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Reproductive > 8. Maternal Physiology > Flashcards

8. Maternal Physiology Flashcards

1
Q

What are the main broad reasons why the body needs to adapt in pregnancy?

A 
Volume support
Nutrition
Waste clearance
Pregnancy maintenance
Childbirth
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2
Q

What drives the adaptations in pregnancy?

A

Hormones - hCG, oestrogen, progesterone, relaxin, hPL

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3
Q

How does the mother adapt to changes in respiration levels?

A

Increased ventilation
TV increase - increase PaO2, decrease pCO2
ERV decrease
TLC decrease due to elevation of diaphragm
Dyspnoea may occur

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4
Q

How does the mother adapt to cardiovascular and haematology needs of pregnancy?

A

Volume expansion

Clotting mechanisms

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5
Q

How does volume expansion occur in the mother?

A

Early - increased volume
Late - increased HR (98bpm)
Progesterone - smooth muscle relaxation (decrease SVR, drop in BP)

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6
Q

How does clotting increase in the mother?

A 
Increased procoagulants (fibrinogen, factor VIII, vWF)
Decreased anticoagulants (protein S)
Reduced fibrinolysis
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7
Q

How does the mother increase stroke volume?

A

Oestrogen and progesterone stimulate RAAS system
Increased angiotensinogen from liver stimulated by oestrogen
No vasoconstriction

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8
Q

What are some consequences of adaptations of CVS in pregnancy?

A

Increased RAAS - leads to peripheral oedema
Change in plasma volume, changes RBC volume - leading to dilutional anaemia
Clotting - hypercoagulable state, increased number of thromboembolic events

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9
Q

How does the mother adapt to increased demand of renal system?

A

Increased GFR

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10
Q

What are the adaptations of the renal/urinary system in the mother?

A

Systemic vasodilation- increased RBF, increased GFR, decrease serum urea and creatinine
Decreased PCT absorption - glucosuria
Smooth muscle relaxation and obstruction - increased size of kidneys and ureters, decreased speed of urine passage

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11
Q

How does the GI system adapt in pregnancy?

A

Slows transit time to increase absorption of nutrients

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12
Q

What are the adaptations in the GI tract in pregnancy?

A 
Structural - uterus displaces bowel, can cause mechanical obstruction
LFTs - ALP levels increase
Decreased LOS tone
Decreased small bowel motility
Decreased large bowel motility
Decreased gallbladder contractility
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13
Q

What are some consequences of the changes in the GI system in pregnancy?

A

GORD, aspiration
Constipation
Gallstones

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14
Q

How does the mothers endocrine system adapt?

A

Thyroid regulation
Parathyroid activation
Insulin resistance

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15
Q

What are the changes in MSK and skin in pregnancy?

A

Make everything loose and stretchy

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16
Q

What are the MSK adaptations in the mother?

A

Change in centre of gravity - increased lordosis and kyphosis, forward flexion of neck
Stretching of abdominal muscles - impede posture, strain paraspinal muscles
Increased motility of sacroiliac joints and pubic symphysis, anterior tilt of pelvis

17
Q

What are the changes in skin in pregnancy?

A

Chloasma
Palmar erythema
Vascular spiders
Linea nigra

18
Q

What is pre-eclampsia?

A

Hypertension and proteinuria

19
Q

What are the risk factors for pre-eclampsia?

A 
Chronic or gestational HTN
Pre-existing renal disease
Diabetes
Obesity
Family history
First pregnancy
Extreme stress of age
IVF
20
Q

What is the pathology in pre-eclampsia?

A

Impaired invasion of trophoblast leading to shallow invasion of spiral arteries
Leads to hypoperfusion and ischaemia - systemic endothelial dysfunction

21
Q

What are the signs and symptoms of mild pre-eclampsia?

A

Elevated blood pressure
Elevated protein in urine
Weight gain exceeding 2lbs per week
Water retention and swelling

22
Q

What are the signs and symptoms of severe pre-eclampsia?

A

Headaches
Changes in vision
Nausea/vomiting
Pain in abdomen and back

23
Q

What are the maternal complications of pre-eclampsia?

A 
Seizure
Cerebral haemorrhage
Renal failure
Pulmonary oedema
DIC and thrombocytopenia
Haptic failure or rupture
24
Q

What are the fetal complications in pre-eclampsia?

A 
Growth restriction
Oligohydramnios
Placental infarct or abruption
Fetal distress
Premature delivery
Stillbirth

Reproductive (22 decks)

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