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PHYS - REPRO > 10. MATERNAL CHANGES > Flashcards

10. MATERNAL CHANGES Flashcards

1
Q

What are the reasons for maternal changes?

A
  • High levels of foetal steroid
  • Foetal & maternal demands
  • Mechanical displacement
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2
Q

What are 6 maternal changes?

A
  1. Increase in uterus size
  2. Increased metabolic demands as the uterus grows
  3. Structural requirements of the foetus
  4. Removal of foetal waste & delivery of nutrients
  5. Provision of amniotic fluid
  6. Preparation for delivery of the foetus & puerpium
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3
Q

What 6 systems do maternal changes occur in?

A
  1. Cardiovascular system
  2. Gastrointestinal system
  3. Endocrine system
  4. Respiratory system
  5. Energy balance
  6. Urinary system
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4
Q

What 4 classes of hormones are responsible for maternal changes?

A
  1. Placental peptides
  2. Maternal steroids
  3. Placental & foetal steroids - Progesterone, oestradiol, oestriol
  4. Maternal & foetal pituitary hormones
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5
Q

What are the placental peptides?

A
  • hCG
  • hPL
  • GH
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6
Q

What are the maternal & foetal pituitary hormones?

A
  • GH
  • Thyroid hormones - increases to cope with metabollic demand
  • CRF (Corticotrophin releasing factor)
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7
Q

What 5 features do placental steroid affect?

A
  1. RAAS
  2. Respiratory centre
  3. GI tract
  4. Blood vessels
  5. Uterine contractility
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8
Q

How does the energy balance change during pregnancy?

A
  • There’s an increased need for energy output & storage during pregnancy
  • Increased energy output to cope with increase in respiration & CO
  • Increased energy to storage for foetus, labour & post-labour needs
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9
Q

What happens to basal metabolic rate during pregnancy?

A
  • During pregnancy, the basal metabolic rate increases - by 350 kcal a day = mid gestation
  • by 250 kcal a day = late gestation
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10
Q

How do maternal glucose reserve change in the first trimester?

A
  • The number of beta pancreatic cells increase
  • Maternal pancreas hypertrophies
  • Insulin in plasma increases
  • Insulin levels increase in order to overcome insulin resistance caused by maternal pancreas hypertrophy
  • Glucose stores are used by muscle, so serum glucose levels fall
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11
Q

How do glucose levels change in the 2nd trimester?

A
  • Increased need for glucose in 2nd trimester
  • Glucose is actively transported across placenta to provide foetal energy source
  • Insulin resistance increases due to hPL
  • Insulin resistance = less glucose in stores
  • Glucose serum levels rise but ca cause gestational diabetes
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12
Q

What causes insulin resistance in the first & second trimester?

A
  • First trimester = hypertrophy of maternal pancreas
  • Second trimester = hPL
  • Insulin resistance means insulin is unable to control glucose & cause storage. Decreases the rate of glucose uptake, meaning less glucose is stored & more is in the serum
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13
Q

What is gestational diabetes?

A
  • Gestational diabetes occurs when the body can’t make enough insulin during pregnancy to control blood glucose levels
  • Body cannot overcome the insulin resistance caused by pregnancy. Insulin levels need to rise to overcome the insulin resistance
  • However, some women already have insulin resistance prior to pregnancy. So the insulin resistance from pregnancy exacerbates their risk to gestational diabetes
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14
Q

Which hormones act on RAAS during pregnancy?

A
  • E2 - oestrogen & oestradiol

- Progesterone

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15
Q

What’s the effect of E2 & progesterone on pregnancy?

A
  • Increased sodium retention
  • The threshold for thirst is lowered = more water consumption
  • Decreased plasma oncotic pressure
  • Sodium retention leads to water retention
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16
Q

How much water weight is gained?

A

8.5L

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17
Q

Where is the water gain redistributed to?

A
  1. Placenta
  2. Amniotic fluid
  3. Uterine muscle
    4, Mammary gland
  4. Plasma volume (main source)
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18
Q

What are the consequences of the increase in body water during pregnancy?

A
  • Oedema in lungs, connective tissue, ligaments, swollen ankles & legs
  • Physiological anemia of pregnancy - increase in plasma volume proportional to RBC can cause anemia
19
Q

What happens to respiration during pregnancy?

A
  • Respiration rate increases during pregnancy to increase oxygen consumption
20
Q

How does respiration rate increase during pregnancy?

A
  • Sensitivity to CO2 (H+ ions) increases to increase oxygen consumption
  • Thoracic ribcage displaced outwards & upwards to expand leading to increase in thoracic volume
  • Longer & deeper breaths to increase minute volume by 40%
  • Arterial O2 (PO2) increases, whilst arterial CO2 (PCO2) decreases
21
Q

How does an increase in respiration facilitate foetal gas exchange?

A
  • Increase in oxygen & decrease in CO2 favours foetal gas exchange
  • Maternal oxygen is higher so diffuses down concentration gradient into foetus
  • Foetus CO2 is lower so diffuses out into maternal circulation to be removed
22
Q

What happens to maternal blood volume?

A
  • Increase in plasma volume
  • Increase in RBC mass
  • But increase in plasma volume is much greater, so the ratio of plasma volume to RBC can cause physiological anemia of pregnancy
  • Increased efficiency of iron absorption from the gut/GI
23
Q

What’s the effect of maternal blood becoming hypercoaguable?

A
  • White blood cells & clotting factors undergo changes making the blood HYPERCOAGUABLE
  • There are higher levels of fibrinogen in hypercoagulable blood
  • Blood becomes hypercoagulable for placental separation & to cope with demands of child
24
Q

What is a risk of the blood becoming hypercoaguable?

A
  • Risk of thrombosis is high

- PE or DVT

25
Q

What happens to foetal blood content?

A
  • Increased haemoglobin

- Different type of haemoglobin

26
Q

What’s the difference between foetal & maternal hemoglobin?

A
  • Foetal haemoglobin has a higher affinity for oxygen/greater binding than maternal Hb
  • Foetal Hb binds to O2 given up by maternal Hb
27
Q

What’s the consequence of smoking on foetal-maternal gas excahnge?

A
  • Smoking can increase maternal carboxyl Hb which is more permanent
  • Reduces the increased oxygen binding
  • Leads to foetal hypoxia
28
Q

What happens to heart sounds during pregnancy?

A
  • Slow murmur due to increased volume of blood flowing through the heart
  • S1 & S3
29
Q

What happens to CO during pregnancy?

A
  • Increase in CO for maternal muscle & foetal supply
  • CO= HR X SV
  • Both HR & SV also increase, but increase in CO is mainly due to SV
  • CO begins to increase at 3 weeks & peaks at 28 weeks
30
Q

What happens to TPR during pregnancy?

A
  • TPR decreases
    WHY?
  • Increase in CO
  • Vasodilation caused by sex steroids specifically progesterone
  • BP = CO X TPR
  • Blood pressure also drops
  • Formation of new blood vessels to cope with heat loss - neoangenesis
31
Q

What are the two main consequences of GI maternal changes?

A
  1. Constipation

2. Acid reflux

32
Q

What are the three main maternal effects on the GI tract?

A
  1. Increase in appetite & thirst due to progesterone
  2. Reduced GIT motility
  3. Relaxation of LOS
33
Q

How can pregnancy cause constipation?

A
  • Progesterone relaxes the smooth muscles
  • Reduced GI tract motility occurs
  • Constipation
34
Q

How can constipation be treated?

A

Lactulose

35
Q

How can pregnancy cause acid reflux?

A
  • Progesterone relaxes smooth muscles
  • LOS (lower oesophageal sphincter) relaxes causing acid reflux of gastric conetnts
  • Also caused by large uterus pressing against GI
  • Heart burn
36
Q

Why is folic acid important in pregnancy?

A
  • Folic acid is involved in DNA production, growth, blood cell production in the uterus, placenta & foetus
  • Folic acid deficiency linked to Spina bifida neural tube defect
37
Q

How much folic acid should pregnant women take?

A
  • 400mcg/day 3 months before pregnancy leading up to Week 12 of pregnancy
  • 5mg in high risk women
38
Q

Why do pregnant women have an increased UTI risk?

A
  • Progesterone acts on smooth muscles so it dilates the ureter, kidney & bladder
  • Urinary tract is dilated in a dilated system
  • Some urine may be retained in bladder = UTI
39
Q

What happens to GFR during pregnancy?

A
  • Increased blood flow to the kidney so increased GFR
  • Increased clearance of creatinine, urea, uric acid
  • GFR reference values used for pregnant women should be adjusted
40
Q

Why do pregnant women experience urinary frequency?

A
  • Early pregnancy = uterus is enlarging but it’s still within the pelvis, so it compresses the bladder leading to urinary frequency
  • 2nd trimester/mid pregnancy = uterus is lifted out of pelvis, decreased pressure on bladder so micturition is normal
  • End of pregnancy = head of foetus descends into pelvis, more pressure = urinary frequency
41
Q

What happens to the uterus?

A
  • Size of uterus increases
  • Increase in muscle mass & blood flow to placenta & uterus
  • Isthmus becomes softened & elongated
  • Lower uterine segment acts as funnel for baby’s head
  • Lower segment formed from isthmus which si less muscular
42
Q

What happens to the cervix?

A
  • Cervix increases in vasculature
  • Tissue softens from 8 weeks
  • Changes in connective tissue in preparation for expansion
  • Proliferation of glandular tissue
  • Progesterone forms a thick mucosal plug protecting baby’s head
43
Q

What happens to the body post-labour?

A
  1. Fall in sex steroid level upon delivery & removal of placenta
  2. Most endocrine related changes returns to normal
    - CO returns to normal after 2 weeks
  3. Uterine muscle shrinks rapidly & loses oedema. Contracts slowly but doesn’t return to pre-pregnancy size. Uterus descends to pelvis by day 10
  4. Removal of sex steroids allows increased prolactin to act on the breast. Suckling of baby allows lactation

PHYS - REPRO (10 decks)

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