3. Pregnancy: Maternal Adaptations

Question 1

List 8 factors that influence adaptation to pregnancy

Answer 1

Age
Parity
Previous experience (obstetric)
Body build ; BMI
Preexisting disease
Socio-economic factors
Ethnic, geographic, climactic variables
No. and size of conceptus

Question 2

List two general effects of pregnancy on the mother

Answer 2

Gain in body water
Weight gain (lordosis: backache, cramps, nerve compression)

Question 3

What is the approximate weight gain of the mother in pregnancy

Answer 3

7kg

Question 4

What effect does pregnancy have on Cardiac Output

Answer 4

Raised Cardiac Output by 1.5l/min by 10 weeks

Question 5

What is the effect of pregnancy on pulse rate

Answer 5

Pulse rate raised by 15bpm

Question 6

What is the effect of Pregnancy on pulse pressure

Answer 6

Raised pulse pressure

Question 7

What is the effect of Pregnancy on Peripheral Resistance

Answer 7

Fall in Peripheral resistance (vasodilation)

Question 8

What is the effect of Pregnancy on the position of the heart

Answer 8

Heart pushed upwards and rotates forwards

Question 9

What is the effect of Pregnancy on the size of the heart

Answer 9

Heart enlargement

Question 10

What is the effect of pregnancy on diastolic blood pressure

Answer 10

Diastolic pressure falls by 10-15mmhg by 2nd Trimester

Question 11

There is a 50% increase in flow to which organs during pregnancy

Answer 11

Uterus
Kidney
Skin

Question 12

How does pregnancy affect the chest shape of the mother

Answer 12

Flaring of the ribs

Diaphragm raised

Question 13

What is the effect of Pregnancy on maternal pCO2

Answer 13

pCO2 lowered

Question 14

What is the effect of Pregnancy on maternal ventilation

Answer 14

Raised maternal ventilation

Question 15

What is the effect of Pregnancy on vital capacity and tidal volume

Answer 15

Tidal volume increases by 200ml (normal 500ml)

Vital capacity increases by 200ml (normal 3000-5000ml)

Question 16

What is the effect of Pregnancy on red cell mass

Answer 16

Red cell mass increases by 20%

Question 17

What is the effect of Pregnancy on plasma volume

Answer 17

Plasma volume Increases by 50%

Question 18

What is the effect of Pregnancy on red cell volume

Answer 18

Red cell volume rises

Question 19

What is the effect of Pregnancy on platelets

Answer 19

Platelets decreased

Question 20

What is the effect of Pregnancy on clotting factors and fibrinogen

Answer 20

Raised clotting factors and fibrinogen

Question 21

What are the changes seen in the uterus in pregnancy

Answer 21

• Increase in size and weight of the uterus (10x) ; hyperplasia and hypertrophy

Question 22

What changes in the Myometrial syncytium are seen in pregnancy

Answer 22

More gap junctions and oxytocin receptors

Question 23

What changes are seen in the cervix in pregnancy

Answer 23

Less collagen as term approaches

Question 24

What changes are seen in the vagina during pregnancy

Answer 24

More glycogen in cells

Question 25

What is the effect of Pregnancy on Glomerular Filtration Rate

Answer 25

50% increase

Question 26

List five effects of pregnancy on the Kidney and Urinary Tract

Answer 26

50% increase in GFR Increased urine production Extrinsic Bladder compression Frequency of micturition, nocturia, stress incontinence

Question 27

What changes are seen in the mouth during pregnancy

Answer 27

Taste change Ptyalism Pica

Question 28

What effect does pregnancy have in the stomach

Answer 28

Reflux, hyperacidity, reduced emptying

Question 29

What effect does pregnancy have on the intestine

Answer 29

Better fluid absorption | ~ constipation

Question 30

What effect does pregnancy have on the liver and gall bladder

Answer 30

Cholestasis

Question 31

List 7 changes seen in the skin seen in pregnancy

Answer 31

``` Increased skin pigmentation Facial chloasma Striae Vasodilation Spider nevi Postnatal shedding of hair and nails Pregnancy prurigo (itchy skin papules) ```

Question 32

How is glucose transferred to the fetus

Answer 32

Facilitated diffusion through placenta in membrane vesicles

Question 33

Does insulin cross the placenta

Answer 33

Nope

Question 34

True or false Fetal hyperinsulinemia promotes transfer of glucose

Answer 34

True

Question 35

What is the effect of maternal hyperglycemia on the fetus

Answer 35

May exaggerate fetal insulin response leading to fetopathy

Question 36

What is the normal weight and length of a 16 week fetus

Answer 36

100gms 14-17 cm long

Question 37

What is the normal weight of a 24 week fetus

Answer 37

600 gms

Question 38

Fat deposition starts at which week in the fetus

Answer 38

24 weeks

Question 39

What is the normal weight and length of a 28 week fetus

Answer 39

1050gms 37cm long

Question 40

What is the normal weight and length of a 32 week fetus

Answer 40

1700gms 42 cm long

Question 41

What is the normal weight and length of a 36 week fetus

Answer 41

2500 gms 47cm long

Question 42

What is the normal weight and length of a 40 week fetus

Answer 42

3200-3500gms 50cm long

Question 43

When does the fetus start its own production of insulin

Answer 43

12 weeks

Question 44

True or False Thyroid Stimulating Hormone TSH, crosses the placenta

Answer 44

False

Question 45

In fetal circulation, what percentage of cardiac output goes to umbilical arteries

Answer 45

60%

Question 46

When does Fetal circulation start

Answer 46

5weeks

Question 47

When does fetal erythropoeisis start

Answer 47

By 6 weeks

Question 48

Which Haemoglobin is dominant in fetal blood by 8 weeks

Answer 48

HbF

Question 49

What is the main source of Amniotic Fluid

Answer 49

Fetal Urinary Tract

Question 50

What is the result of obstruction to the Fetal Urinary Tract

Answer 50

Oligohydramnios