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NUNA 693 Obs/Regional > OB: Uterine Blood Flow and Placental Transfer > Flashcards

OB: Uterine Blood Flow and Placental Transfer Flashcards

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1
Q

blood supply comes mainly from the _____ _____ with lesser variable contribution from the _____ _____

A

uterine arteries
ovarian arteries

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2
Q

blood pathway of starting at internal iliac to intervillous space

A

Internal Iliac > Uterine Artery > Arcuate Arteries > Radial Arteries > Spiral Arteries > Intervillous space

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3
Q

Abdominal Aorta > _____ Artery > _____ plexus

A

Ovarian
Uteroovarian

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4
Q

Uterine blood flow _________ to meet the needs of the growing uterus and fetus

A

increases

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5
Q

uterine arteries are maximally _____

A

dilated

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6
Q

Placental blood flow is supplied via the maternal _____, _____, and _____ arteries

A

arcuate, radial, & spiral

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7
Q

Pressure ____ ____ towards intervillous space

A

down shifting

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8
Q

UBF: Increases to ______ mL/minute at term

A

800

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9
Q

UBF: ____ mL/min to the myometrium

A

150

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10
Q

UBF: Remainder to ___ ____

A

intervillous space

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11
Q

UBF: _______% of Cardiac output

A

10-20%

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12
Q

UBF: ____ mL/min to the decidua

A

100

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13
Q

What decrease UBF?
C_____

A

Contractions

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14
Q

What decrease UBF?
Maternal _____

A

hypotension

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15
Q

What decrease UBF?
Maternal ______

A

HTN

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16
Q

What decrease UBF?
Exogenous _______

A

vasoconstrictors

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17
Q

What decrease UBF?
____ _____ toxicity

A

local anesthetic

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18
Q

What decrease UBF?
______ uterine tone with sympathetic block

A

increased

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19
Q

Causes of decreased uterine arterial pressure
_____ position (aortocaval compression)
H______/h______
Drug induced hypotension
Hypotension during _____ ____

A

Supine
Hemorrhage/Hypovolemia
sympathetic blockage

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20
Q

Causes of increased uterine venous pressure
_______ compression
Uterine _____
Drug induced uterine ______
Skeletal muscle hypertonus (seizures, Valsalva maneuver)

A

Venalcaval
contraction
tachysystole

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21
Q

Endogenous vasoconstrictors that lead to increased uterine vascular resistance (2)

A

Catecholamines (stress)
Vasopressin (in response to hypovolemia)

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22
Q

Exogenous vasoconstrictors that lead to increased uterine vascular resistance (3)

A

Epinephrine
Vasopressors (phenylephrine > ephedrine)
LAs (in high concentrations)

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23
Q

Uterine Blood Flow =

A

(uterine perfusion pressure) / (uterine vascular resistance)

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24
Q

Neuraxial Anesthesia: increased uterine blood flow as a result of:
_____ relief
decreased ______ activity
decreased maternal ______

A

pain
sympathetic
hyperventilation

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25
Neuraxial Anesthesia: decreased uterine blood flow as a result of: Hypo_____ unintentional ____ _____ of LA and/or ephedrine absorbed ____ (little effect)
hypotension IV injection LA
26
Commonly used induction agents have ____ ____ _____ effect on uteroplacental blood flow
little to no
27
uteroplacental blood flow may be affected indirectly by (2)
BP changes Sympathetic response (laryngoscopy/intubation)
28
Inhalational Agents have ___ _____ _____ effect on uterine blood flow
little to no
29
Deeper planes of anesthesia are associated with _____ in C.O., maternal blood pressure, and uterine artery blood flow
reductions
30
A dose dependent reduction in uterine tone by inhalational agents would be expected to ______________ blood flow
increase
31
based on blood flow, how would that impact what inhalational agent to use
Based on blood flow there is little to no reason to choose one inhalational agent over another
32
Umbilical arteries (2) carry O2 _____ saturated blood from the fetus TO the placenta
POOR
33
Blood enters fetal circulation via ____ ____
ductus venosus
34
____ _____ carries O2 rich blood to the fetus
Umbilical vein
35
Inadequate fetal oxygenation occurs if maternal SBP drops below ____ mmHg in awake healthy patients during LEA (labor epidural analgesia)
100 mmHg
36
Oxygenated blood: pathway from Internal Iliac to Fetal RA
Oxygenated blood: Internal Iliac > Uterine Artery > Arcuate Arteries > Radial Arteries > Spiral Arteries > Intervillous space > Umbilical vein > Fetal Ductous Venosus > Fetal IVC > Fetal RA >
37
Deoxygenated blood from fetus back to intervillous space
Fetal Umbilical Arteries (2) > Intervillous space
38
1. arteries 2. vein 3. fetal capillaries 4. intervillous space 5. maternal spiral artery
39
Placental transfer of drugs is dependent on (4)
1. concentration gradient (larger gradient, more crosses) 2. Molecular weight (smaller than 500 Da cross easily, greater than 1000 Da cross poorly) 3. Lipid solubility (high lipid solubility cross easily) 4. Ionization (highly ionized = water soluble = decreased diffusion)
40
Dilution of drugs in maternal blood, then ____ blood, then ____ blood before being circulated in the fetus.
intervillous placental
41
Drug further diluted in fetal blood, goes through a sort of first pass thought the ____ ( ___ ___ ).
liver (ductus venosus)
42
Fetal Drug Dilution Factors Dilution in _____ blood
intervillous
43
Fetal Drug Dilution Factors Some absorbed by _____
placenta
44
Fetal Drug Dilution Factors Diluted in ____ blood
placental
45
Fetal Drug Dilution Factors Distribution in fetal _____ volume
intervascular
46
Fetal Drug Dilution Factors Redistribution to fetal ____
tissues
47
Fetal Drug Dilution Factors 20% of fetal cardiac output returns ____ to placenta without ______
directly circulating
48
Fetal Drug Dilution Factors Not all umbilical venous blood bypasses the ____ via ____ _____
liver via ductus venosus
49
The fetus and neonate do metabolize drugs, just at a ___ ____ rate than adults.
much slower
50
Fetal circulation takes drugs through the ____ first (mostly)
liver
51
Any excreted drugs would later be swallowed as ____ ____
amniotic fluid
52
Elimination of drugs by the fetus is mostly dependent on ____ ____
placental transfer
53
Maternal Pharmacokinetic Basics Absorption and Uptake Decreased ____ & Increased ___ leads to increased pulmonary uptake of inhalational agents
FRC MV
54
Maternal Pharmacokinetic Basics Distribution: Increased ___ increases distribution to all tissues Total body water increases on average by ____ leading to Increased volume of distribution for _____ drugs
CO 8L hydrophilic
55
Maternal Pharmacokinetic Basics Metabolism: Although CO is increased, ____ blood flow is not markedly increased Some _____ _____ have increased activity, others have decreased activity
hepatic CYP450 enzymes
56
Maternal Pharmacokinetic Basics Elimination ___ and ___ increase so drugs that are excreted by the kidneys unchanged (___) are eliminated faster.
Renal blood flow and GFR, cephalosporins
57
PK principles: (6)
- lipid solubility - protein binding - tissue binding - pKa - pH - blood flow
58
Substances are transferred across the placenta by one of several mechanisms. (5)
- simple diffusion - simple diffusion via channels - facilitated diffusion - active transport - endcytosis
59
Drugs that Readily Cross the Placenta Anticholinergic Agents (2)
atropine and scopolamine
60
Drugs that Readily Cross the Placenta Antihypertensive Agents (3)
- BBs - SNP - NTG
61
Drugs that Readily Cross the Placenta Benzos and Opioids
Benzos - specifically diazepam and midazolam opioids was general
62
Drugs that Readily Cross the Placenta _____ anesthetics
Local
63
Drugs that Readily Cross the Placenta vasopressor
ephedrine
64
Drugs that Readily Cross the Placenta induction agents (4)
propofol ketamine etomidate thiopental
65
Drugs that Readily Cross the Placenta Inhalational agents (5)
Halothane Isoflurane Sevoflurane Desflurane N2O
66
Drugs that Do NOT Readily Cross the Placenta anticholinergic agent (1)
Glyco
67
Drugs that Do NOT Readily Cross the Placenta anticoagulants (1)
heparin
68
Drugs that Do NOT Readily Cross the Placenta Muscle Relaxants
Depolarizing: Succinylcholine Nondepolarizing Agents
69
Drugs that Do NOT Readily Cross the Placenta Vasopressor (1)
Phenylephrine
70
What are the 6 pharmacokinetics principles? [Pharmacokinetic Principles]
Lipid solubility Protein Binding Tissue Binding pKa pH Blood Flow
71
Increased Transfer Decreased Transfer Size: molecular weight- [Pharmacokinetic Principles]
Increased < 1000 Decreased >1000
72
Increased Transfer Decreased Transfer Charge of molecules- [Pharmacokinetic Principles]
Increased: uncharged, Decreased: Charged
73
Increased Transfer Decreased Transfer Lipid solubility- [Pharmacokinetic Principles]
Increased Lipophilic Decreased Hydrophilic
74
Increased Transfer Decreased Transfer pH vs drug pKa [Pharmacokinetic Principles]
Increased-Higher porportion of unionized drug in maternal plasma Decreased-Higher proportion of ionized drug in material plasma
75
Increased Transfer Decreased Transfer Placenta efflux transporter proteins (e.g, P-glycoprotein) [Pharmacokinetic Principles]
Increased: Absent Decreased: Present
76
Increased Transfer Decreased Transfer Binding protein type [Pharmacokinetic Principles]
Increased: Albumin (lower binding affinity) Decreased: Alpha1 acid glycoprotein (AAG) higher binding affinity
77
Increased Transfer Decreased Transfer Free (unbound) drug fraction [Pharmacokinetic Principles]
Increased: High Decreased: Low
78
Substances are transferred across the placenta by one of several mechanisms. (5) [Transport Mechanisms]
Simple diffusion, Simple diffusion via channels, Facilitated diffusion, active transport and endocytosis. (see image slide 24)
79
Anticholinergic Agents At___ Sc___ [Drugs that Readily Cross the Placenta]
Atropine Scopolamine
80
Antihypertensive Agents BB___ N___ide N___ine Drugs that Readily Cross the Placenta
Beta Blockers Nitroprusside Nitroglycerine
81
Benzodiazepines Di___ Mi___ Drugs that Readily Cross the Placenta
Diazepam Midazolam
82
Op___ L...A___ Drugs that Readily Cross the Placenta
Opioids Local Anesthetics
83
Vasopressor Ep___(?) Drugs that Readily Cross the Placenta
Ephedrine (not sure why this is listed as a vasopressor)
84
Induction Agents Pro___ Ke___ Et___ Th___ Drugs that Readily Cross the Placenta
Propofol Ketamine Etomidate Thiopental
85
Inhalation Agents Ha___ Is___ Se___ De___** N...Ox___ Drugs that Readily Cross the Placenta
Halothane, Isoflurane, Sevoflurane, Desflurane**, Nitrous Oxide
86
Anticholinergic Agent: Drugs that Do Not Readily Cross the Placenta
Glycopyrrolate
87
Anticoagulants Drugs that Do Not Readily Cross the Placenta
Heparin
88
Muscle Relaxants Drugs that Do Not Readily Cross the Placenta
Depolarizing: Succinylcholine Nondepolarizing Agents
89
Vasopressor Drugs that Do Not Readily Cross the Placenta
Phenylephrine

NUNA 693 Obs/Regional (13 decks)

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