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SUM'20 - Advanced Principles > Week 1 Maternal and Fetal Phy 3 of 4 > Flashcards

Week 1 Maternal and Fetal Phy 3 of 4 Flashcards

1
Q

When talking about circulation in the fetus, most of the oxygenated blood reaching the heart is because of what two veins?

A

umbilical vein and inferior vena cava.

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2
Q

Most of the oxygenated blood reaching the heart via the umbilical vein and inferior vena cava is diverted through the ? and pumped out the ? to the ?

A

diverted through the FORAMEN OVALE and pumped out the AORTA to the HEAD.

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3
Q

What four “products” are transferred from fetal circulation to mother circulation?

A
  1. CO2
  2. H2O
  3. Hormones
  4. Urea, waste products

“CHHU” like shoo :D

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4
Q

What seven “items” are transferred from mother circulation to fetal circulation?

A
  1. O2
  2. H2O, Electrolytes
  3. Nutrients
  4. Hormones
  5. IgG
  6. Drugs (alcohol)
  7. Pathogens (TORCHES*)
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5
Q

When talking about the placental membrane and specifically fetal trophoblast, what layer is outer and what layer is inner?

A

syncytiotrophoblast is outer

cytotrophoblast (Langhans’ cells) is inner

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6
Q

What are the three layers of the Placental membrane?

A
  1. Fetal trophoblast
    a. Cytotrophoblast (inner layer); make cells
    b. Syncytiotrophoblast (outer invading layer; secrete HCG)
  2. Fetal connective tissue
  3. Endothelium of the fetal capillaries
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7
Q

What does a home pregnancy test detect?

A

HCG in urine

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8
Q

In relation to fetal circulation, deoxygenated blood is returned via what vein?

A

superior vena cava

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9
Q

In relation to fetal circulation, the deoxygenated blood that is returned via the superior vena cava is mostly pumped through which two arteries?

A

Pulmonary artery and ductus arteriosus

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10
Q

In relation to fetal circulation, the deoxygenated blood when it is pumped through the pulmonary artery and ductus arteriosus where does it then go?

A

to the feet and the umbilical arteries.

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11
Q

In relation to to fetal circulation, if you are thinking of deoxygenated blood- then what is the final or ultimate destination of this deoxygenated blood?

A

The feet and the umbilical arteries

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12
Q

Where is most of the oxygenated blood pumped out of ultimately when talking about fetal circulation?

A

pumped out the aorta (to the head.)

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13
Q

Am I talking about oxygenated or deoxygenated blood in fetal circulation below:

blood returned via the superior vena cava?

A

deoxygenated

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14
Q

Am I talking about oxygenated or deoxygenated blood in fetal circulation below:

reaching the heart via the umbilical vein and inferior vena cava?

A

oxygenated

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15
Q

Am I talking about oxygenated or deoxygenated blood in fetal circulation below:

diverted through the foramen ovale?

A

oxygenated

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16
Q

Am I talking about oxygenated or deoxygenated blood in fetal circulation below:

Pumped out the aorta to the head?

A

oxygenated

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17
Q

Am I talking about oxygenated or deoxygenated blood in fetal circulation below:

mostly pumped through pulmonary artery and ductus arteriousus?

A

deoxygenated

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18
Q

Am I talking about oxygenated or deoxygenated blood in fetal circulation below:

to the feet and the umbilical arteries?

A

deoxygenated

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19
Q

Fetal Circulation:

  1. Oxygenated blood from placenta enters through what vein?
A

umbilical vein

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20
Q

Fetal Circulation:

  1. Most of the blood bypasses fetal liver via ?
A

ductus venosus

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21
Q

Fetal Circulation:

2.(cont) once blood bypasses the fetal liver via the ductus venosus it mixes with deoxygenated blood in the ?

A

inferior vena cava

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22
Q

Fetal Circulation:

  1. WHAT shunts blood from the right atrium (increased pressure) directly into the left atrium (decreased pressure)?
A

Foramen ovale

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23
Q

Fetal Circulation:

  1. Blood is shunted away from what fetal structure?
A

fetal lungs (increased resistance)

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24
Q

Fetal Circulation:

  1. WHAT connects pulmonary artery directly to aorta?
A

Ductus arteriosus

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25
Q

Fetal Circulation:

  1. Deoxygenated blood returns to the placenta via the ?
A

umbilical arteries

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26
Q

Tell me the pathway of blood through fetal circulation (simple answers, this to this to this to this)

A

Umbilical vein to ductus venosus to inferior vena cava to right atrium to left atrium (through foramen ovale) to left ventricle to aorta to body

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27
Q

In relation to pathway of blood through fetal circulation, Some blood does not pass to left atrium (through foramen ovale), but enters the right ventricle and pumped into the pulmonary artery. If this occurs where does it go next?

A

From pulmonary artery blood passes to the aorta through ductus arteriosus bypassing lungs that are rock solid (infinite pulmonary resistance) during fetal life.

(how Mo worded it)

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28
Q

during fetal life why are the lungs hard as a rock?

A

due to atelactasis and hypoxic vasoconstriction

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29
Q

What does the umbilical arteries (2) do?

A

return deoxygenated blood from fetal internal iliac arteries to placenta

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30
Q

What does the umbilical vein do?

A

supplies oxygenated blood from placenta to fetus, drain into IVC via ductus venosus or liver.

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31
Q

What structure is responsible for returning deoxygenated blood from fetal internal iliac arteries to placenta?

A

The umbilical arteries

32
Q

How many umbilical arteries and veins is their?

A

2 umbilical arteries and 1 umbilical vein.

33
Q

What structure is responsible for supplying oxygenated blood from placenta to fetus?

A

Umbilical vein

34
Q

Is the umbilical vein or arteries more saturated with 02?

A

The umbilical vein is 80% saturated with 02.

Umbilical arteries have LOW 02 saturation.

35
Q

In relation to fetal circulation what are the three important shunts?

A

ductus venosus
foramen ovale
ductus arteriosus

36
Q

Blood entering the fetus through umbilical vein is conducted via the ? into IVC to bypass the liver.

A

ductus venosus

37
Q

Most oxygenated blood reaching the heart via the IVC is diverted through ? and pumped out the aorta to head and body.

A

foramen ovale

38
Q

Deoxygenated blood from the SVC is expelled into the pulmonary artery and ? to the lower body of the fetus .

A

ductus arteriosus

39
Q

explain to me the ductus arteriosus shunt?

A

Deoxygenated blood from the SVC is expelled into the pulmonary artery and ductus arteriosus to the lower body of the fetus.

40
Q

explain to me the foramen ovale shunt?

A

shunts blood from the R atrium into the L atrium

41
Q

explain to me the dectus venosus shunt?

A

blood is shunted through the dectus venosus to bypass the liver and go to the IVC.

42
Q

Tell me what happens at birth when the infant takes a deep breath?

A

decreased resistance in pulmonary vasculature causes increased left atrial pressure vs. right atrial pressure; formen ovale closes (now called fossa ovalis); increase in O2 leads to decrease in prostaglandins, causing closure of ductus atreriosus.

43
Q

Do prostaglandins help close or keep open the PDA?

A

prostaglandins help keep PDA open.

44
Q

Indomethacin does it help close or keep open the PDA?

A

Indomethacin helps close PDA.

45
Q

What is the PACO2 of Fetal blood?

A

PaCO2 = 48 mmHg

46
Q

What is the PaO2 of Fetal blood?

and what increment increase if the mother is on 100% 02?

A

30 mmHg (+10 increase if mother is on 100% O2)

47
Q

How long does it take the ductus arteriosus to close?

A

2-3 weeks

48
Q

How long does it take the foramen ovale to close?

A

months

49
Q

In relation to fetal circulation, hypoxia or acidosis in the first few days will ultimately lead to what? (tell me the process for this as well)

A

pulmonary hypertension

Hypoxia or acidosis in first few days leads to PDA or PFO –> left to right –> pulmonary hypertension

(How MO worded it above)

50
Q

What is the most serious risk factor associated with surgery during pregnancy .

A

Uterine asphyxia

51
Q

Do pregnant ladies have increased gastric emptying time or delayed? How do you treat?

A

Delayed gastric emptying time.

prophylaxis with antacids.

52
Q

What can uterine displacement cause in a pregnant lady? (thus you do not want to place them in supine position)

A

supine hypotension

53
Q

Do pregnant women have increased or decreased FRC?

A

decreased FRC, more prone to hypoxia

54
Q

Do lipid soluble substances diffuse more or less rapidly through the placenta?

A

more rapidly

55
Q

During C/S what will you do to prevent Thromboembolism?

A

prevent DVT with pneumatic compression stockings. (board question)

56
Q

Most frequent complication of spinal and epidural on pregnant women?

A

HYPOTENSION

57
Q

How would you treat hypotension in a pregnant lady who was given a spinal or epidural?
(3 answers)

A
  • perform left uterine displacement
  • IV hydration
  • Ephedrine
58
Q

What Beta 2 agonist is given to stop premature contractions?

A

Albuterol ( what mo mentioned in lecture)

Ritodrine

59
Q

Side effects for the mom and for the baby due to Ritodrine?

A

Mom: hypokalemia, hyperglycemia, tachycardia

Fetus: : hypokalemia, hyperglycemia, tachycardia (+/-)

60
Q

Why would you avoid atropine with ritodrine?

A

can cause tachycardia leading to pulmonary edema.

61
Q

Mag sulfate increases the sensitivity to both depolorizing and non depolorizing muscle relaxants, thus will you increase or decrease the dose of muscle relaxant?

A

decrease the dose of muscle relaxant.

62
Q

What can lidocaine cause in high doses to the pregnant patient.

A

in high doses can cause uterine vasoconstriction and increased tone.

63
Q

What PH of the fetus will cause MORE ion trapping of LA?

A

the lower the fetal PH the more ion trapping.

64
Q

All LA that we use in an IV or injected form (not topical) are what PH?

A

Higher PH, they are bases

65
Q

What is the issue if the mom has alkalosis and the baby has acidosis?

A

because LA are bases the mothers alkalosis promotes un-ionized drug (LA) and thus can cross the placenta very easily, but once it crosses the placenta the babies acidosis promotes ion trapping.

66
Q

Base + acid = ?

A

base + acid = ionized (can not cross, trapped in fetus)

67
Q

Base + base = ?

A

un-ionized (can cross)

68
Q

Pregnant patients are always considered full stomach True or False?

A

True, they are high risk for aspiration

69
Q

What two drugs can you give a full stomach mom?

A

H2 blockers and metoclopramide

70
Q

What are two morbidities associated with Mother/Child?

A

Hemorrhage

Preeclampsia

71
Q

When trying to give pain management to a pregnant patient, are opioids or regionals preferred and why?

A

Regional preferred bc opioids cross placental barrier.

72
Q

Mother/child issues with lumbar epidural?

what will you give to treat?

A

hypotension, give ephedrine and IV fluids.

73
Q

Problems with GA and a pregnant patient?

A

Rapid desaturation, laryngeal spasm/edema, aspiration.

74
Q

Since you do not want to use GA for pregnant patient if you can help it, what type of anesthesia would you prefer to use for C/S?

A

spinal epidural anesthesia/ analgesia

75
Q

Level of the block for a C/S?

A

T4

76
Q

What is an adverse effect of regional for Mother/Child? How would you treat this?

A

hypotension

give phenylephrine with fluid.

SUM'20 - Advanced Principles (16 decks)

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