Week 12

Question 1

whats an easy guide to detrmine which tirmester a pregnant women is in if unconscious?

Answer 1

1st - all in the pelvis
2nd - below the umbilical
3rd - above umbilical

Question 2

how many weeks are in each trimester

Answer 2

1st - <12 weeks
2nd - 12 - 27 weeks
3rd - 27 - delivery

Question 3

what cardiovascular changes do you see in prego women?

Answer 3

• anatomical position of the heart increases to 4th intercostal space by 36 weeks

ECG changes:

• t waves flattened in lead 3
• t waves may be inverted in lead 3
• possible Q waves in 3
• increase in ectopic beats
• decreased pulmonary vascular resistance (greater volume movnign through, more o2 exchange)
• increased CO until end of 2nd trimester
• increased HR
• reduction in SBP & DBP
• blood volume increases by 50%
• haemodilution & increase in Hb concentration
• increase in clotting factors
• fibrinogen levels double
• increased flow through tricuspid valve or mitral valve
• clinical shock may not occur until 30-35% of blood volume is lost

Question 4

what respiratory changes do you see in prego women?

Answer 4

increased sensitivity to co2
insp capacity increased by 300ml
expiratory reserve decreases by 200ml
Tidal volume increases - 500 - 700ml
o2 consumption increases by 15%

Question 5

what GIT changes do you see in prego women?

Answer 5

poor cardiac sphincter tone
increase gastric reflux
decresed gastric emptying
- increased risk of aspiration

Question 6

what Genitourinary changes do you see in prego women?

Answer 6

bladder capacity doubles
increased renal blood flow
uterers dilated and partially obstructed by 3rd trimester

Question 7

what muscle and skeletal changes do you see in prego women?

Answer 7

more relaxin in 3rd trimester
general ligamentous relaxation
increased risk of dislocations and subluxations
change in centre of gravity - increased risk of falling

Question 8

what endocrine changes do you see in prego women?

Answer 8

progesterone:

• relaxes smooth muscle
• more ability to get rid of co2

Question 9

what psych issues do you see in prego women?

Answer 9

risk of being assaulted by a partner
patients off meds
drug abuse often continues

Question 10

What are you concerned about with mechanism of injury with preggos?

Answer 10

• increased risk of placental abruption

- risk of injury to organs not usually susceptible (uterus/bladder)

Question 11

what are the main mechanisms for placental abruption?

Answer 11

• spontaneous
• separation from placental wall
• can occur with even minor trauma
• MVA speed >50kmh is significant

Question 12

how much blood perfuses the uterus in an at term patient?

Answer 12

2-4 litres

Question 13

what do you need to consider with preggo vital signs?

Answer 13

Hypotension = significant blood loss

can compensate well

Question 14

what do you do if a preggo is hypotensive?

Answer 14

tilt them 15-30degrees, remove uterus from squashing inferior vena cava

or shift placenta to the left

Question 15

what mgmt do you give for preggo?

Answer 15

15l non rebreather o2
IV - start early - large bore cannula in vein
will need large amounts of fluid
Transport to royal melbourne

Question 16

when does a ceasarian need to be performed in cardiac arrest for best outcome?

Answer 16

within 5 mins of maternal cardiac arrest