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NUNA 693 Obs/Regional > OB: Maternal Physiology > Flashcards

OB: Maternal Physiology Flashcards

1
Q

Increased ___ demands

[Maternal Physiology]

A

Metabolic

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2
Q

H______ changes
[Maternal Physiology]

A

Hormonal

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3
Q

A__ Changes

[Maternal Physiology]

A

Anatomic

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4
Q

Begin as early as the ___ week and extend into the postpartum period

[Maternal Physiology-VC]

A

4th___

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5
Q

_____ Left Ventricular Hypertrophy by 20 weeks, with a __% increase in mass at term

[Maternal Physiology-CV]

A

Eccentric
50%

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6
Q

___of parturients exhibit tricuspid and pulmonic regurgitation; ____ mitral regurg

[Maternal Physiology-CV]

A

94%, 27%

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7
Q

Heart Rate is increased________% at term

[Maternal Physiology-CV]

A

15-30

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8
Q

Tachyarrhythmias more common in ___ trimester

[Maternal Physiology-CV]

A

third

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9
Q

Cardiac Output increases approximately ___%

[Maternal Physiology-CV]

A

40

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10
Q

Initially due to increased ________

[Maternal Physiology-CV]

A

Heart rate

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11
Q

By the second trimester, increased ____more so than increased _______

[Maternal Physiology-CV]

A

stroke volume, heart rate

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12
Q

Increased stroke volume correlates with increasing ___ levels

[Maternal Physiology-CV]

A

estrogen

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13
Q

At term approximately ___% of CO perfuses the uterus

[Maternal Physiology-CV]

A

10-20

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14
Q

During labor uterine ____ autotransfuse volume to circulation

[Maternal Physiology-CV]

A

contractions

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15
Q

After delivery CO can increase up to ____% due to
____
____

[Maternal Physiology-CV]

A

80
Relief of aortocaval compressionn
Contracted uterus

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16
Q

CO gradually returns to normal at approximately 2 weeks postpartum as ___ and ___ normalize

[Maternal Physiology-CV]

A

HR and SV

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17
Q

Venous return _____ increases due to increased volume

[Maternal Physiology-CV]

A

Preload

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18
Q

Increased susceptibility to____ heart rate changes

[Maternal Physiology-CV]

A

baroreflex-mediated

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19
Q

Third heart sound can be heard in most women by 20 weeks due to early closure of the ____________ valve

[Maternal Physiology-CV]

A

Mitral

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20
Q

A ___ heart sound can be heard in 16% of pregnant women, but usually disappears at term.

[Maternal Physiology-CV]

A

Fourth

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21
Q

__________ murmurs are common, __________ murmurs are pathologic

[Maternal Physiology-CV]

A

Systolic, diastolic

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22
Q

Compression of the ___ ___ by the gravid uterus
More severe in polyhydramnios or multiple gestation pregnancies
Decreased venous return
Significantly decreased SV and ultimately ___________________
Then ___________________________________
May result in loss of consciousness
May be immediate or take up to 10 minutes to be symptomatic
Abdominal aorta may also be compressed
Upper body BP remains normal
Lower body (including uterus) BP decreases

[Aortocaval Compression]

A

vena cava
cardiac output
uterine/fetal oxygenation decrease

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23
Q

More severe in ____ or multiple gestation pregnancies

[Aortocaval Compression]

A

polyhydramnios

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24
Q

____ venous return

[Aortocaval Compression]

A

Decreased

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25
Q

Significantly decreased SV and ultimately ____

[Aortocaval Compression]

A

Cardiac output

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26
Q

Then decreases uterine ___ and fetal ____

[Aortocaval Compression]

A

perfusion and oxygenation

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27
Q

May result in loss of c_____

[Aortocaval Compression]

A

Consciousness

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28
Q

May be immediate or take up to ___ minutes to be symptomatic

[Aortocaval Compression]

A

10

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29
Q

A___ ___may also be compressed

[Aortocaval Compression]

A

abdominal aorta

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30
Q

Upper body___remains normal

[Aortocaval Compression]

A

BP

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31
Q

Lower body (including uterus) BP ___

[Aortocaval Compression]

A

decreases

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32
Q

Relieved by tilting to the ___ < laying on either side

[Aortocaval Compression]

A

left

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33
Q

Left uterine displacement increases intervillous blood flow an average of __% and increases fetal oxygenation __%

[Aortocaval Compression]

A

20, 40

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34
Q

Left uterine displacement can be achieved by tilting the operating table ___ degrees or by placing a ___ high wedge under the parturient’s right hip and back.

[Aortocaval Compression]

A

15, 15 cm

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35
Q

A small percentage of women may benefit from ___ uterine displacement more than___, but this is a small minority.

[Aortocaval Compression]

A

right, left

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36
Q

Needs a ___-degree or a ____ cm wedge under the right hip and back
[Left Uterine Displacement]

A

15, 15

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37
Q

Especially large uterus (___ or ___) may need more lift
[Left Uterine Displacement]

A

polyhydraminos or multiple

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38
Q

Degree of tilt is usually ___
[Left Uterine Displacement]

A

underestimated

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39
Q

Because MAP decreases slightly, the increase in uteroplacental blood flow is dependent on (1) a substantial decrease in ___ ___ ___, (2) increased c___ ___, and (3) increased i___ ___

[Vascular Changes and Regulation]

A

uterine vascular resistance, cardiac output, intravascular volume

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40
Q

Vascular remodeling of arteries in the uterus is believed to include increases in both vessel ___ > ___
(Dust off the cobwebs and think Physics laws!)
[Vascular Changes and Regulation]

A

diameter, length

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41
Q

Changes in vascular reactivity include vasodilatory response mediated at ___ and ___ smooth muscle levels

[Vascular Changes and Regulation]

A

endothelial and vascular

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42
Q

Growth of the placenta creates a [low/high] -resistance vascular pathway by eliminating ___ microcirculation and creating an ___ space

[Vascular Changes and Regulation]

A

low, intramyometrial, intervillous

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43
Q

SVR ___ as much as 21%

[Vasculature Changes]

A

decreases

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44
Q

Venous capacitance loses tone, allowing for pooling of the ___ ___

[Vascular Changes and Regulation]

A

blood volume

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45
Q

Aside from pathology, systolic blood pressure changes [little/more], diastolic blood pressure may decrease by up to ___ mmHg

[Vasculature Changes]

A

little, 15

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46
Q

Generalized reduction on response to ___ and ___ vasoconstrictors

[Decreased Response to Vasoconstrictors]

A

endogenous and exogenous
(lecture notes say exogenous and exogenous)

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47
Q

Angiotensin II, En___, Thromboxane, Epinephrine, Norepinephrine, Phenylephrine, S___, Thromboxane, and A___ ___
[Decreased Response to Vasoconstrictors]

A

Endothelin, Serotonin, Arginine Vasopressin

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48
Q

Concentrations of Angiotensin II increase __-___x more than non-pregnant

[Response to Catecholamines]

A

2-3

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49
Q

BUT the sensitivity to Angiotensin II is [decreased/increased]

[Response to Catecholamines]

A

decreased

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50
Q

The ___ circulation is even less responsive to Angiotensin II than the ___ circulation (contributes to the redistribution of cardiac output, increase of uterine blood flow

[Response to Catecholamines]

A

uterine, systemic

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51
Q

This ___ is decreased in patients with PIH
[Response to Catecholamines]

A

refractoriness

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52
Q

Sensitivity to Epinephrine, Norepinephrine, and Phenylephrine is also [increased/decreased] in pregnancy

[Response to Catecholamines]

A

decreased

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53
Q

BUT the uterine circulation is ___ sensitive to these than the systemic circulation

[Response to Catecholamines]

A

MORE

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54
Q

THEREFORE, during massive hemorrhage/trauma/stresses resulting in large ___ release, it is unlikely that ___perfusion will be preferentially preserved above essential ___perfusion
[Response to Catecholamines]

A

catecholamine, uteroplacental, maternal

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55
Q

Clearance of vasopressin at near/term is 3-4 times ___ than before pregnancy.

[Response to Catecholamines]

A

greater

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56
Q

Vasopressinase levels increase by a factor of ___between early and term pregnancy.

[Response to Catecholamines]

A

50

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57
Q

Vasopressinase is made by the ___
[Response to Catecholamines]

A

placenta

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58
Q

More dependent on ___-___ ___ for maintenance of blood pressure than non-pregnant

[Renin]

A

renin-angiotensin system

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59
Q

Plasma levels of ___ and ___ are increased during pregnancy (**despite increased ____ volume)

[Renin]

A

renin and angiotensin II, blood

60
Q

Baseline renin in the third trimester is ___ times greater than non-pregnant

[Renin]

A

12

61
Q

Sensitivity to Angiotensin II is [reduced/increased] during the third trimester, but varies throughout the ___ in a daily pattern

[Renin]

A

reduced, day

62
Q

Sensitivity to norepinephrine is ___

[Renin]

A

unchanged

63
Q

*** Since the Renin Angiotensin System provides support for ____, the loss of sympathetic controlled vaso___ in the presence of epidural anesthesia → maternal hypotension
[Renin]

A

MAP, vasoconstriction

64
Q

Blood Volume increases ___-___% in part to prepare for the normal blood loss of delivery

[Hematologic Changes]

A

25-40

65
Q

Blood volume increases to _______mL/kg

[Hematologic Changes]

A

85-100

66
Q

Plasma volume increases ___-___%
-Beginning as early as ___ weeks gestation
-Approx 50% net increase by ___ weeks

[Hematologic Changes]

A

40-50
6
34

67
Q

RBC volume increases ___%

[Hematologic Changes]

A

20

68
Q

The result is ___ ___ “physiologic anemia of pregnancy”
-Normal pregnant H/H are about ___/___
Reduced viscosity

[Hematologic Changes]

A

dilutional anemia
12/35

69
Q

Blood Loss
-Vaginal delivery – ___cc
-Uncomplicated Cesarean Section – ___-____cc
Estimations are wildly ____
[Hematologic Changes]

A

500
800-1000
inaccurate

70
Q

In general parturients are ___coagulable

[Hematologic Changes]

A

hyper

71
Q

Factors VII, VIII, IX, X, XII, and fibrinogen are [increased/decreased]

[Hematologic Changes]

A

increased

72
Q

___ ___ are one of the leading causes of maternal mortality

[Hematologic Changes]

A

Thromboembolic events

73
Q

Platelet count remains___ or slightly ___
-Several pathologic conditions of pregnancy are associated with [decreased/increased] platelets, fibrinogen, or both

[Hematologic Changes]

A

stable, decreased
Decreased

74
Q

Maternal thrombocytopenia (<___) in ___% but its not associated with increased morbidity or mortality

[Hematologic Changes]

A

150, 11.6

75
Q

White Blood Count increases – mean of 10.5 but may be as much as ___-___ in labor.
[Hematologic Changes]

A

20-30

76
Q

Diaphragm is displaced ___ by the growing uterus

[Respiratory Anatomic Changes ]

A

cephalad

77
Q

The thorax undergoes both ___ and ___ changes during pregnancy.

[Respiratory Anatomic Changes ]

A

anatomic and hormonal

78
Q

Relaxin (the hormone responsible for relaxation of the ___ ligaments) causes relaxation of the ___ attachments to the lower ribs.

[Respiratory Anatomic Changes ]

A

pelvic, ligamentous

79
Q

The subcostal angle progressively widens from ___ to ___degrees.

[Respiratory Anatomic Changes ]

A

68.5 to 103.5

80
Q

The___ and ___diameters of the chest wall each increase by 2 cm, resulting in an increase of 5 to 7 cm in the circumference of the lower rib cage.

[Respiratory Anatomic Changes ]

A

anteroposterior and transverse

81
Q

These changes peak at ___weeks’ gestation.

[Respiratory Anatomic Changes ]

A

37

82
Q

The ___ angle remains about 20% wider than the baseline value after delivery.

[Respiratory Anatomic Changes ]

A

subcostal

83
Q

The vertical measurement of the chest cavity decreases by as much as ___ cm as a result of the [elevated/lowered] position of the diaphragm.

[Respiratory Anatomic Changes ]

A

4, elevated

84
Q

Capillary engorgement → narrowed ___ opening, ___ in nasal and oropharynx

[Respiratory Changes]

A

glottic, edema

85
Q

Airway tissues are friable and more susceptible to ___/___

[Respiratory Changes]

A

damage/bleeding

86
Q

Generally nasal intubation should be [first choice/avoided]
___-___ ETT is recommended, oral

[Respiratory Changes]

A

Avoided
6.5-7.0

87
Q

___/___ handled laryngoscope is beneficial

[Respiratory Changes]

A

Stubby/Short

88
Q

At term O2 consumption increases up to ___% at rest and ___% or more during labor

[Respiratory Changes]

A

33, 100

89
Q

Minute ventilation at term is increased by ___%

[Respiratory Changes]

A

50

90
Q

Tidal volume increases by ___%

[Respiratory Changes]

A

40

91
Q

Respiratory rate remains the same or slightly [increases/decreases]

[Respiratory Changes]

A

Increases

92
Q

By ___ weeks the partial pressure of CO2 decreases to ___-___ mmHg

[Respiratory Changes]

A

12, 30-32

93
Q

Serum bicarbonate [decreases/increases] to compensate

[Respiratory Changes]

A

decreases

94
Q

Normal partial pressure of oxygen is normally greater than ___mmHg

[Respiratory Changes]

A

100

95
Q

Functional residual capacity , expiratory reserve, and residual volume all decrease due to the upward pressure of the diaphragm which is similar to _____ lung disease

[Respiratory Changes]

A

restrictive

96
Q

CO2 production [increases/decreases] (metabolic) but [increased/decreased] alveolar ventilation [increases/decreases] PaCO2

[Blood Gas Changes in Pregnancy]

A

increases, increased, decreases

97
Q

PaO2 increased as a result of increased ___ ___

[Blood Gas Changes in Pregnancy]

A

alveolar ventilation

98
Q

Metabolic compensation for the respiratory alkalosis of pregnancy reduces serum bicarbonate concentration to approximately ___mEq/L, the base excess by ___ to ___ mEq/L, and the total buffer base by approximately ___ mEq/L.

[Blood Gas Changes in Pregnancy]

A

20, 2 to 3, 5 

99
Q

Sleep disturbances in pregnancy are [common/uncommon]

[Nervous System Changes]

A

common

100
Q

Cerebral blood flow [increased/decreased] in pregnancy

[Nervous System Changes]

A

increased

101
Q

[Increase/Decrease] in Cerebral Vascular Resistance

[Nervous System Changes]

A

Decrease

102
Q

[Increase/Decrease] in Internal Carotid diameter

[Nervous System Changes]

A

Increase

103
Q

Transient restless leg syndrome
-___% in first trimester, ___% in third trimester

[Nervous System Changes]

A

15, 22

104
Q

[Decreased/Increased] permeability of the blood-brain barrier

[Nervous System Changes]

A

Increased

105
Q

Beginning in the first trimester [increased/decreased] sensitivity to local and general anesthetics

[Nervous System Changes]

A

increased

106
Q

[Increased/Decreased] intraabdominal pressure _ engorgement of epidural veins _ decreased volume epidural space & subarachnoid space volume (and CSF volume)

[Nervous System Changes]

A

Increased

107
Q

Dependence on the Sympathetic Nervous System for maintenance of hemodynamic stability [decreases/increases], [declining/peaking] at term then returning to nonpregnant state within 36-48 hours postpartum

[Nervous System Changes]

A

increases, peaking

108
Q

Increased lumbar lordosis during pregnancy may [reduce/augment] the ___ gap.

[Technical Considerations]

A

reduce, interspinous

109
Q

Widening of the pelvis results in a head-[up/down] tilt in the lateral position.
So?

[Technical Considerations]

A

down
Head down tilt can result in a higher spread than intended.

110
Q

The flow of CSF from a spinal needle is [unchanged/changed] in pregnancy
Except?
[Technical Considerations]

A

unchanged
During a contraction, CSF is expelled

111
Q

Consider all parturients ___ stomachs –[Increased/Decreased] gastrin → [Increased/Decreased] gastric volume → [higher/lower] pH

[Gastrointestinal Changes]

A

full, increased, increased, lower

112
Q

Displacement of the ___ may create an outflow obstruction → ___ gastric emptying → ___intragastric pressure

[Gastrointestinal Changes]

A

stomach, delayed, increased

113
Q

[Decreased/Increased] progesterone → [Decreased/Increased] gastric motility and [Decreased/Increased] lower esophageal sphincter tone → heartburn
- ___% first trimester, ___% in the second, ___% in the third

[Gastrointestinal Changes]

A

Increased, decreased, decreased
10, 40, 55

114
Q

Labor pain further [slows/increases] gastric emptying
-Ultrasound has demonstrated solid food in the stomach of ___/___ of women in whom LEA has been initiated.
-Solid food has been shown in the stomach of more than ___% of laboring women who had not eaten in ___-___ hours

[Gastrointestinal Changes]

A

slows, 2/3, 40, 12-24

115
Q

Uncomplicated, elective c-section patients can have clear liquids up to ___ hours prior

[Full Stomach Anesthetic Implications]

A

2

116
Q

Nonparticulate antacids (___) , H2 antagonists (___), and ___ may be beneficial

[Full Stomach Anesthetic Implications]

A

bicitra, Pepcid, metoclopramide

117
Q

If ___ ___ becomes necessary, these are even more important

[Full Stomach Anesthetic Implications]

A

general anesthesia

118
Q

Induction of parturients greater than ___ weeks gestation through the post partum period should be ___ with ___ pressure
[Full Stomach Anesthetic Implications]

A

12
RSI with cricoid

119
Q

___% of pregnant women will experience nausea and vomiting during pregnancy

[Nausea and Vomiting]

A

80

120
Q

Typically begin at ___-___ weeks gestation and persist until ___-___ weeks gestation

[Nausea and Vomiting]

A

4-9
12-16

121
Q

___% will develop symptoms that persist throughout the pregnancy known as ___ ___

[Nausea and Vomiting]

A

1-5, hyperemesis gravidarum

122
Q

Liver is displaced slightly [downwards/upwards] and to the [left/right]; size morphology, and blood flow [do/do not change]

[The Liver and Gall Bladder Changes]

A

upwards, right, do not change

123
Q

Serum bilirubin, ALT, AST, and lactate [decrease/increase] to the [lower/upper] limits of normal. Serum albumin [decrease/increase] somewhat.

[The Liver and Gall Bladder Changes]

A

increases, upper, decreases

124
Q

Biliary stasis and greater bile secretion with cholesterol increase the risk of ___ ___ disease in pregnancy.

[The Liver and Gall Bladder Changes]

A

gall bladder

125
Q

Progesterone inhibits ____ of gastrointestinal smooth muscle leading to gall bladder ___

[The Liver and Gall Bladder Changes]

A

contractility, hypomotility

126
Q

Incidence of ___ ___ is 5-12% in pregnant women

[The Liver and Gall Bladder Changes]

A

gall stones

127
Q

One in 1,600 to 10,000 women will undergo ___ during pregnancy

[The Liver and Gall Bladder Changes]

A

cholecystectomy

128
Q

Serum cholinesterase activity decreases by ___% or more during the ___ and ___ trimesters, and slightly recovers by term

[The Liver and Gall Bladder Changes]

A

30, 1st and 2nd

129
Q

Prolongation of cholinesterase dependent drugs is ___clinically significant
[The Liver and Gall Bladder Changes]

A

not

130
Q

Due to increased intravascular volume, both renal _______ and ___________ volumes increase.
-Enlarged kidneys by as much as ___%

[Renal]

A

Vascular and interstitial
30

131
Q

Vasodilation of the kidneys contributes to overall ___ SVR

[Renal]

A

decreased

132
Q

The collecting system (___, ___, and ___) dilates.

[Renal]

A

calyces, pelvis, and ureters

133
Q

Hydronephrosis may occur in up to ___% of pregnant women by mid-pregnancy

[Renal]

A

80

134
Q

[Increased/decreased] cardiac output → [Increased/decreased] renal plasma flow → [Increased/decreased] GFR and reduced renal absorption
Renal plasma flow is 75% greater by 16 weeks gestation than nonpregnant
[Renal]

A

Increased, increased, increased

135
Q

Renal plasma flow is ___% greater by ___weeks gestation than nonpregnant

[Renal]

A

75, 16

136
Q

At the end of the first trimester the GFR is ___% greater than baseline and does not return to normal values until ___ ___ postpartum

[Renal]

A

50, 3 months

137
Q

Creatinine clearance increases to ___-___mL/min

[Renal]

A

140-160

138
Q

Total protein excretion and urinary albumin excretion are higher than non-pregnant at around ___ mg and ___ mg in 24-hour clearance

[Renal]

A

200, 12

139
Q

___ (>300 mg/24 hr) has been described without the diagnosis of preeclampsia BUT, women with isolated proteinuria are more likely to progress to preeclampsia than women with___hypertension
Glucose is filtered and almost completely reabsorbed in the _________ tubule. Pregnancy reduces the glucose resorptive capacity of the proximal tubules, so all pregnant women exhibit an elevation of glucose excretion.
Kidneys respond to the increased alveolar ventilation with ___________ bicarb excretion -> ____________ bicarbonate levels
[Renal]

A

Proteinuria
isolated
proximal
increased
decreased

140
Q

___ (>300 mg/24 hr) has been described without the diagnosis of preeclampsia BUT, women with isolated proteinuria are more likely to progress to preeclampsia than women with___hypertension

[Renal]

A

Proteinuria, isolated

141
Q

Glucose is filtered and almost completely reabsorbed in the _________ tubule. Pregnancy reduces the glucose resorptive capacity of the proximal tubules, so all pregnant women exhibit an elevation of glucose___.

[Renal]

A

Proximal, excretion

142
Q

Kidneys respond to the increased alveolar ventilation with ___________ bicarb excretion -> ____________ bicarbonate levels
[Renal]

A

Increased, decreased

143
Q

Thyroid
Thyroid gland enlarges ___-___%

[Endocrine Changes]

A

50-70

144
Q

Thyroid
Estrogen-induced increase in thyroid binding globulin results in ___% increase in total T3 and T4 during the ___ trimester

[Endocrine Changes]

A

50, first

145
Q

Thyroid
Concentrations of ___ and ___ do not change, TSH [decreases/increases] during the first trimester then returns to normal shortly thereafter

[Endocrine Changes]

A

T3 and T4, decreases

NUNA 693 Obs/Regional (13 decks)

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