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SUM'20 - Advanced Principles > Week 1 Maternal and Fetal Part 2 of 4 > Flashcards

Week 1 Maternal and Fetal Part 2 of 4 Flashcards

1
Q

Very high risk of hypoxia in pregnancy due to?

A
  1. Decreased FRC
  2. Increased O2 consumption
  3. Increased A-a gradient
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2
Q

In maternal respiratory changes the mother may have airway edema which could lead to what?

A

Airway Edema

1.Difficult intubation, high risk of bleeding

−Use smaller size tubes (6-7 mm)

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3
Q

With maternal respiratory changes, what does the mother have increased sensitivity to?

With maternal respiratory changes, what is decreased for the mother?

A

Increased sensitivity to LA

Decreased MAC for all GA

MAC –> Minimum Alveolar Concentration

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4
Q

Is pregnancy a restrictive or obstructive lung condition?

A

Both

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5
Q
A

note FRC decreasing

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6
Q
A

Note FRC second from bottom.

in order: Vital Capacity

Inspiratory capacity

expiratory reserve

Residual vol

FRC

Total lung capacity

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7
Q
A

non pregnant/Left - FRC 1700

Pregnant at term/ right - FRC 1350

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8
Q

What happens with maternal hematologicall changes during pregnancy? (3 answers)

A

increased hgb, increased clotting factors, increased GFR

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9
Q

A.Physiological anemia of pregnancy

What happens during pregnancy when Estrogen INCREASES renin activity?

A
  1. Estrogen INCREASES renin activity –> 75% increase in blood volume (dilutional effect)
  2. Low crit is good for placental blood flow

−Give iron or folic acid

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10
Q

What happens to the clotting factors during pregnancy?

A

INCREASED clotting factors (VII, fibrinogen)

1.Hypercoagulable state helps to prevent blood loss during labor

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11
Q

Name all the maternal hematological changes?

A

Increased clotting factors

Decreased platelet count (10%)

Decreased folate level

Decreased plasma acetylcholine esterase activity (returns to normal 2-4 weeks postpartum)

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12
Q

What happens to renal and GI systems during pregnancy?

A

A.INCREASED GFR and renal plasma flow

B.DECREASED BUN and creatinine

C.DECREASED renal threshold for glucose and amino acids –> glycosuria and proteinuria

D.DECREASED LES pressure, INCREASED acid and INCREASED intragastric pressure –> reflux (heart burns)

E.INCREASED gastrin secretion

F.Slow gastric emptying

G.Increase risk of aspiration

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13
Q

What to give for slow gastric emptying during pregnancy?

A

1.Give metochlorpromide (Reglan) to

−INCREASES gastric emptying (move forward)

−Tighten up LES

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14
Q

What happens to maternal endocrine system during pregancy?

A

A. INCREASES TBG, INCREASES total T3 and T4

B.No change in free T3 and T4

C.Insulin resistance due to placental lactogen

D.INCREASES cortisole

E.INCREASES endorphins at term

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15
Q

What is the 1° site of nutrient and gas exchange between mother and fetus?

A

Placenta

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16
Q

What are the two fetal components of the placenta and what are their purposes?

A

A.Fetal component

  1. Cytotrophoblast − inner layer of chorionic villi. Cyto makes cells
  2. Syncytiotrophoblast − outer layer of chorionic villi; secretes HCG (Human Chorionic Gonadotropin)
17
Q

What is the maternal component of the placenta?

A

1.Decidua basalis − derived from the endometrium. Maternal blood in lacunae

18
Q
A
19
Q

Placenta

A
20
Q

Uterine blood flow is what during pregnancy?

A

Increased

21
Q

Uterine blood flow is _______ dependent during pregnancy.

A

pressure

22
Q

What are causes of decreased perfusion pressure during pregnancy? (7)

A

A.Causes of decrease perfusion pressure

  1. Supine position: aortocaval compression
  2. Maternal hypotension
  3. Uterine contractions
  4. Oxytocin
  5. Catecholamines (stress)
  6. Vasopressors
  7. LA in high doses
23
Q

What drugs can cross placental barrier?

A

A.Drugs passage across placental barrier

1.Smaller molecular weight, lipid soluble and non-ionized can pass

24
Q

Uterine Blood Flow

___ BP ___blood flow

___SVR ___blood flow

uterine contraction ___BF

alpha-stimulant ___BF

A

DECREASE BP DECREASED blood flow

INCREASED SVR DECREASED blood flow

uterine contraction DECREASED blood flow

alpha stimulant DECREASED blood flow

25
Q

Uterine blood flow equation

A
26
Q

What is classified as fetal bradycardia?

A

< 120 bpm

27
Q

If maternal BP is decreased what will happen to uterine blood flow causing fetal hypoxia and decreased fetal HR?

A

1.Decrease mom’s BP –> decrease uterine BF –> fetal hypoxia –> decrease fetal HR

28
Q

When maternal BP is increased with associated increase in SVR, what happens to fetal HR?

A

1.Increase mom’s BP (with associated increase in SVR) –> decrease fetal HR

29
Q
A
30
Q

Uterine and Placental Blood Flow

A

Maternal BP is the ONLY factor that influence blood flow through placenta

31
Q
A
32
Q

umbilical artery carries —>

Umbilical vein carries —>

A

deoxygenated blood (artery)

oxygenated blood (vein)

SUM'20 - Advanced Principles (16 decks)

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