Pregnancy
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Questions and Answers

What is the number one goal when assessing a pregnant patient?

  • Ensuring good maternal care (correct)
  • Monitoring fetal changes
  • Ensuring good fetal care
  • Detecting cancer early

    • Which organ system is impacted the most during pregnancy?

  • Cardiovascular system (correct)
  • Renal system
  • Respiratory system
  • Hepatic system

    • What is a common physiological change in the respiratory system during pregnancy?

  • Increase in residual volume
  • Decrease in tidal volume
  • Decrease in minute ventilation
  • Increase in respiratory rate (correct)

    • Which of the following liver enzymes increases during pregnancy?

    <p>AST, ALT</p> Signup and view all the answers

    What happens to renal blood flow during pregnancy?

    <p>Increases by 60%</p> Signup and view all the answers

    Which of the following statements about cardiac output during pregnancy is true?

    <p>Stroke volume increases by 25-35%</p> Signup and view all the answers

    How many ml/min of blood flow is delivered to the uterus during pregnancy?

    <p>700 ml/min</p> Signup and view all the answers

    What percentage of the uterine blood flow perfuses the intervillous space (placenta)?

    <p>80%</p> Signup and view all the answers

    What is the leading cause of maternal death worldwide, including in the United States?

    <p>Maternal hemorrhage</p> Signup and view all the answers

    Which trimester is considered the safest for anesthesia during pregnancy?

    <p>Second trimester</p> Signup and view all the answers

    What is the significance of fetal heart rate variability after 25 weeks of pregnancy?

    <p>It indicates fetal wellbeing</p> Signup and view all the answers

    Regional anesthesia is always preferred during surgery in pregnancy.

    <p>True</p> Signup and view all the answers

    The decision to monitor FHTs during surgery should include a conversation with OB provider and surgeon.

    <p>True</p> Signup and view all the answers

    Your patient is pregnant and has been NPO since yesterday morning. You can treat this patient as a true NPO.

    <p>False</p> Signup and view all the answers

    Increased intravascular volume during pregnancy results in a 20-30% increase in erythrocyte volume.

    <p>True</p> Signup and view all the answers

    Respiratory changes in pregnancy include a decrease in tidal volume (TV).

    <p>False</p> Signup and view all the answers

    Plasma cholinesterase levels during pregnancy increase by 30%.

    <p>False</p> Signup and view all the answers

    The production of alkaline phosphate by the placenta results in decreased liver enzyme levels during pregnancy.

    <p>False</p> Signup and view all the answers

    Cardiac output decreases by 35% during pregnancy due to an increased systemic vascular resistance (SVR).

    <p>False</p> Signup and view all the answers

    Uterine blood flow during pregnancy has significant autoregulation

    <p>False</p> Signup and view all the answers

    Cholecystectomy or appendectomy are examples of elective surgeries commonly performed during pregnancy.

    <p>False</p> Signup and view all the answers

    All general anesthetic drugs have been found to cause an increase in birth defects in pregnant women

    <p>False</p> Signup and view all the answers

    Fetal heart rate monitoring should begin after 10 weeks of pregnancy

    <p>False</p> Signup and view all the answers

    Increased levels of progesterone during pregnancy lead to increased gastric emptying

    <p>False</p> Signup and view all the answers

    All general anesthetics cross the placenta.

    <p>True</p> Signup and view all the answers

    Study Notes

    Physiological Changes in Pregnancy

    • Almost every organ system is impacted by pregnancy, with changes beginning in the first trimester.
    • Pharmacokinetics (PK) and pharmacodynamics (PD) are both impacted.
    • Hormone activity increases, leading to:
    • Increased maternal metabolic demands and biochemical alterations.
    • Mechanical effects of a gravid uterus.

    Cardiovascular Changes

    • 35-45% increase in intravascular volume.
    • 45-55% increase in plasma volume.
    • 20-30% increase in erythrocyte volume.
    • 40-50% increase in cardiac output.
    • 25-35% increase in stroke volume (SV).
    • 15-25% increase in cardiac output (CO).
    • 20% decrease in systemic vascular resistance (SVR).
    • 35% decrease in pulmonary vascular resistance (PVR).
    • Supine hypotension develops.

    Respiratory Changes

    • 45-50% increase in minute ventilation (MV).
    • 40-45% increase in tidal volume (TV).
    • 0-15% increase in respiratory rate (RR).
    • 0-5% decrease in total lung capacity (TLC).
    • No change in vital capacity (VC).
    • 20% decrease in functional residual capacity (FRC).
    • 20% increase in oxygen consumption.
    • Upper airway capillary engorgement.

    Hepatic and Biliary Changes

    • AST, ALT, and bilirubin increase to upper limits of normal.
    • Plasma protein concentrations decrease.
    • Plasma cholinesterase levels decrease by 30%.
    • Placenta production of alkaline phosphate levels results in double the normal value, leading to gallbladder issues.

    Renal Changes

    • 60% increase in renal blood flow.
    • Increased clearance of creatinine, urea, and uric acid.
    • Upper limits of BUN and Cr in pregnancy are 50% lower.

    Ureteroplacental Physiology

    • Blood flow increases from 100 ml/min to 700 ml/min (10% of CO).
    • 80% of uterine blood flow perfuses the intervillous space (placenta) and the rest perfuses the myometrium (muscle).
    • Uterine blood flow has minimal autoregulation.

    Surgery in Pregnancy

    • Mostly limited to non-elective surgery (e.g., cholecystectomy, appendectomy, maternal trauma, cancer, fetal procedures).
    • Maternal hemorrhage is the number one cause of maternal death worldwide (including the US).
    • Up to 2% of pregnant patients will require surgery.

    Anesthesia Toxicity

    • All general anesthetic drugs cross the placenta.
    • No studies found increase in birth defects in women undergoing anesthesia while pregnant.
    • Small increase in risk for miscarriage or preterm delivery.
    • In general, the second trimester is the safest.

    Preoperative Considerations

    • Consultation with OB provider, always.
    • Maternal coexisting disease.
    • Pregnancy overlaying the coexisting disease.
    • New disease of pregnancy.
    • Capabilities of the facility.
    • Progression of the pregnancy.
    • Refer to OB provider.

    Fetal Heart Rate Monitoring

    • FHTs should be monitored after 18 weeks.
    • At 25 weeks, FHT variability is a sign of fetal wellbeing.
    • Decision to monitor FHTs during surgery needs to be a three-way discussion (OB provider, surgeon, anesthesia provider).

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