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OB (2/10) Flashcards

(50 cards)

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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?

Study These Flashcards
A

by 2 weeks post delivery

22
Q

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

Study These Flashcards
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

Study These Flashcards
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

Study These Flashcards
A

the decreased lower esophageal tone –> GERD & aspiration risk

25
T/F: gastric emptying of food and liquid is unaltered during pregnancy
true (but have decreased gastric emptying with labor)
26
what hormone causes further relaxation of the lower esophageal sphincter in pregnancy increasing risk of GERD/aspiration
progesterone
27
T/F: there is no change in gastric acid secretion btwn pregnant and non pregnant
true
28
changes to the GI system during LABOR
1. decreased gastric emptying
29
hepatic changes in the pregnant pt
1. liver displacement upward and posteriorly 2. increased bilirubin and liver enzymes 3. increased risk of biliary dz
30
what is THE most common surgery done on a pregnant woman
cholecystectomy
31
what causes the need for cholecystectomy in pregnant woman
1. increased secretion of bile / biliary stasis 2. hypomotility with cholesterol
32
what hormone inhibits contractility of GI smooth muscle which causes gallbladder hypomotility in the pregnant pt
progesterone
33
a completely healthy pregnant woman is a ASA class _________
II
34
ASA class of pregnant woman with a condition?
III or IV
35
what is the most common GU issues with pregnancy
frequent UTIs
36
which organ system changes are the earliest and most dramatic seen in pregnancy
renal changes
37
GFR in pregnancy increases by _________% and does not return to normal until ________ months post-partum
50; 3
38
renal vascular volume ____________ by 30% during pregnancy
increases
39
Renal plasma flow _____________ during pregnancy
increases
40
Cr clearance ___________ during pregnancy
increases
41
BUN/Cr ____________ during pregnancy
decreases
42
total protein excretion and urinary albumin excretion ______________ during pregnancy
increase
43
glucose excretion ______________ during pregnancy
doubles
44
the renal changes that occur with pregnancy occur to compensate for __________________
mild respiratory alkalosis the pt has
45
endocrine changes with pregnancy
1. thyroid gland enlarges 2. increased T3/T4 3. insulin resistance 4. 200% increase in cortisol at term
46
insulin resistance in the mother during pregnancy is caused by what?
hormones from the placenta
47
what are the primary sources of increased release of relaxin during pregnancy
1. corpus luteum 2. placenta
48
what is the purpose of increased relaxin during pregnancy
increases mobility of sacroiliac, sacrococcygeal, and pubic joints to prepare pelvis for passage of placenta
49
what hormone causes carpal tunnel syndrome in pregnant pts (that goes away after delivery)
relaxin
50
____________ is a polypeptide hormone that remodels collagen fibers and pelvic connective tissue
relaxin

AP III (25 decks)

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