Week 1 Maternal and Fetal Part 2 of 4 Flashcards Preview

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Flashcards in Week 1 Maternal and Fetal Part 2 of 4 Deck (32)
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1

Very high risk of hypoxia in pregnancy due to?

 

1. Decreased FRC

2. Increased O2 consumption

3. Increased A-a gradient 

2

In maternal respiratory changes the mother may have airway edema which could lead to what?

Airway Edema

1.Difficult intubation, high risk of bleeding

−Use smaller size tubes (6-7 mm)

3

With maternal respiratory changes, what does the mother have increased sensitivity to?

 

With maternal respiratory changes, what is decreased for the mother?

Increased sensitivity to LA

Decreased MAC for all GA

MAC --> Minimum Alveolar Concentration 

4

Is pregnancy a restrictive or obstructive lung condition?

Both

5

note FRC decreasing

6

Note FRC second from bottom. 

in order: Vital Capacity

Inspiratory capacity

expiratory reserve

Residual vol

FRC

Total lung capacity

7

non pregnant/Left - FRC 1700

 

Pregnant at term/ right - FRC 1350

8

What happens with maternal hematologicall changes during pregnancy? (3 answers)

increased hgb, increased clotting factors, increased GFR

9

A.Physiological anemia of pregnancy

 

What happens during pregnancy when Estrogen INCREASES renin activity?

1.Estrogen INCREASES renin activity --> 75% increase in blood volume (dilutional effect)

2.Low crit is good for placental blood flow

−Give iron or folic acid

10

What happens to the clotting factors during pregnancy?

INCREASED clotting factors (VII, fibrinogen)

1.Hypercoagulable state helps to prevent blood loss during labor

11

Name all the maternal hematological changes?

Increased clotting factors

Decreased platelet count (10%)

Decreased folate level

Decreased plasma acetylcholine esterase activity (returns to normal 2-4 weeks postpartum)

12

What happens to renal and GI systems during pregnancy?

A.INCREASED GFR and renal plasma flow

B.DECREASED BUN and creatinine

C.DECREASED  renal threshold for glucose and amino acids  --> glycosuria and proteinuria

D.DECREASED LES pressure, INCREASED acid and INCREASED intragastric pressure --> reflux  (heart burns)

E.INCREASED gastrin secretion

F.Slow gastric emptying

G.Increase risk of aspiration

13

What to give for slow gastric emptying during pregnancy?

1.Give metochlorpromide (Reglan) to

−INCREASES gastric emptying (move forward)

−Tighten up LES

14

What happens to maternal endocrine system during pregancy?

A. INCREASES TBG, INCREASES total T3 and T4

B.No change in free T3 and T4

C.Insulin resistance due to placental lactogen

D.INCREASES cortisole

E.INCREASES endorphins at term

15

What is the 1° site of nutrient and gas exchange between mother and fetus?

Placenta

16

What are the two fetal components of the placenta and what are their purposes?

A.Fetal component

1.Cytotrophoblast − inner layer of chorionic villi. Cyto makes cells

2.Syncytiotrophoblast − outer layer of chorionic villi; secretes HCG (Human Chorionic Gonadotropin)

17

What is the maternal component of the placenta?

1.Decidua basalis − derived from the endometrium. Maternal blood in lacunae

18

19

Placenta

20

Uterine blood flow is what during pregnancy?

Increased

21

Uterine blood flow is _______ dependent during pregnancy.

pressure

22

What are causes of decreased perfusion pressure during pregnancy? (7)

A.Causes of decrease perfusion pressure

1.Supine position: aortocaval compression

2.Maternal hypotension

3.Uterine contractions

4.Oxytocin

5.Catecholamines (stress)

6.Vasopressors

7.LA in high doses

23

What drugs can cross placental barrier?

A.Drugs passage across placental barrier

1.Smaller molecular weight, lipid soluble and non-ionized can pass

24

Uterine Blood Flow 

___ BP ___blood flow

___SVR ___blood flow

 

uterine contraction ___BF

alpha-stimulant ___BF

DECREASE BP  DECREASED blood flow

INCREASED SVR DECREASED blood flow

 

uterine contraction DECREASED blood flow

alpha stimulant DECREASED blood flow

25

Uterine blood flow equation

26

What is classified as fetal bradycardia?

< 120 bpm

27

If maternal BP is decreased what will happen to uterine blood flow causing fetal hypoxia and decreased fetal HR?

1.Decrease mom’s BP --> decrease uterine BF --> fetal hypoxia --> decrease fetal HR

28

When maternal BP is increased with associated increase in SVR, what happens to fetal HR?

1.Increase mom’s BP (with associated increase in SVR)  --> decrease fetal HR

29

30

Uterine and Placental Blood Flow

Maternal BP is the ONLY factor that influence blood flow through placenta