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SUM'20 - Advanced Principles > Week 1 Maternal & Fetal 1 of 4 > Flashcards

Week 1 Maternal & Fetal 1 of 4 Flashcards

1
Q

MAC progressively does what during pregnancy?

A

Decreases

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2
Q

Why do MAC requirements decrease during pregnancy?

A
  1. Hormonal (Progesterone) Changes 2. LARGE increases in Beta-endorpin level
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3
Q

Name the 3 major changes to the Maternal CNS:

A
  1. Progressive decrease in MAC 2. Increase LA sensitivity 3. Obstruction of IVC by gravid uterus
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4
Q

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

A

up to 30%

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5
Q

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

A
  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
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6
Q

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

A
  1. Decreases Spinal CSF Vol
  2. Decreases potential vol of epidural space
  3. Increases epidural pressure
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7
Q

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

A
  • Heart appears enlarged b/c of upward pressure - lungs have less room to expand
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8
Q

Maternal Cardiovascular Changes: Blood volume

A

increases (25-40%)

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9
Q

Maternal Cardiovascular Changes: Plasma volume

A

Increases (55%) —> leads to dilutional anemia

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10
Q

Maternal Cardiovascular Changes: Cardiac Output

A

Increases (40%)

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11
Q

Maternal Cardiovascular Changes: Stroke volume / EF

A

Increases

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12
Q

Maternal Cardiovascular Changes: Heart Rate

A

Increases

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13
Q

Maternal Cardiovascular Changes: Blood Pressure - Supine

A

Increases

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14
Q

Maternal Cardiovascular Changes: Blood Pressure - Lateral

A

Decreases

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15
Q

Maternal Cardiovascular Changes: Peripheral Resistance (SVR)

A

Decreases (-20%)

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16
Q

Name the two cardiovascular changes that DECREASE in pregnancy:

A

-Lateral position BP - SVR ~ 20%

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17
Q

What is this image showing:

A

Maternal changes in CO -supine, side, sitting

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18
Q

What is this image showing: Insert Image

A

Maternal changes in HR -supine, side, sitting

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19
Q

What is this image showing:

A

Maternal changes in SV -supine, side, sitting

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20
Q

Maternal CO returns to normal how long PP?

A

within 2 weeks

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21
Q

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

A

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

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22
Q

Maternal Cardiovascular changes: 40% increase in:

A

Cardiac Output

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23
Q

Maternal Cardiovascular changes: 17% increase in:

A

weight gain

24
Q

Maternal Cardiovascular changes: increased first ___

A

Heart Sound (S1)

25
Q

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

A

Systolic ejection murmur

26
Q

What is the cause of a heard Systolic ejection murmur?

A

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

27
Q

Maternal Cardiovascular changes: what do S3 and S4 indicate?

A

hyperdynamic states (increased blood vol and pressures)

28
Q

Maternal Cardiovascular Changes:

the PMI shifts which direction? Why?

A
  • Left
  • D/T elevation of diaphragm (d/t enlarging uterus)
29
Q

Maternal Cardiovascular Changes:

ECG

A

changes can occur

30
Q

Maternal Cardiovascular Changes:

Blood pressure

A

Increases: Supine

Decreases: Lateral

31
Q

Maternal Cardiovascular Changes:

SVR does?

A

decrease ~ 20%

32
Q

Supine hypotensive Syndrome is due to:

A

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

33
Q

Symptoms of Supine Hypotensive syndrome:

A
  • pallor
  • sweating
  • n/v
  • dizziness
  • tachycardia
  • veritgo
  • apprehension
  • Change in mental status
34
Q

TX of supine hypotensive syndrome:

A
  • avoid supine position
  • Left Lateral positioning - right hip up 10-15 cm
35
Q

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

A

the vertebral column

36
Q

Maternal Respiratory Changes:

Oxygen consumption

A

Increases (50%)

37
Q

Maternal Respiratory Changes:

Minute ventilation

A

increases ~50%

38
Q

Maternal Respiratory Changes:

Tidal Volume

A

Increases

39
Q

Maternal Respiratory Changes:

Resp. Rate

A

increases

40
Q

Maternal Respiratory Changes:

PO2

A

increases

41
Q

Maternal Respiratory Changes:

PCO2

A

Decreases

42
Q

Maternal Respiratory Changes:

PCO2 PRODUCTION

A

increases

43
Q

Maternal Respiratory Changes:

HCO3

A

Decreases

44
Q

Maternal Respiratory Changes:

P50

A

Inceases

45
Q

Maternal Respiratory Changes:

FRC

A

Decreases

46
Q

Maternal Respiratory Changes:

risk of hypoxemia

A

increases

(d/t decreased FRC)

47
Q

Name the Respiratory Changes that happen during pregnancy that DECREASE:

A
  • PCO2 (production increases though)
  • HCO3
  • FRC
48
Q

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

A
  • 4cm superiorly
  • D/T expanding uterus
49
Q

Increased Alveolar ventilation by what %

A

70%

50
Q

How much does FRC decrease?

A

20%

51
Q

There is NO change in what? (respiratory wise)

A
  • Dead space
  • lung compliance
  • pH
  • VC (vital capacity)
  • FEV
  • FEV1
  • diffusion capacity
52
Q

Maternal hyperventilation causes;

A

fetal hypoxia and respiratory acidosis

53
Q

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

A
  1. Vasoconstriction of umbilical BF (decreased CO2)
  2. LEFT shift of O2-hb curve
54
Q

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

A

fetal HR

55
Q

Very high risk of hypoxia in preganancy d/t:

A
  1. Decreased FRC
  2. Increased O2 Consumption
  3. Increased A-a Gradient
56
Q

Airway edema during pregnancy indicates what precations:

A
  • potentially difficult intubation
  • high risk of bleeding
  • use smaller ETT (6-7mm)
57
Q

Is pregnancy considered a restrictive or obstructive lung condition?

A

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.

SUM'20 - Advanced Principles (16 decks)

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