Unit 3 Module 1 Maternal Phys (Exam 2) Flashcards
Its a numbers game for this one
At what gestational age is a pregnancy considered “term gestation”?
a) 32-34 weeks
b) 34-36 weeks
c) 37-40 weeks
d) 40-42 weeks
c) 37-40 weeks
Slide 3
True or False
Anything before 40weeks is considered “pre-term”
False
Anything before 37 weeks is considered “pre-term”
How many trimesters are there in a full-term pregnancy?
a) 2
b) 3
c) 4
d) 5
b) 3
Slide 3
What is the definition of “parturient”?
a) A woman who has never been pregnant
b) A woman who has had multiple pregnancies
c) One who is pregnant or in labor
d) One who has given birth to more than two children
c) One who is pregnant or in labor
Slide 4
What does “gravida” refer to?
a) Number of pregnancies
b) Number of live births
c) Number of miscarriages
d) Number of gestational weeks
a) Number of pregnancies
Slide 4
The term “para” refers to the number of ___.
a) Pregnancies a woman has had
b) Births that occur at ≥20 weeks gestation
c) Miscarriages before 20 weeks
d) Fertility treatments
b) Births that occur at ≥20 weeks gestation
slide 4
True or False
Still-Births are considered “para” if they happen >/20 weeks of gestation
True
Live or still-births >/20weeks are considered “para”
Slide 4
A woman who has never been pregnant is referred to as ___.
a) Primiparous
b) Primigravida
c) Multiparous
d) Nulligravida
d) Nulligravida
G0P0 = nulligravida/nulliparous
Slide 4
A woman who is G1P0 is considered:
a) Nulligravida and nulliparous
b) Primigravida and multiparous
c) Primigravida and nulliparous
d) Multigravida and multiparous
c) Primigravida and nulliparous
AKA - “Primip” - Pregnant but not yet had the baby
Slide 4
True or False
A G1P0 can mean a patient is pregnant and has had a miscarriage prior to 20weeks.
True
Slide 4
If a woman is currently pregnant for the fourth time and has had one miscarriage at <20wks and two live births, her obstetric history would be recorded as G___P___.
a) G3P2
b) G4P2
c) G3P3
d) G4P3
b) G4P2 - Multigravida/Multiparous “Multip”
This also could mean she has been pregnant 4 times and had two miscarriages prior to 20weeks..
Slide 4
A woman who has had three pregnancies and two live births would be classified as:
a) G2P2
b) G2P3
c) G3P2
d) G3P3
c) G3P2
Also can mean she has has one miscarriage prior to 20weeks..
Slide 4
True or False
A “multip” could have more complications as in bleeding or a fast birth
True
Slide 4
What is considered a normal and healthy minimum weight gain during pregnancy?
a) 8 kg
b) 10 kg
c) 12 kg
d) 15 kg
c) 12 kg
Slide 5
True or False
It is normal for a pregnant person to lose weight in the first trimester
True - d/t food aversion, nausea and vomiting.
Slide 5
Which of the following contributes approximately 2 kg to total pregnancy weight gain?
a) Increased blood volume
b) Placental weight
c) Amniotic fluid
d) Uterine growth
a) Increased blood volume
Slide 5
How much weight gain is attributed to uterus and amniotic fluid combined?
a) 1 kg
b) 2 kg
c) 3 kg
d) 4 kg
b) 2 kg
(1 kg for uterus and 1kg for amniotic fluid)
Slide 5
During pregnancy, new fat and protein stores contribute to an approximate weight gain of ___ kg.
a) 1 kg
b) 2 kg
c) 3 kg
d) 4 kg
d) 4 kg
Which of the following correctly matches a pregnancy weight component to its approximate weight gain?
a) Fetal weight + placenta = 4 kg
b) Blood volume increase = 3 kg
c) New fat and protein stores = 2 kg
d) Uterus and amniotic fluid combined = 3 kg
a) Fetal weight + placenta = 4kg
Slide 5
Matching
Depending on the pre-pregnancy BMI what should be the total weight gain and rate at which they should gain it?
1 → D → IV (Underweight: 28-40 lb, 1 lb/wk)
2 → B → III (Normal weight: 25-35 lb, 1 lb/wk)
3 → A → II (Overweight: 15-25 lb, 0.6 lb/wk)
4 → C → I (Obese: 11-20 lb, 0.5 lb/wk)
Slide 6
By how much does blood volume increase during pregnancy?
a) 10-15%
b) 20-25%
c) 30-35%
d) 40-45%
c) 30-35%
Slide 7
Between which weeks of pregnancy does blood volume expansion occur?
a) 4-20 weeks
b) 8-32 weeks
c) 12-36 weeks
d) 20-40 weeks
b) 8-32 weeks
Slide 7
By what gestational age does the majority of blood volume increase occur?
a) 16 weeks
b) 20 weeks
c) 24 weeks
d) 28 weeks
c) 24 weeks
“front loaded”
Slide 7
During pregnancy, which component of blood increases more significantly?
a) White blood cells (WBCs)
b) Plasma
c) Platelets
d) Clotting factors
b) Plasma
Expansion of both plasma & red blood cell volume (Plasma > RBC)
aka - dilutional anemia
Slide 8
The primary reason for blood volume expansion during pregnancy is:
a) To improve maternal oxygen uptake
b) To increase metabolic rate
c) To compensate for anticipated blood loss during delivery
d) To prevent blood clot formation
c) To compensate for anticipated blood loss during delivery
Slide 8
Approximately how much blood loss occurs during a vaginal delivery?
a) 250 mL
b) 500 mL
c) 750 mL
d) 800 mL
b) 500 mL
Slide 8
How much blood loss is expected during a cesarean section (C/S)?
a) 500 mL
b) 600 mL
c) 800 mL
d) 1000 mL
c) 800 mL
Slide 8
After delivery, blood volume returns to pre-pregnancy levels within:
a) 6 weeks
b) 8 weeks
c) 10 weeks
d) 12 weeks
a) 6 weeks
Slide 8
What is the approximate blood volume (BV) in a non-pregnant individual?
a) 45 ml/kg
b) 55 ml/kg
c) 65 ml/kg
d) 75 ml/kg
c) 65 ml/kg
Slide 9
What is the approximate blood volume (BV) in a pregnant individual?
a) 80-85 ml/kg
b) 85-90 ml/kg
c) 85-100 ml/kg
d) 90-95 ml/kg
b) 85-90 ml/kg
*…remember 30-35% blood volume increase
65ml x (0.30 to 0.35) = 84.5 - 87.75mL*
Slide 9
By how much does cardiac output increase at term during pregnancy?
a) 10%
b) 25%
c) 35%
d) 40%
d) 40%
Slide 10
What physiological factor contributes to the increase in cardiac output by 6 weeks of pregnancy?
a) Increase in maternal stroke volume
b) Increase in maternal heart rate
c) Decrease in maternal oxygen demand
d) Decrease in systemic vascular resistance
b) Increase in maternal heart rate
Slide 10
What additional factor contributes to increased cardiac output by 8-10 weeks of pregnancy?
a) Increased stroke volume
b) Decreased stroke volume
c) Decreased maternal heart rate
d) Increased systemic vascular resistance
a) Increased stroke volume
Slide 10
Increased plasma renin activity during pregnancy is primarily responsible for:
a) Decreased plasma volume
b) Decreased sodium and water retention
c) Increased aldosterone production
d) Increased systemic vascular resistance
c) Increased aldosterone production
This is due to pregnancy hormones like progesterone and estrogen.
slide 11
Rearrange the following physiological changes in the correct order leading from increased plasma renin activity to increased cardiac output during pregnancy:
A. Increased plasma volume
B. Increased stroke volume
C. Increased sodium (Na⁺) reabsorption in the kidneys
D. Increased preload (venous return to the heart)
E. Increased aldosterone secretion
F. Increased cardiac output
G. Increased water retention
Increased plasma renin activity →
E → Increased aldosterone secretion
C → Increased sodium (Na⁺) reabsorption in the kidneys
G → Increased water retention
A → Increased plasma volume
D → Increased preload (venous return to the heart)
B → Increased stroke volume
F → Increased cardiac output
slide 11
How much does uterine blood flow (UBF) increase by term gestation?
a) 2-5 times
b) 5-10 times
c) 10-20 times
d) 20-30 times
c) 10-20 times
Slide 12
What is the baseline uterine blood flow in a non-pregnant individual?
a) 30 ml/min
b) 50 ml/min
c) 100 ml/min
d) 150 ml/min
b) 50 ml/min
Slide 12
What is the approximate uterine blood flow at term gestation?
a) 100 ml/min
b) 250 ml/min
c) 500 ml/min
d) 700 ml/min
d) 700 ml/min
Slide 12
How much does skin blood flow increase during pregnancy?
a) 3-4x
b) 5-6x
c) 6-7x
d) 8-9x
a) 3-4x
Slide 12
Which of the following are effects of increased skin blood flow during pregnancy? (Select three)
A. Increased skin temperature
B. Flushing
C. Decreased cardiac output
D. Itching
E. Reduced blood volume
A. Increased skin temperature
B. Flushing
D. Itching
slide 12
During pregnancy, systemic vascular resistance (SVR) ____________
a) Increases by 20%
b) Decreases by 20%
c) Remains the same
d) Increases due to higher blood volume
b) Decreases by 20% lower than pre-pregnant values
Slide 13
Which of the following contribute to the decrease in systemic vascular resistance (SVR) during pregnancy? (Select four)
A. Increased progesterone levels
B. Decreased relaxin levels
C. Increased prostacyclin
D. Increased systemic vasoconstriction
E. Increased relaxin levels
F. Increased estrogen
A. Increased progesterone levels
C. Increased prostacyclin
E. Increased relaxin levels
F. Increased estrogen
slide 13
Which best describes the vascular state of normal pregnancy?
a) High flow, high resistance
b) Low flow, high resistance
c) High flow, low resistance
d) Low flow, low resistance
c) High flow, low resistance
Slide 14
Which two physiological changes contribute to decreased systemic vascular resistance (SVR) during pregnancy?
select 2
A. Decreased maternal vasodilation
B. Low-resistance placental circulation
C. Increased renal vasculature resistance
D. Increased maternal vasodilation
B. Low-resistance placental circulation
D. Increased maternal vasodilation
Maximal arterial dilation in the uterus!
Slide 14
Which of the following are an effect of decreased SVR in pregnancy?
A. Maternal vasoconstriction
B. Decreased renal vascular resistance
C. High-resistance placental circulation
D. Increased renal vascular resistance
B. Decreased renal vascular resistance
Slide 14
Systemic vascular resistance ___ during pregnancy, leading to a decrease in ___.
a) Increases; cardiac output
b) Increases; venous return
c) Decreases; preload
d) Decreases; afterload
d) Decreases; afterload
Slide 15
By how much does left ventricular (LV) mass increase by term during pregnancy?
a) 10%
b) 25%
c) 50%
d) 75%
c) 50%
slide 16
Which type of ventricular hypertrophy is referred to as the “Athlete’s Heart”?
A. Concentric hypertrophy
B. Eccentric hypertrophy
C. Hypertrophic cardiomyopathy
D. Dilated cardiomyopathy
B. Eccentric hypertrophy
slide 16
Eccentric hypertrophy primarily occurs due to:
A. Increased afterload and decreased blood volume
B. Increased systemic vascular resistance
C. Decreased myocardial oxygen demand
D. Increased preload and blood volume
D. Increased preload and blood volume
Slide 16
During pregnancy, the heart shifts _________ and _________ due to diaphragmatic elevation from the growing uterus.
A. Posterior, right
B. Inferior, right
C. Anterior, left
D. Superior, left
C. Anterior, left
slide 17
The PMI (point of maximal impulse) shifts upward and to the left, typically to the _______ intercostal space, _______ line
a) 5th intercostal space, midclavicular line
b) 4th intercostal space, midclavicular line
c) 6th intercostal space, anterior axillary line
d) 3rd intercostal space, midaxillary line
b) 4th intercostal space, midclavicular line
Slide 17
On a chest radiograph, the heart may appear _________ due to its shift anteriorly.
A. larger
B. smaller
C. compressed
D. inverted
A. larger
Lungs also apprear shifted upward as well
Slide 17
During pregnancy, the QRS axis shifts:
A. Rightward in the 3rd trimester
B. Inferiorly throughout pregnancy
C. Leftward in the 3rd trimester
D. Anteriorly in the 2nd trimester
C. Leftward in the 3rd trimester
Slide 19
Which of the following EKG changes are commonly observed in pregnancy?
(Select 3)
A. Leftward QRS axis shift
B. T wave inversions
C. ST-segment elevation
D. QT interval increased
E. Prolonged PR interval
A. Leftward QRS axis shift
B. T wave inversions (Lead III)
D. QT interval increased (but often WNL)
AND ST-segment depression
Slide 19
What factors contribute to a shortened PR interval in the 3rd trimester of pregnancy? (Select 2)
A. Decreased sympathetic activity
B. Decreased AV node conduction velocity
C. Accelerated AV node conduction velocity
D. Increased sympathetic activity
Shortened PR interval in 3rd trimester
C. Accelerated AV node conduction velocity
D. Increased sympathetic activity (In 3rd trimester)
Slide 19
Which of the following EKG findings are consistent with left axis deviation (LAD)? (Select 4)
A. Positive QRS in Lead I
B. Negative QRS in Lead I
C. Positive QRS in aVL
D. Positive QRS in aVR
E. Negative QRS in aVF
F. Negative QRS in aVL
G Negative QRS in Lead II
A. Positive QRS in Lead I
C. Positive QRS in aVL
E. Negative QRS in aVF
G Negative QRS in Lead II
Slide 20
Increased cardiac size contributes to tachydysrhythmias in pregnancy.
True
These are the most common EKG “abnormalities”
Which of the following arrhythmias are commonly seen in pregnancy?
Select 2
A. PACs
B. Atrial flutter
C. PVCs
D. Third-degree heart block
A. PACs
C. PVCs
Slide 21
Pregnancy-related tachydysrhythmias are caused by ______ in cardiac ion channel conduction and _________ in cardiac size.
A. Change, increase
B. Stasis, decrease
C. Stabilization, decrease
D. Enervation, increase
A. Change, increase
Slide 21
What are common causes of tachydysrhythmias in pregnancy? (Select 2)
A. Decreased sympathetic activity
B. Anorexia
C. Changes in autonomic tone
D. Hormonal influences
C. Changes in autonomic tone
D. Hormonal influences
Slide 21
Which valvular abnormalities occur in more than 90% of pregnant patients by the end of the third trimester?
A. Aortic and mitral regurgitation
B. Tricuspid and pulmonic regurgitation
C. Mitral stenosis and tricuspid stenosis
D. Aortic stenosis and pulmonic stenosis
:B. Tricuspid and pulmonic regurgitation
Freeman - d/t all the extra fluid ‘sloshing around’
Slide 22
What percentage of pregnant patients experience mitral regurgitation?
A. 10-15%
B. 20-25%
C. 25-30%
D. 40-50%
C. 25-30%
Slide 22
The valvular changes in pregnancy are often severe and require long-term management postpartum.
False
These are reversible changes that will
return to normal in postpartum period
Slide 22
The third heart sound (S3), often heard in pregnancy, is also referred to as a _________ and is commonly heard in the _________ trimester.
A. Atrial gallop, first
B. Diastolic gallop, second
C. Systolic murmur, third
D. Ventricular gallop, third
D. Ventricular gallop, third
Freeman - d/t mitral opening and large amounts of fluid filling the very compliant left ventricle
Slide 23
The fourth heart sound (S4) in pregnancy:
A. Becomes more pronounced at term
B. Disappears at term
C. Indicates heart failure in all cases
D. Is best heard over the pulmonic area
B. Disappears at term
Freeman - low pitch sound, d/t late diastolic filling d/t atrial contraction
Slide 23
A Grade II systolic ejection murmur (SEM) due to Cardiac Enlargement in pregnancy is best heard:
A. At the right sternal border
B. Over the left axilla
C. At the apex of the heart
D. Over the carotid arteries
A. At the right sternal border
Slide 23
Which factors can contribute to lower than normal blood pressure changes? (Select 3)
A. Fetal sex
B. Pregnancy complications
C. Gestational age
D. Maternal diet
E. Pre-existing conditions
B. Pregnancy complications
C. Gestational age
E. Pre-existing conditions
Slide 24
Which factors influence lower than normal blood pressure during pregnancy? (Select two)
A. Parity
B. Amount of fetal movement
C. Maternal age
D. Hair growth during pregnancy
A. Parity
C. Maternal age
Slide 24
_________ compression occurs when the enlarged uterus compresses the inferior vena cava and aorta, which can lead to a drop in blood pressure.
A. Carotid
B. Aortocaval
C. Jugular
D. Venous
B. Aortocaval
Supine position causes the gravid uterus to compress inferior vena cava and aorta
Slide 24
Anesthetic drugs that cause _________ can exacerbate aortocaval compression, leading to decreased venous return and hypotension.
A. Vasoconstriction
B. Tachycardia
C. Bradycardia
D. Vasodilation
D. Vasodilation
Freeman - For example - spinals/epidurals that can cause sympathectomy and cause vasodilation
Slide 25
Aortocaval compression can begin as early as _________ weeks gestation due to the increasing size of the gravid uterus.
A. 8–10
B. 13–16
C. 20–24
D. 30–34
B. 13–16
Slide 25
Put the following events of aortocaval compression in the correct order:
1. Decreased cardiac output
2. Decreased perfusion to the fetus
3. Decreased venous return to the right atrium
4. Decreased uterine blood flow
5. Hypotension
3 → 1 → 5 → 4 → 2
Slide 26
The initial cardiovascular response to aortocaval compression is _________, which is later followed by _________.
A. Tachycardia, bradycardia
B. Bradycardia, tachycardia
C. Hypertension, hypotension
D. Increased venous return, decreased cardiac output
A. Tachycardia, bradycardia
Slide 27
Which of the following symptoms may indicate aortocaval compression? (Select 4)
A. Nausea/Vomiting
B. Flushing
C. Loss of consciousness
D. Fetal distress
E. Hypertension
F. Pallor
A. Nausea/Vomiting
C. Loss of consciousness
D. Fetal distress
F. Pallor
Slide 27
To relieve aortocaval compression, the patient should be tilted to which side?
A. Left
B. Trendelenburg
C. Supine
D. Right
A. Left - LUD = Left Uterine Displacement
Displace uterus off vena cava and aorta
Slide 28
Which cardiovascular changes occur during the first stage of labor between and during contractions? (Select 3)
A. Increased cardiac output
B. Decreased blood volume
C. Increased heart rate
D. Autotransfusion of blood from the uterus
E. Decreased systemic circulation
A. Increased cardiac output
C. Increased heart rate
D. Autotransfusion of blood from the uterus
Slide 29
How much blood is autotransfused into the general circulation with each contraction?
A. 100–200 mL
B. 300–500 mL
C. 600–800 mL
D. 50–100 mL
B. 300–500 mL
Slide 29
During the second stage of labor, cardiac output increases by approximately _________%, primarily due to _________ efforts.
A. 25, breathing
B. 45, relaxation
C. 50, pushing
D. 10, reduced stroke volume
C. 50, pushing
Therefore the heart rate also increases
Slide 30
What percentage increase in cardiac output occurs immediately after delivery?
A. 30–50%
B. 50–70%
C. 60–80%
D. 90–100%
C. 60–80%
Slide 31
Which factors contribute to the increased cardiac output immediately postpartum? (Select 2)
A. Increased pressure on the vena cava
B. Uterus continuing to contract
C. Relief of pressure on the vena cava
D. Increased systemic vascular resistance
E. Decreased circulating blood volume
B. Uterus continuing to contract -releasing blood into systemic circulation
C. Relief of pressure on the vena cava
Slide 31
Cardiac output begins to decline within _________ minutes of delivery and returns to normal by _________ hours postpartum.
A. 10, 24
B. 20, 12
C. 5, 48
D. 15, 36
A. 10, 24
Slide 31
Pregnancy leads to vascular engorgement of the airway, resulting in _________ tissue and a potential for a _________ airway.
A. Friable, difficult
B. Thickened, narrowed
C. Stiff, restricted
D. Inelastic, obstructed
A. Friable, difficult
Edemetous as well
Slide 32
One common symptom of increased airway vascularity in pregnancy is _________, which may present as nasal congestion or _________.
A. Bronchospasm, wheezing
B. Rhinitis, nosebleeds
C. Hypoxia, coughing
D. Tracheomalacia, respiratory failure
B. Rhinitis, nosebleeds
Freeman - First thing pregnant patients should do if they feel like they can’t breath through her nose is blow their nose!
Slide 32
True or False
If a pregnant patient is having trouble breathing through their nose you can place a nasal trumpet to open their airway.
False
This can cause nose bleeds
Hyperemia Anesthetic implications include (select 3)
A. ETT 6.0-6.5
B. use nasal trumpets
C.increased risk for airway obstruction
D.Mallampati class improvement
E.airway difficulties
A. ETT 6.0-6.5
C. increased risk for airway obstruction
E. airway difficulties
mallampati class may worsen, keep a bougie on hand
avoid nasal tube. trumpet/NGT
Slide 34
Progesterone can cause what 3 things:
A. Decrease sensitivity to CO2
B. Bronchodilation
C. Hyperemia
D. Increase sensitivity to CO2
E. Bronchoconstriction
F. Hyporemia
B.bronchodilation
C.hyperemia
D. increase respiratory sensitivity to CO2
slide 35
True or False
Estrogen causes a decrease in the number and sensitivity of progesterone receptors in respiratory center of the brain. (T/F)
false
increase number and sensitivity
so then will increase sensitvity to CO2
bronchodilation and hypermia/edema of respiratory passages
slide 35
Relaxin causes hormonal and mechanical changes including (select 3)
A. Ligamentous attachments to lower ribs relax
B. Sunken chest
C. Subcostal angle increases
D. Ligamentous attachements to upper ribs relax
E. Barrel Chest
F. Subcostal angle decreases
A. ligamentous attachments to lower ribs to relax
C. subcostal angle increases
E. Barrel Chest (Widened AP and transverse diameter of chest wall)
slide 36
true or false
Pulmonary changes includes preservation of total lung capacity
true
slide 37
terminology review Matching
- FRC
- ERV
- RV
A. extra volume of air that can be expired with maximum effort beyond the level reached at the end of a normal expiration
B. volume of air that prevents complete emptying of lungs and keeps small airways open
C. the volume of air that remains in the lungs after the ERV is expired
- FRC: B
- ERV: A
- RV: C
FRC=ERV + RV
slide 38
What will the decrease in FRC be at term?
A. 20%
B. 30%
C. 15%
D. 25%
A. 20%
slide 39
Decreased FRC results from decreased ____ and ____ (select 2)
A. RV
B. ERV
C. IC
D. IRV
A. RV
B. ERV
slide 39
With an elevated diaphragm negative pleural pressure is increased causing
A. delayed closure of small airways
B. decreased surfactant in large airways
C. earlier closure of small airway
D. increased surfactant in large airways
C. earlier closure of small airways
slide 40
The FRC decrease in parturient patients is more profound in which position?
A. supine
B. lateral
C. Prone
D. sitting
A. supine (30% decrease)
The diaphragm is elevated, which causes an increased amount of alveolar atelectasis
slide 41
The ________ may exceed FRC causing small airway closure, v/q mismatch, and decreased O2 saturation
A. expiratory reserve volume
B. tidal volume
C. closing capacity
D. Inspiratory reserve volume
C. closing capacity
slide 41
Which 2 respiratory volumes are increased in pregnancy
A. expiratory reserve volume
B. tidal volume
C. inspiratory capacity
D. functional reserve capacity
B. Tidal volume
C. inspiratory capacity
slide 43
Increased metabolic CO2 production and respiratory drive related to high progesterone level is related to
A. expiratory reserve volume
B. tidal volume
C. inspiratory capacity
D. functional reserve capacity
B. Tidal volume
slide 43
Which 2 respiratory volumes are unchanged in pregnancy
A. total lung capacity
B. functional reserve capacity
C. expiratory reserve volume
D. vital capacity
A. total lung capacity - same d/t rib expansion from relaxin
D. vital capacity
slide 44
True or false
Pregnancy makes patient vulnerable to hypoxia
true
d/t elevated diaphragm (decreased FRC) and decreased oxygen reserves
will desat faster!!
slide 45
What is an extremely important factor for the pregnant population regarding anesthesia
A. pain control
B. supine position
C. maintain neutrality
D. preoxygenation
D. preoxygenation
may need supplemental O2 during labor and in times or distress
slide 46
What is the goal for preoxygenation?
A. bringing O2 to 98%
B. denitrogenate and oxygenate
C. nitrogenate and deoxygenate
D.so they can smell the balloon and you have time to get your life together
B. Denitrogenate and oxygenate the bloodstream to a maximal level
* bring O2 sat as near as possible to 100%
* denitrogenate the **residual lung capacity **
* maximize the storage of oxygen in the lungs
slide 47
What are the 2 ways to preoxygenate?
A. 3-5 vital capacity breaths with a tight face mask seal delivering 100% O2
B. 8 deep breaths of an oxygen flow rate of 10L /min within a time period of 60 seconds
C. 10 vital capacity breaths with a tight face mask seal delivering 100% O2
D. 3 deep breaths of an oxygen flow rate of 5L/min within 30 seconds
A. 3-5 vital capacity breaths with a tight face mask seal delivering 100% O2
B. 8 deep breaths of an oxygen flow rate of 10L /min within a time period of 60 seconds
slide 48
Not a question just read the card for tips you deserve a break
Preoxygenation tips: tight mask seal (can use mask straps), watch for an increase in FeO2 (0.9 is ideal), 20 degree reverse trendelenburg shown to be helpful in Pre O2
you’re welcome.. now back to work
slide 49
What is the ideal fraction expired O2 while preoxygenating
A.0.6
B.0.8
C.0.3
D.0.9
D. 0.9
I literally just gave a free one hope you didn’t disappoint
slide 49
How much does Oxygen consumption increase during pregnancy at term
A. 23%
B. 30%
C. 17%
D. 20%
D. 20%
can cause increase work of breathing and increased cardiac workload
increased metabloic need of fetus, uterus, and placenta
slide 50
When does dyspnea begin in pregnancy?
A. first trimester
B. second trimester
C. third trimester
A. first trimester
slide 51
Dyspnea during pregnancy is caused by what three things? (select 3)
A. decreased respiratory drive
B. increased O2 consumption
C. decreased PaCO2
D. lower pulmonary blood volume
E. increase RBC
F. nasal congestion
B. increased O2 consumption
C. decreased PaCO2
F. nasal congestion
also increased respiratory drive, larger pulmonary blood volume, and anemia
slide 51
During pregnancy your minute ventilation increases due to an increase in tidal volume and respiration. By how much does your respiration increase per minute while pregnant?
A. 1-4 breaths
B. 3-4 breaths
C. 2-4 breaths
D.1-2 breaths
D. 1-2 breaths
hormone mediated increase neural drive to breath
slide 52
Alveolar ventilation _________ during pregnancy.
A. increase
B. decrease
C. is unchanged
A. increase
slide 52
Due to increased ventilation caused by pregnancy, you can expect PaCO2 to _____ by _______.
A. increase; 8-10mmHg
B.decrease; 8-10mmHg
C. decrease; 4-6mmHg
D.Increase; 4-6mmHg
B. decrease; 8-10mmHg
30-32 vs 40
respiratory alkolosis (pH 7.41-7.44)
slide 53/54
Due to increased ventilation caused by pregnancy, you can expect PaO2 to _____ by _______.
A. decrease; 10 mmhg
B. decrease 5mmHg
C. increase; 5mmHg
D. increase; 10mmHg
C. increase; 5mmHg
100-105 vs 100
slide 53/54
During pregnancy you can expect your HCO3 to be around
A.25mEq
B. 20mEq
C.22mEq
D. 15mEq
B. 20mEq
vs 24-26
slide 54
During pregnancy you can expect your base excess to be
A. 1-5mEq/L
B. 4-6mEq/L
C. 3-6mEq/L
D. 2-3mEq/L
D. 2-3mEq/L
slide 54
During the first stage of labor your minute ventilation will be up
A. 20%
B. 200%
C. 140%
D. 157%
C. 140%
slide 55
Maternal CO2 will decrease by_____ during the second stage of labor
A. 5-10mmHg
B. 1-3mmHg
C. 4-6mmHg
D. 10-15mmHg
D. 10-15mmHg
slide 55
During second stage of labor you can expect minute ventilation to be up
A. 40%
B.200%
C. 140%
D. 157%
B. 200%
slide 55
During second stage of labor you can expect the following changes to occur. (select 3)
A. CO2 increase
B.O2 consumption increase
C. anaerobic requirements increase
D.aerobic requirments increase
E. maternal lactate level increase
B. O2 consumption increase (may need supplemental O2)
D. aerobic requirements increase
E. maternal lactate level increase
slide 55
What is the primary cause of dilutional anemia during pregnancy?
a) Decreased red blood cell production
b) Increased red blood cell destruction
c) Plasma volume increase exceeding red cell mass increase
d) Iron deficiency
C. plasma volume increase exceeding red cell mass increase
slide 57
By approximately 36 weeks’ gestation, how much does hemoglobin typically drop from pre-pregnancy levels?
a) 1.2 g/dL
b) 2.4 g/dL
c) 3.6 g/dL
d) 4.8 g/dL
B. 2.4g/dL
slide 57
A pregnant woman’s hematocrit decreases by approximately what percentage during pregnancy?
a) 3.25%
b) 5.0%
c) 6.5%
d) 8.0%
C. 6.5%
slide 57
What maternal hemoglobin concentration is considered abnormal during pregnancy?
a) Less than 9 g/dL
b) Less than 15 g/dL
c) Less than 13 g/dL
d) Less than 11 g/dL
D. less than 11g/dL
slide 57
If a pregnant woman’s hemoglobin is greater than 13 g/dL, what conditions should she be monitored for? Select 2
a) Hemoconcentration
b) Iron deficiency anemia
c) Dilutional anemia
d) Pre-eclampsia
e) Gestational diabetes
A. hemoconcentration
d) Pre-eclampsia
slide 57
Iron is needed to make RBC’s. During pregnancy how do you treat iron deficiency anemia.
A. oral iron formulations
B. PRBCs
C. Albumin
D. fluid
A. oral iron formulations
slide 58
What is a normal platelet count for a non pregnant patient?
A. 130,000-300,000mm3
B. 200,000-350,000mm3
C. 150,000-500,000 mm3
D. 165,000-415,000mm3
D. 165,000-415,000mm3
slide 59
What can you expect to see regarding the platelet count in a pregnant patient
A. no change
B. profound decrease
C. increase
A. no change (to moderate decrease)
slide 59
What is considered thrombocytopenia
A. <150,000
B.<100,000
C. <200,000
D. <250,000
A. <150,000
for gestational <150k, no abnormal platelet function or bleeding seen
slide 59
Thrombocytopenia is considered (select 2)
A. normal
B. psychopathic
C. idiopathic
D. hypertensive disorder of pregnancy
C. idiopathic
D. hypertensive disorder of pregnancy
slide 59
What is the incidence of epidural hematoma
A. 1: 100,000-150,000
B. 1:300,000-350,000
C.1:150-000-250,000
D. 1:200,000 - 1:250,000
D. 1:200,000-1:250,000
“low risk”
slide 60
What is the big concern with epidural hematoma formation?
A. cause temporary or permanent neurological damage
B. cause headache and n/v
C. cause increase in difficuly breathing
D. can cause mom to be really really mad at you
A. cause temporary or permanent neurological damage
slide 60
If an emergency delivery comes in and a c-section is needed, the patient has no labs… what is anesthetic plan?
A. combined spinal/epidural
B.GETA
C. epidural
D. spinal
B. GETA
can be dependent on hopsital/anesthesia group policies
slide 60
For a plt count of_____ you would cancel surgery/procedure
A. 17,000mm3
B. 15,000mm3
C. 50,000mm3
D. 10,000mm3
D. 10,000mm3
Thrombocytopenia
slide 61
Before major surgery plt count needs to be
A. 25,000mm3
B. 10,000mm3
C. 50,000mm3
D. 80,000mm3
C. 50,000mm3
slide 61
Before an epidural plt count needs to be
A. 25,000mm3
B. 10,000mm3
C. 50,000mm3
D. 80,000mm3
D. 80,000mm3
slide 61
True or false
Pregnancy produces a hypocoagulable state.
False
pregnancy produces a hypercoagulable state
slide 62
All factors except ___ increase in concentration (Select. 4)
A. II
B. I
C.VII
D.V
E.XI
F.XII
G.XIII
A. II
D. V
E. XI
G. XIII
slide 62
Which factor has a siginificant increase during pregnancy
A. I
B. II
C. III
D. IV
A. I (fibrinogen)
>400mg/dL at term (slide 63)
slide 62
Hyperfibrinogenemia leads to (select 2)
A. hemorrhage
B. increased clotting efficiency
C. impaired fibrinolysis
D. bleeding
B. increased clotting efficiency
C. impaired fibrinolysis
protects against hemorrhage… but risk for blood clots increase
slide 63
What factors are increased at term gestation (select 6) … sorry i know it sucks
A. I
B. II
C.III
D.IV
E.V
F.VI
G. VII
H.VIII
I. IX
J. X
K. XI
L. XII
A. I (fibrinogen)
G. VII (proconvertin)
H. VIII (antihemophilic factor)
I. IX (Christmas factor)
J. X (Stuart-Prower factor)
L. XII (Hageman factor)
slide 64
Which factors are unchanged at term gestation (select 2)
A. I
B. II
C.III
D.IV
E.V
F.VI
G. VII
H.VIII
I. IX
J. X
K. XI
L. XII
B. II (prothromin)
E. V (proaccelerin)
slide 65
Which factors are decreased at term gestation (select 2)
A. I
B. II
C.III
D.IV
E.V
F.VI
G. VII
H.VIII
I. IX
J. X
K. XI
L. XII
M. XIII
K. XI (throboplastin antecedent)
M. XIII (fibrin-stabilizing factor)
fibrinolytic activity decrease in third trimester
slide 65
What decreased by 20% at term gestation (select 2)
A. PT
B.PTT
C.INR
D. Plt
A. PT
B. PTT
slide 65
What decreased in the third trimester
A. sanity
B. fibrinolytic activity
C. clotting
D. blood pressure
B. fibrinolytic activity
slide 65
White blood cell count during pregnancy typically increases steadily to ___.
A) 6,000 – 8,000/mm³
B) 9,000 – 11,000/mm³
C) 15,000 – 20,000/mm³
D) 30,000 – 34,000/mm³
B) 9,000 – 11,000/mm³
Slide 66
During labor, WBC count can increase up to ___.
A) 15,000/mm³
B) 25,000/mm³
C) 34,000/mm³
D) 50,000/mm³
C) 34,000/mm³
Slide 66
During pregnancy, polymorphonuclear leukocyte function is:
A) Enhanced, leading to increased immune response
B) Impaired, leading to increased infection risk
C) Unchanged from pre-pregnancy levels
D) Increased only in the third trimester
B) Impaired, leading to increased infection risk
Slide 67
Which of the following best describes the immune system changes in pregnancy?
A) Increased polymorphonuclear leukocyte function and decreased infection risk
B) Decreased humoral antibody response but improved autoimmune disease symptoms
C) Increased antibody titers to viral infections
D) No significant changes in immune function
B) Decreased humoral antibody response but improved autoimmune disease symptoms
Slide 67
Decreased humoral antibody titers during pregnancy are specifically associated with which viruses?
A) Hepatitis B, Influenza B, and HIV
B) Measles, Influenza A, and Herpes Simplex
C) COVID-19, Epstein-Barr, and Measles
D) Influenza B, Varicella, and Mumps
B) Measles, Influenza A, and Herpes Simplex
Slide 67
Which of the following changes contribute to an increased risk of aspiration in pregnancy? (Select 3)
A) Enlarged uterus displacing the stomach cephalad
B) Increased gastric pressure
C) Decreased competence of the lower esophageal sphincter (LES)
D) Enhanced gastric motility leading to faster emptying
A) Enlarged uterus displacing the stomach cephalad
B) Increased gastric pressure
C) Decreased competence of the lower esophageal sphincter (LES)
Slide 68
How does lower esophageal sphincter (LES) tone change during pregnancy?
A) Increases throughout pregnancy, leading to decreased aspiration risk
B) Decreases throughout pregnancy and reaches its lowest at term
C) Remains constant until postpartum, when it decreases
D) Fluctuates randomly throughout pregnancy due to hormonal shifts
E) Only decreases in the first trimester and then stabilizes
B) Decreases throughout pregnancy and reaches its lowest at term
Slide 69
All parturients are considered to have a ___ regardless of fasting status.
A) Delayed gastric emptying
B) Full stomach
C) Increased LES tone
D) Reduced gastric pressure
B) Full stomach
Slide 68
LES tone typically returns to normal around ___ postpartum.
A) Immediately
B) 4 weeks
C) 3 months
D) 6 months
B) 4 weeks
Slide 69
How does gastric emptying change during pregnancy and labor?
A) Gastric emptying is delayed throughout pregnancy and worsens in labor
B) Gastric emptying remains the same throughout pregnancy but becomes delayed during labor
C) Gastric emptying increases during labor to provide more energy for contractions
D) Gastric emptying is completely stopped during pregnancy and labor
B) Gastric emptying remains the same throughout pregnancy but becomes delayed during labor
Slide 70
What type of food or liquid is generally allowed during labor?
A) Clear liquids
B) Solid foods
C) Both clear liquids and solid foods
D) Nothing by mouth (NPO) for all laboring patients
A) Clear liquids
Solid food generally not
(depends on where you give birth/provider)
Slide 70
For how long should postpartum patients continue to be treated as having a full stomach?
A) 1-2 weeks
B) 2-3 weeks
C) 4-6 weeks
D) 8-10 weeks
C) 4-6 weeks
LES tone returns to normal around 4 weeks
Slide 71
How long does it take for the uterus to return to its normal size postpartum?
A) 2 weeks
B) 4 weeks
C) 6 weeks
D) 8 weeks
C) 6 weeks
Slide 71
Which of the following increases the risk of aspiration pneumonia?
A) Gastric pH < 4.5 and gastric volume > 50 mL
B) Gastric pH < 2.5 and gastric volume > 25 mL
C) Gastric pH > 5.0 and gastric volume < 10 mL
D) Gastric pH > 3.5 and gastric volume > 40 mL
B) Gastric pH < 2.5 and gastric volume > 25 mL
Slide 72
What is Mendelson’s Syndrome?
A) A syndrome caused by increased gastric acid production
B) Perioperative aspiration of gastric contents leading to lung inflammation
C) A gastrointestinal disorder leading to delayed gastric emptying
D) An infection caused by bacteria in the stomach
B) Perioperative aspiration of gastric contents leading to lung inflammation
Slide 72
Which of the following are true regarding hepatic changes in pregnancy? (Select 2)
A) Liver size remains unchanged
B) Hepatic blood flow shows little to no change
C) Portal venous pressure decreases
D) Risk of esophageal varices decreases
A) Liver size remains unchanged
B) Hepatic blood flow shows little to no change
Slide 73
An increase in ____, ____, and ____ venous pressure during pregnancy contributes to the risk of esophageal varices.
A) Splanchnic
B) Portal
C) Esophageal
D) Renal
E) Pulmonary
A) Splanchnic
B) Portal
C) Esophageal
Slide 73
Hepatic Changes
Which liver enzymes are known to increase during pregnancy? (Select 3)
A) Serum aspartate aminotransferase (AST)
B) Lactic dehydrogenase (LDH)
C) Alkaline phosphatase (ALP)
D) Gamma-glutamyl transferase (GGT)
A) Serum aspartate aminotransferase (AST)
B) Lactic dehydrogenase (LDH)
C) Alkaline phosphatase (ALP)
Slide 74
Hepatic Changes
It is normal for a healthy parturient to have increased ________ and ________.
A) Liver enzymes and cholesterol
B) Bilirubin and creatinine
C) Albumin and hemoglobin
D) Blood pressure and glucose
A) Liver enzymes and cholesterol
Slide 74
Hepatic Changes
Which of the following factors contribute to a decrease in colloid oncotic pressure during pregnancy? (Select 2)
A) Decreased total protein levels
B) Increased albumin synthesis
C) Decreased albumin-to-globulin ratio
D) Increased intravascular oncotic pull
A) Decreased total protein levels
C) Decreased albumin-to-globulin ratio
Slide 75
Hepatic Changes
____ oncotic pressure decreases further after delivery and returns to normal at approximately ___ weeks postpartum.
A) Colloid; 6
B) Hydrostatic; 4
C) Capillary; 8
D) Interstitial; 2
A) Colloid oncotic pressure ; 6 weeks postpartum
Slide 75
Hepatic Changes
Pseudocholinesterase activity decreases by ____ before delivery and by ___ on the third postpartum day.
A) 10%; 15%
B) 25%; 33%
C) 50%; 75%
D) 5%; 10%
B) decreases by 25% before deliver; by 33% on the third postpartum day
Slide 76
Cholestasis is most commonly associated with which stage of pregnancy?
A) First trimester
B) Second trimester
C) Third trimester
D) Postpartum period
C) Third trimester
(1/100 people)
Slide 77
What physiological change does cholestasis cause in pregnancy?
A) Increased bile secretion and biliary stasis
B) Decreased liver enzyme production
C) Increased renal clearance of bilirubin
D) Suppression of the immune system
A) Increased bile secretion and biliary stasis
Slide 77
What is a potential complication of cholestasis in pregnancy?
A) Decreased risk of gallstones
B) Increased risk of cholelithiasis (gallstones)
C) Increased renal excretion of bile salts
D) Permanent liver failure
B) Increased risk of cholelithiasis (gallstones)
Slide 77
Cholestasis has a high probability of ___ in future pregnancies.
A) Improving liver function
B) Not recurring
C) Returning
D) Preventing cholelithiasis
C) Returning
May have to have gallbladder out
Slide 77
Which symptoms are commonly associated with cholestasis in pregnancy? (Select 3)
A) Pruritus
B) High serum bilirubin
C) Abnormal liver function tests
D) Bradycardia
A) Pruritus
B) High serum bilirubin
C) Abnormal liver function tests
Slide 77
What happens to the kidneys during pregnancy?
A) They shrink due to increased renal clearance and decreased metabolic demand
B) They remain unchanged in size and function throughout pregnancy
C) They enlarge due to increased blood flow and return to baseline ~6 weeks postpartum
D) They atrophy due to decreased blood flow and reduced filtration rate
C) They enlarge due to increased blood flow and return to baseline ~6 weeks postpartum
Slide 78
During pregnancy, renal blood flow increases by ____.
A) 25%
B) 50%
C) 75%
D) 100%
C) 75%
Slide 78
Renal vasodilation during pregnancy contributes to a decrease in ____.
A) Systemic vascular resistance (SVR)
B) Renal perfusion
C) Glomerular filtration rate (GFR)
D) Cardiac output
A) Systemic vascular resistance (SVR)
Slide 78
Which renal changes occur during pregnancy? (Select 3)
A) Increased glomerular filtration rate (GFR)
B) Increased creatinine clearance
C) Decreased blood urea nitrogen (BUN)
D) Decreased renal blood flow
A) Increased glomerular filtration rate (GFR)
B) Increased creatinine clearance
C) Decreased blood urea nitrogen (BUN)
Slide 79
Pregnancy causes increased creatinine clearance and decreased serum creatinine, which is typically ___ at term.
A) 0.2 – 0.3 mg/dL
B) 0.5 – 0.6 mg/dL
C) 0.8 – 1.2 mg/dL
D) 1.0 – 1.5 mg/dL
B) 0.5 – 0.6 mg/dL
Slide 80
Blood urea nitrogen (BUN) decreases to approximately ____ mg/dL at term.
A) 2 – 4
B) 5 – 7
C) 8 – 9
D) 10 – 12
C) 8 – 9
Slide 80
Which of the following are normal findings in pregnancy but can also indicate underlying pathology if excessive? (Select 2)
A) Glucosuria
B) Proteinuria
C) Hematuria
D) Ketonuria
A) Glucosuria
B) Proteinuria
Slide 81
Why does glucosuria occur in healthy pregnant women?
A) Increased insulin resistance leading to glucose excretion
B) Tubular glucose reabsorption may not keep up with increased glomerular filtration rate (GFR)
C) Decreased renal clearance of glucose
D) Increased renal glucose reabsorption capacity
B) Tubular glucose reabsorption may not keep up with increased glomerular filtration rate (GFR)
Slide 81
Proteinuria is common during pregnancy, but excessive protein in the urine can be a sign of ____.
A) Gestational diabetes
B) Hypoglycemia
C) Preeclampsia
D) Hyperthyroidism
C) Preeclampsia
Slide 81
Which of the following laboratory findings may indicate abnormal renal function in a pregnant woman near term and require further evaluation? (Select 3)
A) BUN greater than 15 mg/dL
B) Serum creatinine greater than 1.0 mg/dL
C) Creatinine clearance less than 100 mL/min
D) Serum creatinine between 0.5 - 0.6 mg/dL
E) BUN less than 15mg/dL
F) Creatinine clearance greater than 100 mL/min
A) BUN greater than 15 mg/dL
B) Serum creatinine greater than 1.0 mg/dL
C) Creatinine clearance less than 100 mL/min
Slide 82
Which of the following is a common thyroid change during pregnancy?
A) Thyroid size decreases due to metabolic adaptations
B) Thyroid enlarges by 50-70%, increasing the potential for a difficult airway
C) Hypothyroidism is rare and has no significant fetal impact
D) Thyroid hormone levels remain unchanged during pregnancy
B) Thyroid enlarges by 50-70%, increasing the potential for a difficult airway
Slide 83
Which of the following are possible complications of untreated hypothyroidism in pregnancy?
A) Fetal cognitive issues and growth restriction
B) Increased risk of spontaneous abortion
C) Placental abruption
D) All of the above
E) None of the above
D) All of the above
Slide 83
What is the primary treatment for hypothyroidism in pregnancy?
A) Metformin
B) Synthroid (levothyroxine)
C) Insulin
D) Radioactive iodine therapy
B) Synthroid (levothyroxine)
Slide 83
What hormone is responsible for insulin resistance during pregnancy?
A) Human chorionic gonadotropin (hCG)
B) Human placental lactogen (hPL)
C) Progesterone
D) Estrogen
B) Human placental lactogen (hPL)
Increased blood glucose
Slide 84
How much does cortisol increase during pregnancy?
A) 50% in the first trimester, 100% by term
B) 100% in the first trimester, 200% by term
C) 200% in the first trimester, 400% by term
D) Cortisol levels remain unchanged during pregnancy
B) 100% in the first trimester, 200% by term
Slide 85
Which additional hormonal change occurs alongside increased cortisol during pregnancy?
A) Decrease in plasma endorphins
B) Increase in plasma endorphins
C) Decrease in aldosterone secretion
D) Complete suppression of the adrenal gland
B) Increase in plasma endorphins
Slide 85
During pregnancy, how much does the pituitary gland increase in size?
A) It remains the same size
B) Doubles in size
C) Triples in size
D) Shrinks due to hormonal changes
C) Triples in size
Slide 86
Which anterior pituitary hormone increases significantly during pregnancy?
A) Growth hormone
B) Prolactin
C) Oxytocin
D) Adrenocorticotropic hormone (ACTH)
B) Prolactin
Slide 86
anterior pituitary
What is the primary function of increased prolactin during pregnancy, and what is a potential side effect of hyperprolactinemia?
A) Milk production preparation for breastfeeding; Acne
B) Inhibition of uterine contractions; Increased fertility
C) Enhancing glucose metabolism; Hyperthyroidism
D) Suppressing immune function; Decreased pituitary function
A) Milk production preparation for breastfeeding
Hyperprolactinemia → acne
Slide 86
What hormone in the Posterior Pituitary
increases by 30% by term and plays a key role in labor and lactation?
A) Prolactin
B) Oxytocin
C) Estrogen
D) Progesterone
B) Oxytocin
Slide 87
Which of the following is a function of oxytocin during pregnancy and postpartum?
A) Stimulation of uterine contractions
B) Breast milk letdown
C) Facilitation of maternal-infant bonding
D) All of the above
E) None of the above
F) A&C
D) All of the above
Slide 87
Which of the following musculoskeletal symptoms is commonly associated with increased relaxin levels during pregnancy?
A) Sacroiliac pain
B) Knee pain
C) Increased risk of joint overstretching
D) All of the above
E) None of the above
F) A&B
G) B&C
D) All of the above
Slide 89
Which type of pain is commonly experienced due to nerve compression during pregnancy?
A) Sciatic pain
B) Migraine headaches
C) Abdominal cramping
D) Trigeminal neuralgia
A) Sciatic pain
Slide 90
Which nerve is compressed in meralgia paresthetica during pregnancy?
A) Sciatic nerve
B) Lateral femoral cutaneous nerve
C) Obturator nerve
D) Tibial nerve
B) Lateral femoral cutaneous nerve
Slide 90
Meralgia paresthetica affects which area of the body?
A) Outer side of the thigh
B) Lower back
C) Inner calf
D) Sole of the foot
A) Outer side of the thigh
compressed at the inguinal ligament as it exits the pelvis
Slide 91
Which of the following are symptoms of meralgia paresthetica?
A) Tingling
B) Numbness
C) Burning pain
D) All of the above
D) All of the above
Slide 91
What musculoskeletal change during pregnancy contributes to back and hip pain?
A) Kyphosis
B) Scoliosis
C) Lumbar lordosis
D) Thoracic compression
C) Lumbar lordosis
Slide 92
Which of the following are key characteristics of lumbar lordosis during pregnancy? (Select 2)
A) Widening of intervertebral spaces
B) Anterior pelvic tilt
C) Reduced spinal curvature
D) Shift in center of gravity
B) Anterior pelvic tilt
D) Shift in center of gravity
Slide 92
What structural spinal change occurs due to lumbar lordosis during pregnancy?
A) Widening of the intervertebral spaces
B) Narrowing of the intervertebral spaces
C) Decreased spinal flexibility
D) Fusion of the lumbar vertebrae
B) Narrowing of the intervertebral spaces
Slide 92
An increased anterior pelvic tilt due to lumbar lordosis can result in ________.
A) Better balance and stability
B) Increased back and hip pain
C) Reduced risk of musculoskeletal issues
D) Shortening of the spine
B) Increased back and hip pain
Slide 92
Which nervous system changes occur during pregnancy? (Select 3)
A) Increased cerebral blood flow (CBF)
B) Increased permeability of the blood-brain barrier (BBB)
C) Decreased pain threshold
D) Increased plasma endorphins
A) Increased cerebral blood flow (CBF)
B) Increased permeability of the blood-brain barrier (BBB)
D) Increased plasma endorphins
Slide 93
True or False
Plasma endorphins increase during pregnancy, leading to an increased pain threshold
True
Slide 93
Progesterone contributes to pain relief by activating ____ receptors in the spinal cord.
A) Mu-opioid
B) Kappa-opioid
C) Delta-opioid
D) Serotonin
B) Kappa-opioid
Slide 93
What happens to the volume of the venous plexus in the epidural space during pregnancy?
A) It decreases due to vascular constriction
B) It remains unchanged
C) It increases, leading to engorged epidural veins
D) It becomes compressed, reducing blood flow
C) It increases, leading to engorged epidural veins
Slide 94
Why does local anesthetic spread more widely in pregnant patients receiving an epidural?
A) Increased CSF volume
B) Decreased CSF volume leading to reduced epidural space
C) Decreased venous congestion
D) Higher metabolic breakdown of anesthetics
B) Decreased CSF volume leading to reduced epidural space
Slide 94
True or False
Pregnant patients require higher doses of local anesthetic for epidural anesthesia due to increased CSF volume.
False
Dr Freeman: You have a much greater spread than if you were injecting it into a high volume of fluids. So that’s why that decreased CSF is going to cooperate lower total dose of local anesthetic.
Slide 94
What is a major concern when performing epidural placement in a pregnant patient?
A) Increased risk of arterial puncture
B) Higher risk of venous puncture due to engorged epidural veins
C) Decreased effectiveness of local anesthetic
D) Greater cerebrospinal fluid (CSF) volume
B) Higher risk of venous puncture due to engorged epidural veins
Slide 94
Pregnant patients exhibit enhanced sensitivity to which class of neuromuscular blockers?
A) Depolarizing neuromuscular blockers
B) Non-depolarizing neuromuscular blockers
C) Both depolarizing and non-depolarizing
D) Neither depolarizing nor non-depolarizing
B) Non-depolarizing neuromuscular blockers
Enhanced sensitivity to Vecuronium and Rocuronium
Slide 96
How does pregnancy affect the metabolism of depolarizing neuromuscular blockers?
A) Increases pseudocholinesterase activity, shortening duration
B) Decreases pseudocholinesterase activity, potentially prolonging effects
C) Has no effect on neuromuscular blocker metabolism
D) Increases breakdown of Succinylcholine
B) Decreases pseudocholinesterase activity, potentially prolonging effects
Not usually clinically significant with one dose of Succinylcholine, but can be.
