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943 > Test 2 OB Complications/Management > Flashcards

Test 2 OB Complications/Management Flashcards

1
Q

The 3 significant risk factors for preterm

A
  • History of preterm labor
  • Non-Hispanic black race
  • Multiple gestation
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2
Q
  • Side effects of f terbutaline 5
A
  • Side effects of f terbutaline
    • hypotension
    • tachycardia
    • pulmonary edema
    • hyperglycemia
    • hypokalemia
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3
Q

Factors assoc. with Breech Presentation:

Main 4:

A

Factors assoc. with Breech Presentation:

Main 4:

  • Uterine distention or relaxation
  • Abnormalities of uterus or pelvis
  • Abnormalities of fetus
  • OB conditions
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4
Q

Factors assoc. with Breech Presentation:

These may cause: Uterine distention or relaxation:

A
  • multiparity
  • multiple gestation
  • macrosomia
  • hydramnios
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5
Q

Factors assoc. with Breech Presentation:

These may cause: Abnormalities of uterus or pelvis

A
  • Pelvic tumors; contractures
  • Uterine anomalies
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6
Q

Factors assoc. with Breech Presentation:

Abnormalities of fetus

A
  • Hydrocephalus
  • Anencephaly
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7
Q

Factors assoc. with Breech Presentation:

OB conditions

A
  • Previous breech delivery
  • Preterm
  • Oligohydramnios
  • Cornual-fundal placenta
  • Previa
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8
Q

Fetal complications assoc with multiple gestation

A
  • preterm delivery
  • congenital anomalies
  • polyhydramnios
  • cord entanglement
  • cord prolapse
  • fetal growth restriction
  • twin to twin transfusion
  • malpresentation
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9
Q

Maternalcomplications assoc with multiple gestation

A
  • pPROM
  • preterm labor
  • prolonged labor
  • pre-eclampsia/eclampsia
  • DIC
  • forceps/csec
  • uterine atony
  • OB trauma
  • ante/post partum hemorrhage
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10
Q

most common medical disorder of pregnancy:

effects 6-10%

gestational cause: 5%

A

HTN

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11
Q

No proteinuria with HTN ,may consider Pre-eclamptic if any of following are present

A
  • No proteinuria with HTN ,may consider Pre-eclamptic if any of following are present
    • 1) persistent epigastric or RUQ pain
    • 2) persistent cerebral symptoms
    • 3) fetal growth restriction
    • 4) thrombocytopenia
    • 5) elevated liver enzymes
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12
Q
  • Chronic hypertension with superimposed preeclampsia
    • Will menifest how?
A
  • will see New onset proteinuria
  • or sudden INC in proteinuria or hypertension or both
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13
Q
  • Pre-eclampsia w/o severe features includes what parameters for each:
    • BP
    • Proteinuria
    • protein - Cr ratio
    • dip stick urine
A
  • BP >140/90
  • Proteinuria >/= 300mg/24h
  • protein - Cr ratio >/= 0.3
  • dip stick urine 1+ protein
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14
Q

Diagnostic criteria for SEVERE Pre-eclampsia

A
  • BP > 160/110
  • plt < 100k
  • Cr > 1.1 or > 2x baseline
  • pulm edemer
  • new onset cerebral/visual disturbance
  • impair liver fx
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15
Q

Pre-eclampsia: symptoms

CNS

A
  • severe HA,
  • hyperexcitability
  • hyperreflexia
  • coma
  • visual disturbances (scotoma, amaurosis, & blurred vision)
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16
Q

Pre-eclampsia: symptoms

Airway

A
  • pharyngolaryngeal edema
  • subglottic edema (made worse with preeclampsia)
  • Dysphonia, stridor, hoarseness, snoring, and hypoxemia are s/s of airway swelling
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17
Q

Pre-eclampsia: symptoms

Pulmonary

A
  • INC colloid osmotic pressure + INC vascular permeability & loss of intravascular fluid & protein into interstitium = pulmonary edema
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18
Q

Pre-eclampsia: symptoms

CV

A
  • hypertension
  • vasospasm
  • end-organ ischemia
  • hyperdynamic state ( INC CO, hyperdynamic LV function, INC SVR) – exaggerated response to circulating catecholamines
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19
Q

Pre-eclampsia: symptoms

Hematology

A
  • thrombocytopenia (most common hematologic abnormality);
  • platelet counts < 100,000 mm3 seen in severe stages & in HELLP DIC can occur if severe liver involvement
  • intrauterine fetal demise
  • placenta abruption
  • postpartum hemorrhage
    • Disease state can begin with hypercoagulability but progresses to hypocoagulability
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20
Q

Therapeutic range for serum Mg level:

mg/dLs

mEq/L

A
  • Therapeutic range for serum Mg level:
    • 5-9 mg/dLs (Chestnut’s)
    • 4-6 mEq/L (M&M)
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21
Q
  • Hypermagnesemia: changes with these levels
    • 12 mg/dL
    • 15-20 mg/dL
    • > 25 mg/dL
A
  • Hypermagnesemia: when pass therapeutic levels and get toxic
    • 12 mg/dL Patellar reflexes lost i(deally stop gtt at this time)
    • 15-20 mg/dL Respiratory arrest
    • > 25 mg/dL Asystole
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22
Q

GA: indications in Preeclampsia

A
  • GA: indications in Preeclampsia
    • severe maternal hemorrhage
    • fetal bradycardia
    • severe thrombocytopenia &/or coagulopathy
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23
Q
  • Placenta Previa (cont)
    • Classic sign:
A
  • Placenta Previa (cont)
    • Classic sign:
      • Painless vaginal bleeding 2nd or 3rd trimester
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24
Q
  • Anesthetic management: Previa
    • Technique depends on: 3
A
  • Anesthetic management
    • Technique depends on:
      • indication & urgency of delivery
      • severity of maternal hypovolemia
      • obstetric history
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25
Q

most common cause of maternal mortality

A

obstetric hemorrhage is the most common cause of maternal mortality and postpartum hemorrhage contributes to 80% of that.

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26
Q

Major risk factors for VTE in PP period: need at least one of these to be able to be put on anticoagulation

A
  • immobility (strict bed rest >= week during antepartum
  • previous VTE
  • Preeclampsia w/ fetal growth restriction
  • Thrombophilia
    • AT III def
    • Fact V leiden (homo or heterozygous)
    • PT G20210A “ “
  • Medical
    • SLE
    • HD
    • Sickle cell
  • PP hemorrhage >= 1000ml and surgery
  • PP infection
  • Blood tx
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27
Q

Minor risk factors for VTE in PP period: need at least two of these to be able to be put on anticoagulation

A
  • BMI > 30 kg/m2 (Obesity)
  • Csec (E)
  • multiple pregnancy
  • PP hemorrhage > 1000 ml
  • Smoking > 10 cig/day
  • Fetal growth restriction
  • Thrombophilia
    • Protein C or Protein S deficiency
  • Preeclampsia
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28
Q

Uterine artery/blood supply

Chronic BF reduction – usually due to:

A
  • abnormal placental development
  • maternal disease (preeclampsia)
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29
Q
  • In pregnancy, flow may differ between R & L uterine arteries
    • In the uterine arteries (compared with contralateral artery):
      • Vessel diameter is __ greater (on side of placenta)
      • Blood flow is ___greater (on side of placenta)
A
  • In pregnancy, flow may differ between R & L uterine arteries
    • In the uterine arteries (compared with contralateral artery):
      • Vessel diameter is ~ 11% greater (on side of placenta)
      • Blood flow is ~ 18% greater (on side of placenta)
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30
Q

uterine BF increases during pregnancy

3 phases of increase:

A
  • 1) before & during implantation & early placentation
  • 2) growth & remodeling of uteroplacental vasculature
  • 3) progressive uterine artery vasodilation to meet fetal needs
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31
Q
  • 3 major factors that decrease UBF:
A

1) hypotension

2) vasoconstriction (uterine)

3) contraction (uterine)

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32
Q
  • Common causes of hypotension during pregnancy
A
  • ACC
  • Hypovolemia
  • Sympathetic blockade w/ NAA
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33
Q

use UPP, UVR, UAP and UAP to make 2 formulas for UBF:

  • Uterine blood flow =
  • Uterine blood flow =
A
  • Uterine blood flow = UPP/UVR
  • Uterine blood flow = (UAP – UVP)/ UVR
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34
Q
  • Embryonic placenta circulation begins about __weeks gestation
A
  • about 8 weeks gestation
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35
Q
  • Mature placenta:
    • Ave diameter __ cm
    • Weight __ g
    • Thickness__ mm
  • At term, fetal-placental weight is __% of maternal wt
A
  • Mature placenta:
    • Ave diameter 18.5 cm
    • Weight 500 g
    • Thickness 23 mm
  • At term, fetal-placental weight is 6% of maternal wt
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36
Q

where most of the placental exchange of nutrients, gases and wastes occur.

A

terminal villi - where most of the placental exchange of nutrients, gases and wastes occur.

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37
Q
  • UBF at term:
    • Max __ ml/min (~ 10% CO)
      • __ ml/min to myometrium
      • __ ml/min to decidua
      • Remainder to intervillous space ~ __% UBF
A
  • UBF at term:
    • Max 700-900 ml/min (~ 10% CO)
      • 150 ml/min to myometrium
      • 100 ml/min to decidua
      • Remainder to intervillous space ~ 80% UBF
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38
Q
  • Passive Transport Depends on:
A
  • concentration & electrochemical difference
  • molecular weight
  • lipid solubility
  • degree of ionization
  • membrane surface area & thickness
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39
Q

Things that make facilitated transport different from passive transport: Facilitated involves these: 4

A

1) Saturation kinetics

2) Competitive & noncompetitive inhibition

3) Stereospecificity

4) Temperature influences – a higher temp will result in a greater transfer

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40
Q
  • Other Factors Influencing Placental Transport
A
  • Maternal & fetal blood flow
  • placental binding
  • placental metabolism
  • diffusion capacity
  • maternal & fetal plasma protein binding
  • gestational age
  • lipid solubility
  • pH gradients
  • plasma protein levels
  • disease states
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41
Q
  • Uterine blood flow is about ___**mL/minute
  • Uterine cord blood flow is about ___ mL/minute
A
  • Uterine blood flow is about 700 mL/minute
  • Uterine cord blood flow is about 300 mL/minute
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42
Q
  • Oxygen
    • Placenta provides ___ml O2/min/kg fetal body weight—it acts as the lung for the fetus; however:
A
  • Oxygen
    • Placenta provides 8 ml O2/min/kg fetal body weight—it acts as the lung for the fetus; however:
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43
Q
  • Transfer of Respiratory Gases & Nutrients
  • Carbon Dioxide
    • Transfer occurs through several forms:
A
  • dissolved CO2
  • carbonic acid
  • bicarbonate ion
  • carbonate ion
  • carbaminohemoglobin
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44
Q
  • Concentration of amino acids is highest in this order: (highest to lowest)
A
  • Concentration of amino acids is highest in this order: (highest to lowest)
  1. Placenta
  2. umbilicus venous blood (Umbilical vein)
  3. maternal blood
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45
Q

what determines the fetus’s exposure to drugs that the mother has received.

A

Placental permeability and pharmacokinetics

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46
Q
  • Drug Transfer
    • Factors affecting drug transfer across the placenta:
A
  • lipid solubility
  • protein binding
  • tissue binding
  • pKa
  • pH
  • blood flow
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47
Q
  • Rate of diffusion (Drug Transfer) depends on:
A
  • Maternal-to-fetal concentration gradient
  • maternal protein binding
  • molecular wt of substance
  • lipid solubility
  • degree of ionization of substance
  • placental properties
  • hemodynamic events within the fetomaternal unit
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48
Q
  • Maternal blood concentration of a drug is typically the primary determinant of how much drug will ultimately reach the fetus. Factors that effect this are:
A
  • Dose
  • Mode and Site of administration
  • Additive drugs (ex- epinephrine added to a local)
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49
Q
  • Transfer of drugs from maternal circulation to the fetal unit is determined primarily by diffusion.
    • Factors favoring diffusion include:
A
  • Low molecular weight
  • High lipid solubility
  • Low degree of ionization
  • Low protein binding
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50
Q

factors that minimize drug effects on fetus

A
  • Dilution
  • fetal cardiac output
  • acid base status of fetus
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51
Q

Extremely high levels of local, such as those with unintended maternal intravascular injection, can cause:

A
  • fetal bradycardia,
  • ventricular arrhythmias
  • acidosis
  • severe cardiac depression
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52
Q

Roles of Amnio fluid

A

1) Facilitates fetal growth
2) Provides of microgravity environment that cushions fetus
3) Generates defense mechanism against invading microorganisms

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53
Q

Amniotic fluid

  • Between 10 & 20 weeks, volume increases from ~ __ to __
A
  • Between 10 & 20 weeks, volume inc from ~ 25 ml to 400 ml
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54
Q

Amnio fluid

  • Near term fetal urine production is __ mL/ day, respiratory tract __ mL/kg fetal body weight/day, and swallowing is __ml/kg fetal body weight/day
A
  • Near term fetal urine production is 600-1200 mL/ day, respiratory tract 60-100 mL/kg fetal body weight/day, and swallowing is 200-250 ml/kg fetal body weight/day
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55
Q

amnio fluid

  • b/w amniotic fluid and fetal blood w/in placenta
  • b/w amniotic fluid and maternal blood within the uterus
A
  • intramembranous - b/w amniotic fluid and fetal blood w/in placenta
  • transmembranous - b/w amniotic fluid and maternal blood within the uterus
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56
Q

Amniotic Fluid

  • Composition
    • Keratinization + fetal production of urine results in:
A

Amniotic Fluid

  • Composition
    • Keratinization + fetal production of urine results in:
      • urea & creatinine
      • Na+ & Cl-
      • osmolality
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57
Q

composition of amnio fluid complete by this many wks gestation

A

25 weeks

58
Q

Play important role in fetal intestinal development (within amnio fluid):

there are six

A
  • Growth factors: Play important role in fetal intestinal development
    • epidermal growth factor
    • transforming growth factor-alpha
    • transforming growth factor-beta 1
    • insulin-like growth-factor 1
    • erythropoietin
    • granulocytes colony-stimulating factor
59
Q
  • Antimicrobial defenses
    • Humoral mediators:
A
  • alpha-defensins
  • lactoferrin
  • calprotectin
  • leukocyte protease inhibitor
  • cathelicidin
60
Q
  • In fetal tissues, hypoxia occurs at oxygen tension < __ mm Hg
    • (normal, 20-25 mm Hg)
  • In adults, hypoxia= PO2 <__ mmHg
A
  • In fetal tissues, hypoxia occurs at oxygen tension < 17 mm Hg
    • (normal, 20-25 mm Hg)
  • In adults, hypoxia= PO2 <20 mmHg
61
Q

Normal and only source of glucose is

A
  • Normal and only source of glucose is transfer across placenta
62
Q
  • Fetal glucose concentrations are Range of ___ to ___ mg/dl
A
  • Fetal glucose concentrations are Range of 54-90 mg/dl
63
Q

Umbilical cord uptake is ______ (uptake speed /min) at normal maternal arterial plasma glucose concentrations

A
  • Umbilical cord uptake is 5mg/kg/min at normal maternal arterial plasma glucose concentrations
64
Q

Total lactate production is about ___ (per min) though the exact source has not been identified by studies.

A
  • Total lactate production is about 4mg/kg/min though the exact source has not been identified by studies.
65
Q

name of maternal-fetal difference in temperature

A
  • Heat clamp
66
Q

Fetal intravascular volume: ml/kg

% in placenta:

fetal body blood volume:

A
  • Fetal intravascular volume ~ 110 ml/kg
  • 25% of this blood voulme is in placenta
  • Blood volume in fetal body is about ~ 80 ml/kg ​
67
Q
  • Systolic BP
    • 16 weeks: Systolic BP inc from ____ mmHg
    • 28 weeks: inc to ___ mmHg
A
  • Systolic BP
    • 16 weeks: Systolic BP inc from 15-20 mmHg
    • 28 weeks: inc to 30-40 mmHg
68
Q
  • Diastolic ventricular pressure slower & smaller increases
    • 16-18 weeks: __ mmHg or less
    • 19-26 weeks: __ mmHg
A
  • Diastolic ventricular pressure slower & smaller increases
    • 16-18 weeks: 5 mmHg or less
    • 19-26 weeks: 5-15 mmHg
69
Q

timing of SNS and PNS development

A
  • PNS ~ 8 wks
  • SNS ~9-10 wks
70
Q
  • Full maturation of vagal response not observed until __ mo after birth
A
  • Full maturation of vagal response not observed until 1-2 mo after birth
71
Q
  • At birth, ANS can mediate hemodynamics via changes in: 3
A
  • HR
  • PVR
  • Redistribution of blood flow
72
Q
  • True alveoli develop ~ __wk
    • Majority occur in__ months of life
A
  • True alveoli develop ~ 36 wk
    • Majority occur in 6-18 months of life
73
Q
  • Pulmonary circulation documented at __days gestation
  • Pulmonary vasculature starts early w/ full pulmonary circulation at the __days
A
  • Pulmonary circulation documented at 34 days gestation
  • Pulmonary vasculature starts early w/ full pulmonary circulation at the 34 days
74
Q
  • Attempt respiratory movement starts at:
A
  • Attempt respiratory movement starts at end of 1st trimester
75
Q
  • Vessel reactivity to local & hormonal influences seen after __wk
A
  • Vessel reactivity to local & hormonal influences seen after 20 wk
76
Q
  • During this time of pregnancy, respiratory movement are inhibited
A
  • Last 3-4 months of pregnancy respiratory movement inhibited
77
Q

↓ PVR at birth due to:

A
  • Creation of alveolar surface tension
  • Abrupt surge in pulmonary blood flow r/t the change in breathing movements & sheer stress
  • Predominance of vasodilators (e.g: nitric oxide & prostacyclin) vs vasoconstrictors
  • Expulsion of lung liquid
    • In utero, fetal lungs are filled with fluid to maintain proper expansion for normal pulmonary development
78
Q
  • one of the last systems to develop before birth
A

Pulmonary surfactant system: one of the last systems to develop before birth

79
Q
  • Fetal surfactant production can be accelerated by:
A

“TAG”

  • thyroid hormones
  • autonomic transmitters
  • Glucocorticoids
80
Q

mainly regulates the fluid and electrolyte balance, as well as the acid-base balance for the fetus

A
  • The placenta mainly regulates the fluid and electrolyte balance, as well as the acid-base balance for the fetus
81
Q
  • Fetal glomeruli develop__weeks
A
  • Fetal glomeruli develop 8-9 weeks
82
Q

Produce urine at __ weeks

A

Produce urine at 10 weeks

83
Q
  • At 20 weeks,____% of amniotic fluid is provided by kidneys
A
  • At 20 weeks, > 90% of amniotic fluid is provided by kidneys
84
Q
  • GFR at birth: ____
  • At 1 mo of age: increases to _____
  • The GFR levels continue to increase until they reach adult levels between 1 and 2 years of age
A
  • GFR at birth: 20 ml/min/1.73m2
  • At 1 mo of age: increases to 50 ml/min/1.73m2
  • The GFR levels continue to increase until they reach adult levels between 1 and 2 years of age
85
Q
  • Kidneys filter, reabsorb, & secrete (tubular function) begins ___ weeks gestation
A
  • Kidneys filter, reabsorb, & secrete (tubular function) begins 14 weeks gestation
  • but… regulation of fetal ECF volume and electrolyte balances are almost nonexistent until late fetal life
86
Q
  • 2 erythroid lineages (in hematology)
A
  • Primitive (embryonic) – support transition from embryo to fetus
  • Definitive (adult) – transition from fetal to extrauterine life
87
Q

adult vs fetal hemaglobin chain make up

A
  • Tetramer for HGB F (fetal): (a2y2)
    • 2 a - chains (alpha)
    • 2 y - chains (gamma)
  • Tetramer for HGB A (adult): (a2B2)
    • 2 a - chains
    • 2 B - chains
88
Q

Term:

  • HGB A ≈ __%
  • P50 ≈ __ mmHg
A
  • Term:
    • HGB A ≈ 25%
    • P50 ≈ 19 mmHg
89
Q
  • Intestinal villi start to appear at:
  • Peristaltic waves & motility
A

7 weeks gestation - Villi

8 weeks gestation - Peristalsis

90
Q
  • Active absorption of glucose & amino acids
A
  • 10-12 weeks gestation
    • Active absorption of glucose & amino acids
91
Q
  • Teniae (ribbons of smooth muscle on outside of colon) appear & contract to form haustra (bulges) in colon (what week?)
A
  • 12 weeks - Teniae –> haustra bulges in colon
92
Q

Peyer patches in ileum being to appear what week

A
  • 20 weeks gestation - Peyers
93
Q

swallowing starts when

injest amnio how much per day!

A
  • 15 wks - swallowing
  • Ingests about 500-750 ml/day amniotic fluid
94
Q

meconium first appearance

whats in it?

A

10-12 weeks gestation - meconium

  • intestinal secretions
  • squamous cells
  • lanugo hair
  • bile pigments
  • blood and H2O
95
Q

fetal colonic contents appear

A

14-22 - colon contents

96
Q
  • Structural & Functional Brain Development
    • 4 wk:
    • 8-12 wk:
    • 20 wk:
    • 24-28 wk:
    • 3rd TRI:
    • 1st fetal movement:
    • EEG activity ~
A
  • Structural & Functional Brain Development
    • 4 wk: primary neuromodulation & neural tube formation
    • 8-12 wk: prosencephalon development is initiated
      • As well as the subplate layer
    • 20 wk: cortical development, organization, & synapse formation
    • 24-28 wk: subplate layer disintegrates
    • 3rd TRI:cerebral cortexvolume increases4x
    • 1st fetal movement: end of 1st TRI
    • EEG activity ~ 24 wks
97
Q

fetus relies on what type of metabolism for energy

primary source of energy of cerebral energy

A

oxidative metabolism

glucose

98
Q
  • Development of neural tube begins with formation of ___ ___
A
  • Development of neural tube begins with formation of vascular channels
99
Q
  • 10 wk: extensive network of ______arteries covering brain
A
  • 10 wk: extensive network of leptomeningeal arteries covering brain
100
Q
  • cutaneous sensory receptors present when
  • current evidence: fetal nociception at cortical level begins 24-30 wks
A
  • 7 wks cutaneous sensory receptors present
  • current evidence: fetal nociception at cortical level begins 24-30 wks
  • term: cutaneous sensory same or exceeds adult
101
Q

reliability of fetal scoring systems

A
  • Scoring systems not reliable for identifying high-risk fetuses b/c more than half infants with asphyxia had none of the risk factors on the scoring systems
102
Q
  • One of the most important determinants of placental function
A

One of the most important determinants of placental function is UBF

103
Q

Compensatory responses of healthy fetus if there is a transient decrease in UBF: 4

A
  • Compensatory responses of healthy fetus if there is a transient decrease in UBF:
    • 1) decreased oxygen consumption
    • 2) vasoconstriction of nonessential vascular bed
    • 3) redistribution of blood flow to vital organs
    • 4) humoral responses
104
Q

initial fetal response to hypoxia per studies

A

bradycardia is the initial fetal response to hypoxia

105
Q

normal baseline FHR

A
  • Normal: 110-160
    • determined by assessing mean over 10 min;
    • Rounded to increments of 5 bpm
  • Term HR < preterm (greater PNS activity)
106
Q

define FHR variability

A

Fluctuation in FHR of 2 cycles or more per min

107
Q

role of SNS vs PNS in FHR variability

which has more important role

A

PNS > SNS

SNS least important role

108
Q

Differential Diagnosis of decreased variability

A
  • Differential Diagnosis of decreased variability:
    • Hypoxia
    • sleep state
    • neurologic abnormality
    • decreased CNS from drug exposure (opioids)
109
Q

Late decels + dec/absent variability

A

combination of these type of decels and variability pattern IS an omnious sign of fetal compromis

110
Q
  • PFO closes → more blood directed to __
  • PDA closes → more blood directed to __
A
  • PFO closes → more blood directed to RV
  • PDA closes → more blood directed to PA
111
Q
  • Fetal breathing at __weeks
A
  • Fetal breathing at 11 weeks
112
Q
  • Fetal lung liquid is an ultrafiltrate of plasma
    • Volume is ~ __ mL/kg
A
  • Fetal lung liquid is an ultrafiltrate of plasma
    • Volume is ~ 30 mL/kg
113
Q
  • Fetal lunf fluid - 2/3 expelled during birth
  • Retained liquid thought to cause _________
A
  • Fetal lunf fluid - 2/3 expelled during birth
  • Retained liquid thought to cause transient tachypnea of newborn (TTN)
114
Q

surfacant released during lung inflation, present at birth but not significant until __ wks

A

surfacant released during lung inflation, present at birth but not significant until 34-38 wks

115
Q

Characteristics of persistent PHTN/fetal circ: 3

A
  • Characteristics of persistent PHTN/fetal circ:
    • Sustained ↑ PVR
    • ↓ lung perfusion
    • Continued right-to-left shunting (patent foramen ovale & ductus arteriosus)
116
Q

Persistent Fetal Circ also Associated with these diseases/conditions:

A
  • Persistent Fetal Circ also Associated with these diseases/conditions:
    • Severe birth asphyxia
    • Meconium aspiration
    • Sepsis
    • Congenital diaphragmatic hernia (CDH)
    • Maternal use of NSAIDS
117
Q

Persistent pulmonary HTN of newborn (cont)

  • Primary Precipitating Factors:
A

Persistent pulmonary HTN of newborn (cont)

  • Primary Precipitating Factors:
    • Hypoxemia
    • Acidosis
    • Pneumonia
    • Hypothermia
118
Q

“Other” risk factors persistent pulm HTN/fetal circ:

A
  • “Other” risk factors persistent pulm HTN/fetal circ:
    • Maternal diabetes
    • Maternal asthma
    • Cesarean delivery
119
Q

Treatment for Persistent Pulm HTN

A
  • Correcting predisposing disease (hypoglycemia, polycythemia, etc)
    • Goal:
      1. improve oxygenation
      2. PaO2 50-70 mmHg
      3. PaCO2 50-55 mmHg
    • Mechanical ventilation; high-frequency ventilation
    • Exogenous surfactant
    • Inhaled nitric oxide
    • Alkalinization of blood
    • ECMO
120
Q
  • Rapid change in hematopoietic physiology – “physiologic anemia” contributed to by the following 3 items & peaks at ~ 3 months of age:
A
  • Rapid change d/t oxygen
  • Decrease in erythropoiesis
  • Decrease lifespan of RBC
121
Q

when do terminal bronchi form

when do these turn into alveoli

A

2 TRI

after birth

122
Q

when do type 2 cells produce surfactant

A

beginning 22-26 week

in terminal airways 34-38 weeks

123
Q

initial negative ITP needed to expand alveoli

A

40-60 cm H2O

124
Q
  • CBF in a premature infant is about __ mL/100g/min
  • CBF in the older child is about ___ mL/100g/min
A
  • CBF in a premature infant is about 40 mL/100g/min
  • CBF in the older child is about 100 mL/100g/min
125
Q
  • Loss of autoregulation (CBF) can occur with
A
  • Hypoxia
  • severe hypercapnia (>80 mmHg)
  • blood-brain barrier disruption after head trauma
  • subarachnoid or intracerebral hemorrhage
  • cerebral ischemia
  • high concentration of volatile agents
  • vasodilators (such as Nipride)
126
Q
  • Liver begin to develop at __wk gestation
  • Starts functioning at __ wk
  • Fetal liver starts storing glycogen at __ wk
A
  • Liver begin to develop at 10 wk gestation
  • Starts functioning at 12 wk
  • Fetal liver starts storing glycogen at 14 wk
127
Q
  • At about ___wks the bone marrow starts producing RBCs
A
  • At about 4-6 wks the bone marrow starts producing RBCs
128
Q
  • Neonate has low GFR (___ ml/min/kg) & renal blood flow
    • 4 reasons:
A
  • 1) low systemic arterial pressure
  • 2) high renal vascular resistance
  • 3) low permeability of the glomerular capillaries
  • 4) small size & number of glomeruli
    • Does not tolerate fluid overload
129
Q
  • < ____ml/kg/hr indicative of hypovolemia or decreased renal function
A
  • < 1ml/kg/hr indicative of hypovolemia or decreased renal function
130
Q
  • Limited ability to concentrate urine
    • Neonate __mOsm/L
    • Adult __ mOsm/L
A
  • Limited ability to concentrate urine
    • Neonate 700 mOsm/L
    • Adult 1200 mOsm/L
131
Q
  • Factors responsible for heat loss after birth: (not evaporation, conduction, rad, etc)
A
  • Cold environment
  • high ratio of surface area-to-body weight
  • reduced SQ fat
  • poor shiver response to cold
  • Compensatory response: nonshivering thermogenesis
132
Q

Perioperative cause of hypothermia:

A
  • cold OR
  • anesthetic-induced vasodilation
  • room-temp IVF
  • open body cavities
  • cool irrigation fluid
  • inspiration of cool anesthetic gases
133
Q

____ heat loss is responsible for most heat loss.

(ie conv, evap, rad, etc)

A

Radiant heat loss is responsible for most heat loss.

134
Q

Factors affecting metabolism of drugs in neonates:

A
  • volume of distribution
  • Reduced protein binding
  • fat content
135
Q

Cardiac output

  • ___ ml/kg/min in newborn
A

Cardiac output

  • 200 ml/kg/min in newborn
136
Q
  • normal renal drug excretion by ___ weeks of age
  • Renal fxn reaches adult levels b/w ___months
A
  • normal renal drug excretion by 3-4 weeks of age
  • Renal fxn reaches adult levels b/w 8-12 months
137
Q
  • Inhalation Agents
    • Equilibrate more rapidly in neonate bc: (3)
A
  • Increased level of ventilation
  • Increased cardiac output
  • Reduced solubility in blood
138
Q
  • Preferred concentration for peripheral nerve block:
    • Bupivacaine__% or __%, ropivacaine __%
    • (yes or no) Cross the blood-brain barrier
    • Bupivacaine: max dose for neonates & infants:
      • __mg/kg bolus or__mg/kg/hr infusion
    • Ropivacaine; less toxicity; bolus: __ mg/kg; infusion: __ mg/kg/hr
A
  • Bupivacaine 0.25% or 0.125%,
  • Ropivacaine 0.2%
  • Major adverse effect of bupivacaine is toxicity related to CV or CNS
  • Bupivacaine: max dose for neonates & infants:
    • 2mg/kg bolus
    • 0.2mg/kg/hr infusion
  • Ropivacaine; less toxicity;
    • bolus: 2 mg/kg
    • infusion: 0.2 mg/kg/hr
139
Q
  • Blood vol in Full-term newborn: __ ml/kg
  • ­Preterm: __ ml/kg
  • Approximately __ ml/kg is plasma volume
A
  • Blood vol in Full-term newborn: 85 ml/kg
  • ­Preterm: 90-100 ml/kg
  • Approximately 50 ml/kg is plasma volume
140
Q

Urine osmolality, specific gravity, & serum osmolality important for managing intraop fluids

  • Urine osmolality: __mOsm/L
  • Specific gravity: __
  • Serum osmolality: __mOs/kg
A

Urine osmolality, specific gravity, & serum osmolality important for managing intraop fluids

  • Urine osmolality: 200-400mOsm/L
  • Specific gravity: 1.006-1.012
  • Serum osmolality: 270-280 mOs/kg
141
Q
A

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