10. Antenatal Care Flashcards
What physiological changes occur to the maternal cardiovascular system and blood during pregnancy and why?
Increases in plasma volume, cardiac output, stroke volume, heart rate - as mother needs to provide fetus with oxygen. Leads to hypertrophy.
Compression of inferior vena cava by the under us.
What physiological changes occur to the maternal kidneys during pregnancy and why?
Increases in renal blood flow and glomerular filtration rate as removing waste produced by fetus also.
What physiological changes occur to the maternal liver during pregnancy?
Changes in oxidative liver enzymes such as cytochrome P450.
What physiological changes occur to the maternal respiratory system during pregnancy and why?
Increase in tidal volume and minute ventilation, in order to also provide fetus with enough oxygen.
What physiological changes occur to the maternal gastrointestinal system during pregnancy and why?
Nausea and vomiting.
Delayed gastric emptying and prolonged small bowel transit time as a result of high progesterone levels, leading to constipation and haemorrhoids.
What hormone stimulated appetite in early pregnancy, promoting maternal deposition of fat in order to support the increased metabolic needs of the fetus later in pregnancy?
Progesterone.
What are the clinical features of pre eclampsia? And what symptoms does this lead to?
BP >140/90 with >0.3g/save protein in a 24 hour urine collection. Leads to symptoms of epigastric pain, CNS problems, bleeding and nausea/vomiting.
What are the clinical features of gestational diabetes?
Abnormal blood sugar levels leading to symptoms such as fatigue, excessive thirst and urination.
What are the clinical features of gestational anaemia?
Lack of iron gives symptoms such as fatigue, lethargy, shortness of breath, noticeable heartbeats, pale complexion.
What is the cause of pre eclampsia?
Placental insufficiency such as due to deferred implantation or shallow invasion of the placenta.
What causes gestational diabetes?
In the second half of pregnancy, there is dismissed maternal responsiveness to insulin, in order to maintain blood sugar levels high enough to provide the fetus with enough glucose. Maternal glucose usage declines and gluconeogenesis increases. If mother becomes too resistant to insulin, then this causes gestational diabetes.
What causes gestational anaemia?
Increased blood flow in pregnancy to the breasts, kidneys and GI tract (increased metabolism), also as pregnancy advances, the fatal-placental units increasing need for nutrition is met via maternal vascular-neogenesis. Plasma volume increases by 50% and RBC mass by 20%. This increase in the number of RBCs can cause anaemia if the mother is not consuming enough iron.
What ECG changes are physiological, not pathological, during pregnancy?
Atrial and ventricular ectopics.
Left shift in the QRS axis.
Small Q wave and inverted T wave in the lead III.
ST segment depression and I wave inversion in the inferior and lateral leads.
What ECG change is not physiological in pregnancy, and should make you consider whether the mother has had an MI?
ST elevation.
