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.AdvPrin A - Spr25 > Maternal Physiology pt3 > Flashcards

Maternal Physiology pt3 Flashcards

(44 cards)

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1
Q

Why are all parturient patients are considered to be full stomach?

A
  • Enlarged gravid uterus displaces stomach cephalad
  • Increased gastric pressure
  • Decreased competence of the LES

significant aspiration risk

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2
Q

How does lower esophageal sphincter tone change throughout pregnancy?

A
  • Tone decreases throughout pregnancy with the lowest tone occurring at term.
  • LES tone normalizes at 4 weeks post-partum.
    (remain aspiration risk for up to 4 weeks postpartum)
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3
Q

What is Mendelson’s Syndrome?

A

Aspiration pneumonitis & inflammatory response of lung parenchyma

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4
Q

What puts one at high risk of Mendelson’s syndrome? What is the primary preventative intervention for pregnant patients?

A
  • pH < 2.5
  • > 25mL gastric volume

Bicitra given to pregnant patients before delivery to neutralize gastric pH.

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5
Q

Uterus takes ____ weeks to return to normal size. The LES tone returns to normal around ________? What are the anesthesia implications in the postpartum period?

A
  • Uterus takes 6 weeks to return to normal size
  • LES tone returns to normal around 4 weeks.

Treat as full stomach for 4-6 weeks postpartum

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6
Q

What changes occur in the liver during pregnancy?

A

↑ risk of esophageal varices due to increased splanchnic, portal and esophageal venous pressure.

  • Careful use of OGT

↑ Liver enzymes and cholesterol (this is normal)

  • serum aspartate aminotransferase
  • lactic dehydrogenase
  • alkaline phosphatase
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7
Q

How is colloid oncotic pressure affected by pregnancy?

A

Colloid oncotic pressure decreases due to:

  • decreased total protein
  • decreased albumin to globulin ratio

decreases further after delivery/returns to normal ~6 weeks postpartum

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8
Q

What occurs with pseudocholinesterase levels during pregnancy?

A
  • pseudocholinesterase activity decreases by 25% before delivery
  • decreases by 33% on 3rd postpartum day.
  • return to normal 2-6 weeks postpartum

Usually not enough decrease in PseudoChE to prolong paralysis after single dose of SCh.

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9
Q

When can cholestasis occur to parturient patients? What factors attribute to cholestasis?

A
  • Occurs during 3rd trimester (1/100 people)
  • Cause: biliary stasis and increased bile secretion

Leads to increase risk for cholelithiasis

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10
Q

What are the s/s of cholestasis?

A
  • Pruritis
  • ↑ serum bilirubin
  • abnormal LFTs
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11
Q

What are the consequences of cholestasis in obstetric patients?

A
  • ↑ risk of cholelithiasis
  • may require cholecystectomy
  • ↑ risk of cholestasis in subsequent pregnancies
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12
Q

During pregnancy the kidneys see a _____ increase in renal blood flow.

A

75%
-renal vasodilation

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13
Q

What are the results of increased renal blood flow during pregnancy?

A
  • ↑ GFR
  • ↑ Creatinine clearance
  • ↓ Creatinine
  • ↓ BUN
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14
Q

What BUN/Creatinine levels are typical of pregnant patients?

A
  • BUN: ~8 - 9 mg/dL at term (decreased)
  • Serum Creatinine: ~0.5 - 0.6 mg/dL at term (decreased)
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15
Q

What changes in the urine can occur during pregnancy?

A
  • Glucosuria common (tubular Glucose reabsorption can’t keep up with ↑ GFR)
  • Proteinuria is common (excessive protein can indicate pre-eclampsia)
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16
Q

What would a finding of proteinuria possibly indicate in a parturient patient?

A

preeclampsia

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17
Q

What labs in a parturient patient suggest abnormal renal function?

A
  • BUN > 15mg/dL
  • Creatinine > 1.0 mg/dL
  • Creatinine Clearance < 100 mL/min

Further evaluation required.

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18
Q

What occurs with the thyroid during pregnancy?

Study These Flashcards
A

Enlargement by 50 - 70%

  • increased risk of diff. airway

Hypothyroidism in 10% pts

19
Q

What are the pancreatic function changes during pregnancy?

Study These Flashcards
A
  • Insulin resistance due to Human placental lactogen
    (Hormone that prepares the body for breastfeeding)
  • Increased blood glucose
20
Q

How does adrenal function change in the parturient patient?

Study These Flashcards
A

↑ cortisol

  • Increased by 100% in 1st trimester
  • Increased up to 200% by term

↑ plasma endorphins

21
Q

How does the anterior pituitary change during pregnancy?

Study These Flashcards
A

Hyperplasia of lactotrophic cells ⇒↑Prolactin secretion

  • preparation for breastfeeding
  • hyperprolactinemia (may l/t acne)
22
Q

How does the posterior pituitary change during pregnancy?

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A

Oxytocin secretion increases by 30% by term

  • Stimulates contractions
  • Breast milk letdown
  • “Bonding hormone”: Helps mother bond to baby postpartum
23
Q

What nerves are commonly compressed and lead to nerve pain in pregnancy?

Study These Flashcards
A
  • Sciatic
  • Meralgia paresthetica
    (compression of lateral femoral cutaneous nerve at location that it exits pelvis)
24
Q

What is meralgia paresthetica?

Study These Flashcards
A

Compression of lateral femoral cutaneous nerve at exit site of pelvis

  • Affects outer side of thigh

S/s:

  • Numbness & Tingling
  • Burning pain (lateral aspect of the thigh)
25
What is the reason for lots of pelvic pain during pregnancy?
Lumbar lordosis which causes: * Anterior pelvic tilt * Narrowing of intervertebral spaces. * Center of gravity changes
26
What CNS changes occur during pregnancy?
- ↑ CBF - ↑ BBB permeability - ↑ pain threshold
27
What is the mechanism for increased pain threshold for parturient patients?
- ↑ plasma endorphins - Progesterone activates κ-opioid receptors analgesic mechanisms
28
What occurs with the epidural space and subarachnoid space in pregnant women?
- ↑ Venous plexus volume ⇒ engorged veins - ↓ CSF volume => greater spread of LA
29
What is the result of increased venous plexus volume?
**Engorged epidural veins** * decreased free volume of epidural space * higher risk of venous puncture during epidural placement.
30
What is the result of decreased CSF volume on local anesthetic spread?
* ↑ spread of LA * drug will reach higher concentration in lower CSF volume (less dilution)
31
Parturient patients have an increased sensitivity to _______ neuromuscular blockers.
**Non-depolarizing**. Roc & Vec
32
What can happen with succinylcholine administration in a pregnant patient?
Prolonged paralysis due to ↓ pseudocholinesterase activity * not usually clinically significant with one dose of succinylcholine **but can be**
33
What considerations must be made for multiparous patients?
Multiple births may indicate: * increased risk of bleed * may have rapid delivery
34
How is blood flow and perfusion affected with aortocaval compression?
Decreased venous return to right atrium → Decreased cardiac output → Hypotension → Decreased uterine blood flow → Decreased perfusion to fetus
35
Why is it important to utilize LUD as a primary intervention when patient and fetus in distress?
- IF patient and baby not doing well it may be related to aortocaval compression. - LUD is a quick fix and can help rule out other pathologies.
36
What are some causes of thrombocytopenia (Plt <150k) in pregnancy?
* Idiopathic * hypertensive disorder of pregnancy * gestational: no plt dysfunction or bleeding (may be a side effect of pregnancy rather that malignancy) **Low platelets may progress to preeclampsia and to HELLP syndrome**
37
What is the occurrence of epidural hematoma and what are some of the potential side effects?
1:200,000- 1:250,000 Can cause temporary or permanent neurological damage
38
Is it appropriate to utilize epidural anesthesia for an emergency c section?
**Depends on hospital/anesthesia group policy** * If patient is established and received adequate prenatal care, an epidural may be used. * If patient is not established and no prenatal care, GETA for c section
39
How is gastric emptying affected with pregnancy?
Gastric emptying mostly unchanged **delayed during labor**
40
For surgery in pregnant patient, if succinylcholine used and need for prolonged relaxation, what is crucial to assess?
Must check twitches before using non depolarizing drug. This may help identify pseudocholinsterase deficiency that would be seen with initial succinylcholine administration.
41
How does the pituitary size change in pregnancy?
Size increase by 3x
42
What are some of the effects of release of the hormone Relaxin during pregnancy?
Increased joint mobility * sacroiliac pain * knee pain Overstretching of joints is possible * caution with exercise/stretching
43
What physically happens to the kidneys with pregnancy? When do they go back to baseline?
* kidneys enlarge * back to baseline ~6 weeks postpartum
44
Untreated thyroid dysfunction in pregnant patients can have what consequences?
* fetal cognitive issues * spontaneous abortion * growth restriction * placental abruption *treated with synthroid*

.AdvPrin A - Spr25 (33 decks)

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