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Reproduction > 8.2 Maternal Physiological Adaptations To Pregnancy > Flashcards

8.2 Maternal Physiological Adaptations To Pregnancy Flashcards

1
Q

When is fat laid down in pregnancy?

A

In the first half to meet demands of the foetus in the later half

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2
Q

What are the changes in glucose metabolism that occurs in pregnancy?

A
  • reduction in maternal blood glucose and amino acid concentrations
  • diminished maternal responsiveness to insulin (insulin resistance) in the second half of pregnancy
  • increase in maternal free fatty acid, ketone and triglyceride levels (as an alternative metabolic fuel)
  • increased insulin release in response to a normal meal
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3
Q

What hormones influence glucose metabolism in the mother?

A

Human placental lactogen / human chorionic somatomammotrophin
Oestrogen
Progesterone

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4
Q

What is the action of hPL /hCS?

A

generates a maternal resistance to insulin. The hormone prolactin also has a similar role.

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5
Q

How does oestrogen influence glucose metabolism?

A

Stimulates increase in prolactin release

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6
Q

How does progesterone influence glucose metabolism?

A

Increases appetite in the first half of pregnancy

Diverts glucose into fat synthesis

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7
Q

What is gestational diabetes?

A

Gestational Diabetes is defined as glucose intolerance that is first recognised in pregnancy, and does not persist after delivery

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8
Q

How is gestational diabetes diagnosed?

A

Oral glucose tolerance test.

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9
Q

Why does gestational diabetes occur?

A

Insulin resistance occurs in pregnancy, but compensatory rise in maternal insulin production does not. Leads to hyperglycaemia

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10
Q

Why is gestational diabetes important?

A

May harm foetus causing increased birth weight, congenital defects, still birth.

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11
Q

How is the fetal-placental units need for nutrition met?

A

Vascular-neogenesis

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12
Q

How is vascular-neogenesis achieved?

A

Changes in function of the maternal baroreceptors and volume receptors
Increases blood flow to the breast, kidneys and GI (increased metabolism)

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13
Q

How does maternal blood change in pregnancy?

A

Plasma volume increases by 50%

Red cell mass increases by 20%

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14
Q

How does cardiac output change in pregnancy?

A

Increase from 4.5L to 6L per minute. Mainly due to increase in stroke volume, but heart rate also increases.

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15
Q

What can the increase in plasma volume cause?

A

Flow murmurs

Upward displacement of the apex beat

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16
Q

What are the cardiovascular changes seen in pregnancy?

A

Increase in stroke volume (early stage), cardiac output and heart rate (late stage up to 95bpm)
Increased plasma volume
Hypotension/ reduced blood pressure in the first and second trimester.

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17
Q

Why do pregnant people often get hypotension?

A

Progesterone levels continuously increasing, causing vasodilation. Decrease in TPR causes drop in mean arterial blood pressure.

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18
Q

What is pre-eclampsia?

A

condition relating to placental insufficiency, which manifests itself as a clinical syndrome in pregnancy of hypertension and proteinuria

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19
Q

What can poorly controlled pre-eclampsia lead to?

A

Foetus: intrauterine growth restriction, preterm labour, and infant respiratory distress syndrome
Mother: eclampsia (seizures and multi organ failure)

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20
Q

What haematological changes are seen in pregnancy?

A

1) Pro-thrombotic state -increased clotting factors
- Increased fibrinogen
- reduced fibrinolysis

2) Anaemia
- physiological anaemia due to increased plasma volume
- Iron and folate deficiency

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21
Q

Why can warfarin not be given to treat the pro-thrombotic state of pregnant patients?

A

Warfarin is teratogenic and can cross the placenta

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22
Q

How is respiratory function affected in pregnancy?

A
  1. Diseases of the respiratory system more serious due to increased oxygen requirement of gestation
  2. Tidal volume and oxygen uptake increase
  3. Increased awareness of desire to breathe (dyspnoea)
  4. Chest diameter can increase by 2cm - affects total lung capacity to increase and also tidal volume
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23
Q

How does progesterone cause increased tidal volume?

A

Acts on the respiratory centre and sensitising chemoreceptors to CO2 changes

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24
Q

How is renal function affected in pregnancy?

A
  1. Increased renal blood flow
  2. Increase GFR (160%)
  3. Increased renin, aldosterone and angiotensin II secretion to compensate for the sodium loss
  4. Decreased serum levels of creatinine and urea
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25
Q

What gastrointestinal changes are seen in pregnancy?

A
  1. Slow gastric emptying ( nausea, constipation, heartburn)
  2. Gallbladder emptying reduced due to decreased contractility (gallstones )
  3. Mechanical obstruction of the bowel by the retro flex angle of the uterus (painful)
26
Q

Why is gastric emptying slowed in pregnancy?

A

Progesterone causes smooth muscle to relax throughout the GI tract

27
Q

How is calcium metabolism affected in pregnancy?

A
  1. Placenta contributes to maternal synthesis of calcitriol (active form of vitamin D)
  2. Increase in maternal calcium absorption
28
Q

Why must GFR increase?

A

As increased waste (mother and child)

29
Q

Which hormones are highest at the end of pregnancy?

A

Steroid hormones - oestrogen and progesterone

30
Q

When is the levels of human chorionic gonadotrophin highest?

A

Week 12 to maintain corpus luteum in first trimester

31
Q

What is the function of relaxin?

A

Soften ligaments

Widens cervix

32
Q

What changes in immunity happens in the mother?

A

Baby is genetically different to mum and is not compatible. Mother will take on immunosuppressed phenotype.

33
Q

Why is a foetus considered to be a hemisphere-allograft?

A

As it is recognised by the maternal immune system as being genetically different

34
Q

What affects can be caused by the mother being in an immunosuppressed state?

A

Higher attack rate and severity of certain viral
pathogens ie. varicella
May improve certain autoimmune
conditions e.g. psoriasis

35
Q

How does immune regulation occur in pregnancy?

A

Progesterone causes increased levels of interleukin 10 to be produced (IL10). This causes less cytotoxic cytokines (TH1) to be produced and more tolerant cytokines (TH2).

36
Q

How much does the oxygen intake change in pregnancy?

A

Increase by 20%

37
Q

Why might the pH of blood change in pregnancy?

A

As minute ventilation increases, the PaO2 increases and the PaCO2 decreases. This can cause the pH to become more alkaline.

38
Q

Why does the total lung capacity decrease by 5% in later stage of pregnancy?

A

As there is elevation of the diaphragm as the growing child presses on the diaphragm.
TLC is also increased by the increase in chest diameter

39
Q

What causes sense of dyspnoea in pregnancy?

A

Mostly due to increases progesterone causing hyperperfusion at lungs. Decreased PaCO2 and hyperventilation causes dyspnoea.

40
Q

Why is hypotension experienced in pregnancy?

A

As progesterone causes smooth muscle relaxation

This causes a drop in TPR and BP

41
Q

How is the stroke volume increased in pregnancy?

A

Progesterone cause drop in BP
Drop in BP detected in the kidneys and renin released by granular cells
Oestrogen and progesterone also stimulate granular cells to release renin
Oestrogen stimulates liver to release angiotensinogen
Renin converts angiotensinogen to angiotensin 1
Ace converts angiotensin 1 to angiotensin 2
Angiotensin 2 acts on adrenal glands to stimulate release of aldosterone.
Aldosterone acts on kidneys to stimulate reabsorption of salt and water (H2O)
Increase circulating volume of fluid and increased SV

42
Q

Why does stimulation of the RAAS system in pregnancy not cause an increase in vasoconstriction?

A

Angiotensin 2 usually causes vasoconstriction of blood vessels but its actions are counteracted by the vasodilatory effect of progesterone

43
Q

Why might pregnant patients get swollen ankles?

A

Increase in RAAS causes increased circulating volume of fluid. May cause peripheral oedema

44
Q

Why might glucosuria occur in pregnancy?

A

Due to massive increase in glomerular filtration rate and renal blood flow.

45
Q

Why are UTIs seen in pregnancy?

A

Smooth muscle relaxation of ureters can cause renal backflow

Smooth muscle relaxation might result in decreased speed of passage.

46
Q

Why might gastric reflux happen in pregnancy?

A

Progesterone causes decrease tone of the lower oesophageal sphincter

47
Q

What changes will we see in LFTs in pregnancy?

A

Increase in ALP levels due to placental synthesis

48
Q

How is the thyroid adapted in pregnancy?

A

Decreased maternal free thyroxine due to:
Foetus dependant on maternal thyroxine (T4) until 12 weeks.
Oestrogen stimulates thyroxine binding globulin (TBG) production, lowering free T4 levels.
Human chorionic gonadotropin released by the syncytiotrophoblast has a similar alpha-subunit to TSH. Can stimulate the thyroid to increase the synthesis of T4.
When foetus produces its own thyroxine excess maternal thyroxine is degraded by the placenta.

49
Q

How does pregnancy stimulate an increase in calcium and phosphorus absorption in the gut?

A

Foetus requires calcium from maternal blood supply.
Free calcium in mother drops
Parathyroid glands stimulated to increase production of parathyroid hormone
Increase in 25 hydroxyvitamin D3(calcifediol)
Placenta stimulates kidney to express 1 alpha-hydroxylase
Enzyme catalyses conversion of calcifediol to calcitriol
Results in increase of calcium and phosphorus absorption in the gut.

50
Q

Why might impaired glucose metabolism cause enhanced foetal growth?

A

Insulin resistance stimulated in pregnancy by hPL/hCS
Increased glucose levels raise more due to per existing insulin resistance
Increased glucose flux across the placenta
Increase in substrates for foetal growth results in enhanced foetal growth

51
Q

What adaptations occur in MSK in pregnancy?

A

Change in centre of gravity
Stretching of abdominal muscles
Increased mobility of sacroiliac joints and pubic symphysis
Anterior tilt of pelvis

52
Q

What changes occur to influence change in centre of gravity in pregnancy?

A

Increased lordosis and kyphosis

Forward flexion of the neck.

53
Q

How might changes in MSK influence the mother in pregnancy?

A 
Change in posture
Back pain
Shoulder pain
Tension headaches
Pelvic pain
54
Q

Why might mum develop carpal tunnel syndrome in pregnancy?

A

Fluid retention can lead to compression of structures such as the median nerve

55
Q

What adaptations are seen to skin in pregnancy?

A

Spider angiomas
Palmar erythema
Chloasma
Linea nigra

56
Q

What are the 2 main symptoms of pre-eclampsia?

A

Hypertension and proteinuria

57
Q

When does pre-eclampsia occur?

A

Usually in third trimester

Resolves after delivery usually

58
Q

What are risk factors of pre-eclampsia?

A
  • Chronic or gestational HTN
  • Pre-existing renal disease
  • Diabetes (any type)
  • Obesity
  • Family history
  • First pregnancy
  • Extremes of age
  • Pre-eclampsia in prior pregnancy
  • Multiple gestation
  • IVF
59
Q

What is the pathogenesis of pre-eclampsia?

A

Impaired invasion of trophoblast into the decidual layer.
Leads to shallow invasion of the spiral arteries
Small diameter of spiral arteries cause high resistance.
Leads to hypoperfusion and ischaemia of placenta
Systemic endothelial dysfunction (vasoconstriction) in mother

60
Q

What are the maternal complications of pre-eclampsia?

A
  • Seizure (eclampsia)
  • Cerebral hemorrhage
  • Renal failure
  • Pulmonary edema
  • DIC and thrombocytopenia
  • Hepatic failure or rupture
61
Q

What are the foetal complications of pre-eclampsia?

A
  • Growth restriction
  • Oligohydramnios (low levels of amniotic fluid)
  • Placental infarct or abruption
  • Fetal distress
  • Premature delivery
  • Stillbirth

Reproduction (11 decks)

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