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3 Reproduction Unit > 14 Maternal Physiology > Flashcards

14 Maternal Physiology Flashcards

1
Q

What changes in glucose metabolism occur during pregnancy in the mother?

A
  • Maternal response to insulin: diminished (second half of pregnancy)
  • Insulin release: increased
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2
Q

What causes the changes in maternal metabolism of glucose?

A
  • hPL (Human Placental Lactogen)
    • resistance to insulin
    • prolactin has the same effect
  • Progesterone
    • increases appetite
    • diverts glucose into fat synthesis
  • Oestrogen
    • stimulates prolactin release
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3
Q

What is gestational diabetes?

A

Glucose intolerance- first recognised in pregnancy- does not persist after delivery

Maternal hyperglycaemia- resistance to insulin- not met with compensatory rise in maternal insulin

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4
Q

Why does gestational diabetes pose a risk to the fetus?

A

Associated with increased birth weight, congenital defects and stillbirth

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5
Q

What cardiovascular changes to the mother occur during pregnancy?

A
  • Maternal vascular-neogenesis
    • Changes in function of maternal baro- and volume receptors
      • Increased blood flow to breasts, kidneys and GI tract
  • Plasma volume increases 50%, RBC mass increases 20%
  • Cardiac output- increases 4.5L/min - 6L/min
    • Increase stroke volume
      • Flow mumurs heard and upward displacement of apex beat
  • Vasodilation- progesterone
    • Fall in TPR
      • Hypotension- usually returns to normal in third trimester
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6
Q

What is pre-eclampsia?

A

Condition- relates to placental insufficiency

  • Hypertension
  • Proteinuria
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7
Q

Why is it important to control pre-eclampsia?

A

Can lead to:

  • Intrauterine growth restriction
  • Preterm labour
  • Infant respiratory distress syndrome
  • Eclampsia (seizures and coma)
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8
Q

What are the risk factors for developing pre-eclampsia?

A
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9
Q

What haematological changes occur in the mother during pregnancy? What complications can this cause?

A

Pro-thrombotic state

  • increased clotting factors and fibrinogen
  • reduced fibrinolysis

Physiological anaemia

-red cell mass increase but not to same extent as rest of blood volume

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10
Q

What changes occur to the respiratory function as a result of pregnancy in the mother?

A

Progesterone acts on respiratory centre and sensitises chemoreceptors to CO2 changes

Tidal volume and oxygen uptake increases- physiological hyperventilation

Increased awarenes of desire to breathe

Increased tidal volume lowers: pCO2

Respiratory alkalosis

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11
Q

What changes occur to renal function due to pregnancy in the mother?

A
  • Increased renal blood flow
  • Increased GFR 160%
  • Increased renin, aldosterone, angiotensin II secretion (to compensate for expected sodium loss)
  • Increased creatinine clearance
  • Serum levels of creatinine and urea fall
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12
Q

What GI changes occur in the mother as a result of pregnancy?

A

Smooth muscle relaxes

Slow gastric empting

Heart burn, constipation, nausea

Gall bladder emptying reduced

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13
Q

To allow for optimal bone development, their is an increase in maternal calcium absorption, which leads to more calcium being available for the fetus. How is calcium absorption increased?

A

Placenta contributes to maternal synthesis of 1,25 dihydroxycalciferol D3 (calcitriol)

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14
Q

When do concentrations of maternal hCG peak?

A
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15
Q

Outline the immunological changes that occur as a result of pregnancy.

A

Mother= immunosuppressed state

May improve certain autoimmune conditions BUT may increase severity of certain infections

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16
Q

If a pregnant patient presents with swollen legs, what test can be done to rule out a DVT?

A

Ultra-sound doppler

17
Q

Why might being pregnant increase someones risk of acquiring a UTI?

A

Smooth muscle relaxation- increase size of kidneys and ureters

Decreased speed of urine passage- can get backflow of urine

18
Q

Explain why pregnancy is considered a euthyroid state (normal thyroid gland function).

A

Fetus takes up alot of mothers free thyroxin

  • Estrogen stimulates Thyroxine-binding globulin production in liver to increase thyroxine production
  • hCG- similar structure to subunit on TSH- weaken stimulating effect on thyroid- binds to receptors on thyroid
19
Q

Pregnancy can result in back, shoulder and pelvic pain. Explain why:

20
Q

What skin changes can you get during pregnancy?

21
Q

How should pre-eclampsia be managed?

22
Q

Why does venous distension and engorgement occur during pregnancy?

A
  • Vena cava- compressed
  • Vasodilation
23
Q

What are the diagnostic criteria for pre-eclampsia? (2)

A

Proteinuria and hypertension >130/90

24
Q

Give some signs and symptoms that pre-eclampsia is worsening in severity:

A

Headache, nausea, pain in abdomen, changes in vision (check for papilloeodema- raised ICP)

3 Reproduction Unit (21 decks)

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