPIDURAL, opt for GETA C/S

115
Q

Incidence of epidural hematoma from neuraxial techniques

A

1:200K to 1:250K

116
Q

When do you want to replace platelets if a patient undergoes major surgery ?

A

Replace plt if less than 50K

117
Q

When do you want to replace platelets if a patient undergoes an epidural placement?

A

Replace plt if less than 80K

118
Q

Plt levels below this will require cancelation of surgery/procedure.

A

Less than 10K

119
Q

What coagulation changes will be seen during pregnancy?

A

Pregnancy produces a hypercoagulable state

120
Q

All coagulation factors are increased in concentration EXCEPT for these factors.

A
  • Factor II (unchanged)
  • Factor V (unchanged)
  • Factor XI (decreased)
  • Factor XIII (decreased)
121
Q

Which factor will have a significant increase during pregnancy?

A
  • Factor I (Fibrinogen)

Protective against blood loss

122
Q

What will the level of Fibrinogen (Factor I) be at term?

A

> 400 mg/dL at term

This will increase clotting effciency and impair fibrinolysis.
This will protect against hemorrhage, but risk for blood clot increases.

123
Q

Name the factors that are increased at term gestation.

A
  • Factor I (fibrinogen)
  • Factor VII (proconvertin)
  • Factor VIII (antihemophilic factor)
  • Factor IX (Christmas factor)
  • Factor X (Stuart-Prower factor)
  • Factor XII (Hageman factor)
124
Q

Name the factors that are unchanged at term gestation.

A
  • Factor II (prothrombin)
  • Factor V (proaccelerin)
125
Q

Name the factors that are decreased at term gestation.

A
  • Factor XI (thromboplastin antecedent)
  • Factor XIII (fibrin-stabilizing factor)
126
Q

Changes in PT and PTT during pregnancy

A

Decrease by 20%

127
Q

During which trimester will fibrinolytic activity decrease?

A

3rd trimester

128
Q

WBC changes during pregnancy.
WBC changes during labor.

A
  • WBC increase steadily to 9K-11K in pregnancy
  • WBC increases up to 34K in labor
129
Q

Consequences of polymorphonuclear leukocyte function impairment during pregnancy.

A
  • Increase risk/severity of infection
  • May see autoimmune disease symptom improvement
130
Q

Pregnancy can result in a humoral antibody titer decrease to these viruses.

A
  • Measles
  • Influenza
  • Herpes Simplex
131
Q

Why are all parturients considered to be full stomachs?

A
  • Enlarged gravid uterus displaces the stomach cephalad
  • Increase gastric pressure
  • Decrease competence of LES
132
Q

When does the LES return to normal postpartum?

A

4 weeks postpartum

133
Q

When will gastric emptying become delayed in during pregnancy?

A

Gastric emptying is the same throughout pregnancy but becomes delayed during labor.

134
Q

What is Mendelson’s Syndrome?

A
  • Peri-operative aspiration of gastric contents
  • Cause inflammatory response of lung parenchyma
135
Q

Criteria for high aspiration pneumonia risk

A
  • Gastric pH < 2.5
  • Gastric Volume > 25 mL
136
Q

Continue to treat patients as full stomachs for ______ weeks postpartum

137
Q

How long does it take uterus to go back to normal size after birth?

138
Q

What changes are seen in size and blood flow of the hepatic system during pregnancy?

A

Little to no change seen during normal pregnancy

139
Q

Increase splanchnic, portal, and esophageal venous pressure during pregnancy will lead to increase risk of what?

A

Esophageal varices

140
Q

What liver enzymes are increased during pregnancy?

A
  • Serum aspartate aminotransferase (AST)
  • Lactic dehydrogenase
  • Alkaline phosphate
141
Q

What happens to cholesterol levels for a healthy parturient?

A

↑ Cholesterol Level

142
Q

What changes are seen with the protein levels during pregnancy?

What does this do to the colloid oncotic pressure?

A
  • Decrease total protein and albumin-to-globulin ratio
  • Colloid oncotic pressure decreases (further decreases after delivery)
143
Q

How long after birth does maternal colloid oncotic pressure return to normal?

A

6 weeks postpartum

144
Q

Describe what happens to pseudocholinesterase levels during pregnancy.

A
  • Activity decreased 25% before delivery
  • Activity decreased by 33% on the third pospartum day
145
Q

How is succinylcholine metabolized?

A

SCH is rapidly hydrolyzed by butyrylcholinesterase (BCHE; also known as plasma cholinesterase and pseudocholinesterase), which is synthesized in the liver and present in plasma.

146
Q

Does the decrease cholinesterase activity in pregnant patients cause prolonged paralysis?

A

Usually not enough to cause prolonged paralysis after a single dose of succinylcholine

147
Q

What is cholestasis?

A
  • Cholestasis is the slowing or stalling of bile flow from your liver.
  • Biliary stasis and increased bile secretions
148
Q

What are symptoms and lab findings of cholestasis?

A
  • Pruritus
  • High serum bilirubin
  • Abnormal liver function test
149
Q

What trimester does cholestasis occur?
Incidence rate?
Surgical Treatment?

A
  • 3rd trimester
  • 1/100 patients
  • May have to gallbladder taken out
150
Q

How does the size and blood flow of the kidney change during pregnancy?

When does it go back to normal?

A
  • Kidney becomes enlarge
  • 75% increase in RBF (No MAP increase d/t ↓ SVR)
  • Back to baseline 6 weeks postpartum
151
Q

What are the changes in GFR, Creatine Clearance, and BUN during pregnancy?

A
  • ↑ GFR
  • ↑ Creatine Clearance which will result in ↓ Creatinine
  • ↓ BUN
152
Q

What would be the range of creatinine and BUN in a pregnant patient at term?

A
  • Cr: 0.5-0.6 mg/dL at term
  • BUN: 8-9 mg/dL at term
153
Q

What would cause glucosuria to occur in pregnant patients?

A

Tubular glucose absorption may not keep up with ↑ GFR

154
Q

Excessive protein in the urine during pregnancy may indicate what condition?

A
  • Pre-eclampsia
  • Proteinuria is common, an excessive amount might indicate Pre-eclampsia
155
Q

What labs will suggest abnormal renal function requiring further evaluation in pregnant patients (BUN, Cr, Creatine Clearance)?

A
  • BUN > 15 mg/dL
  • Cr > 1.0 mg/dL
  • Creatine Clearance <100 mL/min
156
Q

What are the changes in size and function of the thyroid during pregnancy?

A
  • Thyroid enlarges by 50-70%
  • 10% of the patients will experience hypothyroidism
157
Q

Result of the fetus secondary to hypothyroidism in pregnant patients.
Treatment?

A
  • ↑ Incidence of fetal cognitive issues, spontaneous abortions, growth restrictions, placental abruption
  • Place patient on Synthroid
158
Q

What are pancreatic function changes seen in pregnancy?

A

Insulin resistance d/t human placental lactogen leading to ↑ blood glucose

159
Q

What are adrenal function changes seen in pregnancy?

A
  • Increase cortisol (100% increase in 1st trimester, 200% increase by term)
  • ↑ Plasma endorphin
160
Q

How much does the pituitary gland increase during pregnancy?

A
  • Increase 3x in size
161
Q

What are functional changes seen in the anterior pituitary?

A
  • Hyperplasia of lactotrophic cells leading to increase prolactin secretions (preparation for breast feeding)
162
Q

Hyperprolactinemia can lead to this unwanted outcome in women.

163
Q

What hormone is increased in the posterior pituitary during pregnancy?

Function?

A
  • Oxytocin is increased by 30% by term
  • Responsible for stimulation of uterine contraction, breast milk letdown, bonding hormone
164
Q

This hormone allows the patient’s muscles and ligaments to loosen up. Although the body produces this hormone to prepare for childbirth, it can make them less stable and more prone to injuries and conditions, such as sacroiliac joint dysfunction and knee pain.

A

Relaxin

(Overstretching of joints is possible, caution with exercise)

165
Q

What nerve is commonly compressed during pregnancy that cause the patient to complain about pain down the back of the leg?

A

Sciatic nerve

166
Q

Compression of this nerve will cause meralgia paresthetica.

Where does this nerve affect?

A
  • Lateral femoral cutaneous nerve
  • Outer side of the thigh
167
Q

What will patients complain of with Meralgia Paresthetica?

A
  • Tingling
  • Numbness
  • Burning Pain
168
Q

What causes lumbar lordosis during pregnancy?

A
  • Anterior pelvic tilt
  • Center of gravity change
  • Narrowing of intervertebral spaces

(Back and hip pain is very common in pregnancy)

169
Q

What are CNS changes seen in pregnancy?

A
  • ↑ CBF
  • ↑ Permeability of BBB
  • ↑ Pain Threshold (↑ Endorphins)
170
Q

What hormone activates the spinal cord kappa-opioid receptor analgesic mechanism during pregnancy?

A

Progesterone

171
Q

What causes a higher risk for venous puncture during epidural placement?

A

Engorged epidural veins d/t volume of venous plexus increase during pregnancy

172
Q

How will a decrease in CSF volume affect the spread of local anesthetic during pregnancy?

A

Greater spread of LA

(Less LA required)

173
Q

Effects of Non-depolarizing neuromuscular blockers in pregnant patients

A

Enhance sensitivity to Vecuronium and Rocuronium

Advanced Principles A (17 decks)

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