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Class 1 Maternal and Fetal Physiology Flashcards

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1
Q

5 neurological changes with pregnancy.

A
  • ↓ MAC
  • ↓ epidural space
  • ↓ CSF
  • ↑ sensitivity to LA
  • epidural vein engorge
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2
Q

With pregnancy there is a net increase in ventilation, what 3 things contribute to that?

A
  • ↑ Minute ventilation
  • ↑ Tidal volume
  • ↑ RR
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3
Q

Increase in ventilation causes ________ to decrease and can lead to _________ _________

A
  • PaCO2

- Respiratory Alkalosis

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4
Q

What compensates for the respiratory alkalosis found in pregnant women?

A

-Metabolic acidosis by excreting bicarb

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5
Q

The _______ displaces the _______ and decreases _______ by _____%.

A
  • Uterus
  • Diaphragm
  • FRC
  • 20%
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6
Q

What 2 things lead to maternal hypoxia during induction?

A
  • ↓ FRC

- ↑ Maternal O2 consumption

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7
Q

________ is mandatory prior to induction!!!

A

Preoxygenation

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8
Q

What mechanisms aids in the delivery of O2 to the fetus?

A

-P50 hemoglobin increase from 27-30

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9
Q

Should you use a smaller or larger ETT and why?

A
  • Smaller

- Mucosal venous engorgement / edema

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10
Q

_________ scores increase throughout labor.

A

Mallampati

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11
Q

What causes hypervolemia and anemia during pregnancy?

A

-Increase in plasma volume (45%) that is greater than the increase in RBC (20%)

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12
Q

How O2 delivery optimized during pregnancy?

A
  • Increase in CO

- Right shift of oxyhemo curve

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13
Q

What causes the 40% increase in CO?

A

Increase in HR and Stroke volume

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14
Q

Peripheral vascular resistance drops by 15% why?

A

-Progesterone relaxes venous smooth muscle

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15
Q

Response to adrenergic drugs is _______

A

Blunted

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16
Q

________ _________ can be seen on CXR

A

Cardiac hypertrophy

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17
Q

________ ________ are often present on auscultation

A

heart murmurs

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18
Q

________ in plasma osmotic pressure

A

Decline

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19
Q

What 5 things can be seen when a prego lies flat?

A
  • Hypotension
  • Pallor
  • Nausea
  • Vomiting
  • Diaphoresis
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20
Q

How early can supine hypotension be seen?

A

20 weeks

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21
Q

Pregos are at a hypercoagulable state witch puts them at a greater risk of what?

A

-PE

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22
Q

BUN and Creatinine are ______ reduced.

A

Mildly

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23
Q

Renal blood flow and GFR are _______ by ______

A

Increased

50%

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24
Q

What 2 things decrease gastroesopheagal sphincter tone?

Study These Flashcards
A
  • Stomach displacement by uterus

- Progesterone

25
What increase acid secretion in pregos?
-Placental gastrin
26
Pregos are at a greater risk for aspiration why?
- >25 cc of gastric fluid | - pH less than 2.5
27
A 20% decrease in pseudocholinesterase does not affect succs length, why?
-Due to a simultaneous increase in volume of distribution.
28
Why are pregos more susceptible to gallstones?
-Decreased CCK and contractile response
29
What leads to higher fetal glucose transfer?
- Maternal insulin resistance | - Higher plasma glucose levels
30
What 5 ways do agents cross the placenta?
- Diffusion - Bulk flow - Active transport - Pinocytosis - Breaks
31
What is oxygen transfer dependent on?
-Maternal uterine flow vs. fetal umbilical flow
32
What has the smallest storage to utilization ratio in the fetus?
--Oxygen (42 ml stored, 21 ml/min consumption)
33
How long can a fetus survive w/ O2 deprivation?
-10 minutes
34
What 2 compensatory mechanisms are present during O2 deprivation?
- Redistribution | - Anaerobic metabolism
35
How are the Oxyhemo curves of the fetus and mother shifted and why?
- Fetus to the left - Maternal to the right - Allows for transfer of O2 from mother to fetus
36
Placental blood has a PaO2 of what?
-40 mmHg
37
Fetal hemaglobin is _______ than maternal hemaglobin.
Higher
38
Who's Hgb has a lower affinity for CO2, mom or fetus?
Fetus
39
How does CO2 cross into the placenta?
Simple diffusion
40
Uterine blood flow represents ______ of CO at about _______ ml per minute?
10% | -600-700 mls/min
41
What is non pregnant uterine blood flow?
50 mls/min
42
Where does uterine blood flow go?
- 80% placenta | - 20% myometrium
43
Name the 3 factors that influence uterine blood flow.
- Systemic BP - Uterine vasoconstriction - Uterine Contractions
44
How does propofol effect UBF?
-Mild reduction via maternal hypotension
45
At what dose will Ketamine effect UBF.
->1.5 mg/kg
46
Volatile agents effect on UBF?
- Decrease via hypotension | - Less than 1 MAC has minor effects
47
______ and ______ have little effects on UBF
- Nitrous | - Opioids
48
High serum LA can result in what?
-Uterine vasoconstriction
49
Uterine blood flow may _______ with neuriaxial analgesia due to a reduction in maternal __________ levels that ________ vasoconstriction as long as _______ is normal
- Improve - Catecholamines - Reduces - Blood pressure
50
What does filing the babies lungs with O2 do?
-Decreases pulmonary vascular resistance
51
Increased pulmonary blood flow increases ______ volume and closes the ________.
- Left ventricle | - Foramen ovale
52
What closes the ductus?
-Increase O2 tension
53
What will hypoxia or acidosis do?
Increase R to L shunting through ductus
54
When does normal labor start?
-40 weeks +/- 2 weeks after LMP
55
What stage of labor is from onset of true labor until complete dilation?
1st stage
56
Name the 2 phases of 1st stage?
- Latent = dilation 2-4 cm | - Active = Dilation to 10 cm w/ regular contractions
57
Describe the 2nd stage of labor
-Complete dilation till infant delivered
58
What is 3rd stage of labor?
-Time from delivery of infant to placenta delivery

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