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AP III > OB (2/10) > Flashcards

OB (2/10) Flashcards

1
Q

Total blood volume during pregnancy increases from 76 mL/kg to ____________ mL/kg

A

94

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2
Q

why is there a prominent increase in blood volume in the parturient?

A
  1. helps transports nutrients to the fetus better ( d/t: low SVR & thinner blood)
  2. protects the mother from the amount of blood loss with delivery
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3
Q

average blood loss with vaginal delivery

A

400-600 mL

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4
Q

average blood loss with C - section

A

800-1000 mL

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5
Q

estrogen and progesterone are increased __________ fold in pregnancy

A

100

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6
Q

T/F: pregnancy is a hypercoagulable state

A

true

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7
Q

pregnancy is associated with what coagulation changes

A
  1. enhanced plt turnover (i.e. greater plt consumption)
  2. clotting
  3. fibrinolysis
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8
Q

what coagulation factors are INCREASED in concentration at term pregnancy

A
  1. factor I (fibrinogen)
  2. Factor VII (procovertin)
  3. Factor VIII (antihemophilic factor)
  4. Factor IX (christmas factor)
  5. Factor X (stuart power factor)
  6. Factor XII (hageman factor)
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9
Q

what coagulation factors are decreased at term pregnancy

A

Factor XI (thromboplastin) & XIII (fibrin-stabilizing factor)

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10
Q

which coagulation factors are UNCHANGED at term pregnancy

A

Factor II (prothrombin) and Factor V (proaccelerin)

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11
Q

change in PT and PTT at term pregnancy

A

shortened by 20%

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12
Q

TEG changes at term pregnancy

A

hypercoagulable

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13
Q

Fibrinopeptide A, Fibrin degradation products, plasminogen are all ____________ at term pregnancy

A

increased

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14
Q

changes to bleeding time and plt count at term pregnancy

A

no change

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15
Q

change to antithrombin III at term pregnancy

A

decreased

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16
Q

what is more important in pregnancy: plt count or plt fx?

A

plt function

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17
Q

what is gestational thrombocytopenia

A

low plt count, but no bleeding or bruising.

if pt has this, they will have it every subsequent pregnancy

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18
Q

T/F: it is a contraindication to give pt with gestational thrombocytopenia and epidural

A

false; typically still do epidurals in theses pts.

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19
Q

during a C-section, the first 300-400 mL that ends up in the suction canister is __________________

A

amniotic fluid

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20
Q

changes to hematology/coagulation with delivery and first day post-partum

A
  1. rapid decrease in plt count, fibrinogen, factor VIII, and plasminogen
  2. increase in antifibrinolytic activity
  3. clotting times remain shortened
  4. hypercoagulable state continues
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21
Q

when does coagulation profile return to pre-pregnancy state?

A

by 2 weeks post delivery

22
Q

what are the changes to the position of the stomach with pregnancy

A

it is displaced up to the left and rotated 45 degrees (which leads to GERD)

23
Q

changes to the GI system with pregnancy

A
  1. stomach moves up to the left and rotated 45 degrees
  2. decreases lower esophageal tone
  3. esophageal peristalsis and intestinal transient are slowed (but emptying is not effected) –> constipation
24
Q

what is the biggest change to the GI system that is a concern to anesthesia in the pregnant pt

A

the decreased lower esophageal tone –> GERD & aspiration risk

25
Q

T/F: gastric emptying of food and liquid is unaltered during pregnancy

A

true (but have decreased gastric emptying with labor)

26
Q

what hormone causes further relaxation of the lower esophageal sphincter in pregnancy increasing risk of GERD/aspiration

A

progesterone

27
Q

T/F: there is no change in gastric acid secretion btwn pregnant and non pregnant

A

true

28
Q

changes to the GI system during LABOR

A
  1. decreased gastric emptying
29
Q

hepatic changes in the pregnant pt

A
  1. liver displacement upward and posteriorly
  2. increased bilirubin and liver enzymes
  3. increased risk of biliary dz
30
Q

what is THE most common surgery done on a pregnant woman

A

cholecystectomy

31
Q

what causes the need for cholecystectomy in pregnant woman

A
  1. increased secretion of bile / biliary stasis
  2. hypomotility with cholesterol
32
Q

what hormone inhibits contractility of GI smooth muscle which causes gallbladder hypomotility in the pregnant pt

A

progesterone

33
Q

a completely healthy pregnant woman is a ASA class _________

A

II

34
Q

ASA class of pregnant woman with a condition?

A

III or IV

35
Q

what is the most common GU issues with pregnancy

A

frequent UTIs

36
Q

which organ system changes are the earliest and most dramatic seen in pregnancy

A

renal changes

37
Q

GFR in pregnancy increases by _________% and does not return to normal until ________ months post-partum

A

50; 3

38
Q

renal vascular volume ____________ by 30% during pregnancy

A

increases

39
Q

Renal plasma flow _____________ during pregnancy

A

increases

40
Q

Cr clearance ___________ during pregnancy

A

increases

41
Q

BUN/Cr ____________ during pregnancy

A

decreases

42
Q

total protein excretion and urinary albumin excretion ______________ during pregnancy

A

increase

43
Q

glucose excretion ______________ during pregnancy

A

doubles

44
Q

the renal changes that occur with pregnancy occur to compensate for __________________

A

mild respiratory alkalosis the pt has

45
Q

endocrine changes with pregnancy

A
  1. thyroid gland enlarges
  2. increased T3/T4
  3. insulin resistance
  4. 200% increase in cortisol at term
46
Q

insulin resistance in the mother during pregnancy is caused by what?

A

hormones from the placenta

47
Q

what are the primary sources of increased release of relaxin during pregnancy

A
  1. corpus luteum
  2. placenta
48
Q

what is the purpose of increased relaxin during pregnancy

A

increases mobility of sacroiliac, sacrococcygeal, and pubic joints to prepare pelvis for passage of placenta

49
Q

what hormone causes carpal tunnel syndrome in pregnant pts (that goes away after delivery)

A

relaxin

50
Q

____________ is a polypeptide hormone that remodels collagen fibers and pelvic connective tissue

A

relaxin

AP III (20 decks)

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