Week 1 Maternal & Fetal 1 of 4

Question 1

MAC progressively does what during pregnancy?

Answer 1

Decreases

Question 2

Why do MAC requirements decrease during pregnancy?

Answer 2

1. Hormonal (Progesterone) Changes 2. LARGE increases in Beta-endorpin level

Question 3

Name the 3 major changes to the Maternal CNS:

Answer 3

1. Progressive decrease in MAC 2. Increase LA sensitivity 3. Obstruction of IVC by gravid uterus

Question 4

Because of increased LA sensitivity, how much of a reduction in dose should be made?

Answer 4

up to 30%

Question 5

Name 4 things the obstruction of IVC by the growing uterus causes:

Answer 5

1. Distension of epidural venous plexus
2. Increased epidural blood volume
3. The cephalad spread of LA during spinal / epidural anesthesia (as a result of decreased CSF and potential epidural space volumes)
4. Increased Risk of unintentional intravenous injection

Question 6

Increased epidural blood volume (b/c of IVC obstruction) does what 3 things (to volumes and pressures):

Answer 6

1. Decreases Spinal CSF Vol
2. Decreases potential vol of epidural space
3. Increases epidural pressure

Question 7

What are two anatomical changes seen in pregnancy: *regards to diagram of CXR /black and blue lines

Answer 7

• Heart appears enlarged b/c of upward pressure - lungs have less room to expand

Question 8

Maternal Cardiovascular Changes: Blood volume

Answer 8

increases (25-40%)

Question 9

Maternal Cardiovascular Changes: Plasma volume

Answer 9

Increases (55%) —> leads to dilutional anemia

Question 10

Maternal Cardiovascular Changes: Cardiac Output

Answer 10

Increases (40%)

Question 11

Maternal Cardiovascular Changes: Stroke volume / EF

Answer 11

Increases

Question 12

Maternal Cardiovascular Changes: Heart Rate

Answer 12

Increases

Question 13

Maternal Cardiovascular Changes: Blood Pressure - Supine

Answer 13

Increases

Question 14

Maternal Cardiovascular Changes: Blood Pressure - Lateral

Answer 14

Decreases

Question 15

Maternal Cardiovascular Changes: Peripheral Resistance (SVR)

Answer 15

Decreases (-20%)

Question 16

Name the two cardiovascular changes that DECREASE in pregnancy:

Answer 16

-Lateral position BP - SVR ~ 20%

Question 17

What is this image showing:

Answer 17

Maternal changes in CO -supine, side, sitting

Question 18

What is this image showing: Insert Image

Answer 18

Maternal changes in HR -supine, side, sitting

Question 19

What is this image showing:

Answer 19

Maternal changes in SV -supine, side, sitting

Question 20

Maternal CO returns to normal how long PP?

Answer 20

within 2 weeks

Question 21

Maternal Blood volume increases around what % in 2nd and 3rd trimesters?

Answer 21

2nd- ~25-30% 3rd - 30-45% *mostly plasma volume

Question 22

Maternal Cardiovascular changes: 40% increase in:

Answer 22

Cardiac Output

Question 23

Maternal Cardiovascular changes: 17% increase in:

Answer 23

weight gain

Question 24

Maternal Cardiovascular changes: increased first ___

Answer 24

Heart Sound (S1)

Question 25

Maternal Cardiovascular changes: What cardiac abnormality can be heard on some pregnant pts?

Answer 25

Systolic ejection murmur

Question 26

What is the cause of a heard Systolic ejection murmur?

Answer 26

d/t the hyperdynamic state (increase blood volumes, etc)

Question 27

Maternal Cardiovascular changes: what do S3 and S4 indicate?

Answer 27

hyperdynamic states (increased blood vol and pressures)

Question 28

Maternal Cardiovascular Changes: the PMI shifts which direction? Why?

Answer 28

- Left - D/T elevation of diaphragm (d/t enlarging uterus)

Question 29

Maternal Cardiovascular Changes: ECG

Answer 29

changes can occur

Question 30

Maternal Cardiovascular Changes: Blood pressure

Answer 30

Increases: Supine Decreases: Lateral

Question 31

Maternal Cardiovascular Changes: SVR does?

Answer 31

decrease ~ 20%

Question 32

Supine hypotensive Syndrome is due to:

Answer 32

compression of aorta IVC by gravid uterus in supine position (at term)

Question 33

Symptoms of Supine Hypotensive syndrome:

Answer 33

* pallor * sweating * n/v * dizziness * tachycardia * veritgo * apprehension * Change in mental status

Question 34

TX of supine hypotensive syndrome:

Answer 34

- avoid supine position - Left Lateral positioning - right hip up 10-15 cm

Question 35

in supine hypotensive syndrome the inferior vena cave is compressed against:

Answer 35

the vertebral column

Question 36

Maternal Respiratory Changes: Oxygen consumption

Answer 36

Increases (50%)

Question 37

Maternal Respiratory Changes: Minute ventilation

Answer 37

increases ~50%

Question 38

Maternal Respiratory Changes: Tidal Volume

Answer 38

Increases

Question 39

Maternal Respiratory Changes: Resp. Rate

Answer 39

increases

Question 40

Maternal Respiratory Changes: PO2

Answer 40

increases

Question 41

Maternal Respiratory Changes: PCO2

Answer 41

Decreases

Question 42

Maternal Respiratory Changes: PCO2 PRODUCTION

Answer 42

increases

Question 43

Maternal Respiratory Changes: HCO3

Answer 43

Decreases

Question 44

Maternal Respiratory Changes: P50

Answer 44

Inceases

Question 45

Maternal Respiratory Changes: FRC

Answer 45

Decreases

Question 46

Maternal Respiratory Changes: risk of hypoxemia

Answer 46

increases | (d/t decreased FRC)

Question 47

Name the Respiratory Changes that happen during pregnancy that DECREASE:

Answer 47

* PCO2 (production increases though) * HCO3 * FRC

Question 48

Displacement of the diaphragm is about how much (cm) and which direction? Why?

Answer 48

- 4cm superiorly - D/T expanding uterus

Question 49

Increased Alveolar ventilation by what %

Answer 49

70%

Question 50

How much does FRC decrease?

Answer 50

20%

Question 51

There is NO change in what? (respiratory wise)

Answer 51

* Dead space * lung compliance * pH * VC (vital capacity) * FEV * FEV1 * diffusion capacity

Question 52

Maternal hyperventilation causes;

Answer 52

fetal hypoxia and respiratory acidosis

Question 53

The extreme hyperventilation of mom causes fetal hypoxia and respiratory acidosis by:

Answer 53

1. Vasoconstriction of umbilical BF (decreased CO2) 2. LEFT shift of O2-hb curve

Question 54

Mild hyperventilation is safe but what do we need to monitor?

Answer 54

fetal HR

Question 55

Very high risk of hypoxia in preganancy d/t:

Answer 55

1. Decreased FRC 2. Increased O2 Consumption 3. Increased A-a Gradient

Question 56

Airway edema during pregnancy indicates what precations:

Answer 56

* potentially difficult intubation * high risk of bleeding * use smaller ETT (6-7mm)

Question 57

Is pregnancy considered a restrictive or obstructive lung condition?

Answer 57

Both technically. Restrictive for the most part (fetal/uterus growth restricts lung expansion) but can have Obstructive elements d/t edema, swelling, etc as well.