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Repro > 8.2 Maternal problems in pregnancy (lecture) > Flashcards

8.2 Maternal problems in pregnancy (lecture) Flashcards

1
Q

what is carried out an antenatal screening?

A

history + examination
blood test
urinalysis

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2
Q

what do you check for in history + examination in antenatal screening?

A

risk factors e.g. gestational diabetes

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3
Q

what do you check for in blood tests in antenatal screening?

A
  1. blood group (mother and foetus) - blood transfusion e.g. C-section, haemorrhage
  2. haemoglobin
  3. infection
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4
Q

why do you check for maternal haemoglobin within a blood test?

A

the demand on the maternal iron store - baseline measurement of maternal haemoglobin
(check if mother has become anaemic)

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5
Q

what do you check for in urinalysis within a blood test at antenatal screening?

A

protein

baseline measurement, check of proteinuria - for pre-eclampsia

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6
Q

which systems undergo physiological changes in pregnancy?

A 
CVS
urinary
respiratory
metabolic
GI
immune
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7
Q

what are the metabolic changes that occur during pregnancies?

A

carbohydrate

thyroid hormones

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8
Q

what are the changes undergone by the CVS during pregnancies?

A

blood volume increases (CO = SV x HR)

therefore CO, SV, HR all increase

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9
Q

what are the CVS changes from the first trimester (T1)?

A

CO: increase 40%
SV: increase 35%
HR: increase 15%
(CO = SV x HR, therefore changes in CO most significant if the other 2 increase)

Systemic vascular resistance decrease 25-30%

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10
Q

why does Systemic Vascular Resistance decrease 25-30% from the first trimester (T1)?

A

release of prostaglandins causes relaxation of SM - including vascular SM

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11
Q

what are the changes to blood pressure throughout pregnancy?

A

T1 + T2: BP decrease (vascular resistance decrease - SM)

T3: BP returns to normal

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12
Q

what effects will pregnancy have on pre-load and after-load? why?

A

pregnancy will increase pre-load and after-load because of increase CO (and HR, SV)

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13
Q

what is never increased in pregnancy normally?

A

SYSTOLIC BP

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14
Q

why can pregnancy result in hypotension in T1 + T2?

A

progesterone effects on SVR

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15
Q

why can pregnancy result in hypotension in T3?

A

aortocaval compression by gravid uterus (pregnant, enlarged uterus)

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16
Q

what is aortocaval compression syndrome by gravid uterus? (resulting in hypotension in T3)

A

compression of the abdominal aorta and inferior vena cava by the gravid uterus when a pregnant woman lies on her back, i.e. in the supine position

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17
Q

function of the endothelium within pregnancy?

A

controls vascular permeability
contributes to the vascular tone

vasodilation in pregnancy

18
Q

how would endothelium in a normal pregnancy appear?

A

vasodilated (prostaglandins, vascular permeability)

plasma-expanded (increase BV)

19
Q

how does epithelium appear in pre-eclamptic pregnancy?

A

vasoconstricted

plasma-contracted

20
Q

what is pre-eclampsia?

A

pregnancy-induced hypertension in association with proteinuria (>0.3 g in 24 hours) with or without oedema. Virtually any organ system may be affected

21
Q

what can cause pre-eclampsia?

A
  1. defect in placentation
  2. poor uteroplacental circulation
  3. widespread endothelial dysfunction
22
Q

what can pre-eclampsia lead to?

A

eclampsia

seizures during pregnancy - impact mother and baby

23
Q

what are the effects of pregnancy on the urinary system?

A

GFR increases
renal plasma flow increases
filtration capacity intact
functional renal reserve decreases as GFR increases

(increase CO, therefore increase GFR (from increase in renal plasma flow))

24
Q

what is the functional renal reserve?

A

the reserve of glomerular filtration rate (GFR) and renal blood flow

25
Q

within the urinary system, which variables increase during pregnancy?

A

RPF - 60-80%
GFR - 55%
creatinine clearance - 40-50%
protein excretion: up to 300mg/24 hours

26
Q

within the urinary system, which variables decrease during pregnancy?

A

urea - 50%
uric acid - 33%, but rises with gestation (before birth)
bicarbonate: 18-22mmol/L
creatinine: 25-75 micromol/L

27
Q

what are the consequences of changes to the urinary system?

A
  1. urinary stasis:
    - progesterone effect on urinary collecting system –> hydroureter
    - obstruction
  2. UTI: pyelonephritis –> pre-term labour

(Compression of uterus on bladder (with hydroureter) can lead to hydronephrosis)

28
Q

what are the anatomical changes to the respiratory system during pregnancy?

A
  1. diaphragm displaced

2. A-P and transverse diameters of thorax increase (to compensate for the displaced diaphragm)

29
Q

what are the consequences of anatomical and physiological changes to the respiratory system?

A
  1. decreased functional residual capacity (decrease residual volume)
  2. vital capacity unchanged (largest in + out), total lung capacity ~ unchanged
  3. increased minute + alveolar ventilation
  4. increased tidal volume (resting), RR unchanged
30
Q

what are the 2 overall physiological changes to the respiratory system?

A
  1. physiological hyperventilation

2. ‘physiological’ dyspnoea (SoB)

31
Q

why does physiological hyperventilation occur?

A
  1. increased metabolic CO2 production (has to excrete foetus CO2 in maternal blood)
  2. increased respiratory drive effect of progesterone (stimulate respiration, breath off more CO2)
  3. resulting in respiratory alkalosis (high pH), compensated by increased renal bicarbonate excretion (partially)
32
Q

why does ‘physiological’ dyspnoea occur?

A

due to progesterone-driven hypERventilation

physiological SoB normal, harder to take in a large breath

33
Q

which variables increase in the respiratory system during pregnancies?

A

O2 consumption increase 20%
resting minute ventilation: 15% (ventilate more, different from RR)
tidal volume increase: resting breath breathe in more air

PaO2 results in increase

34
Q

which variables decrease in the respiratory system during pregnancies?

A

functional residual capacity in T3

PaCO2 decrease - physiological hyperventilation

35
Q

which variables remain unchanged in the respiratory system during pregnancies?

A 
respiratory rate (RR)
vital capacity (max in and out)
FEV1 (breath out in first second)
36
Q

why is vital capacity unchanged during pregnancy?

A

although pulmonary function is altered during pregnancy, it is not compromised. Therefore, in the absence of any respiratory condition (ie, asthma), does not induce any mechanical stress on the respiratory efficiency of the pregnant patient

37
Q

what are the carbohydrate metabolism changes during pregnancy?

A
  1. placental transport of glucose: facilitated diffusion (GLUT)
  2. pregnancy increases maternal peripheral insulin resistance
38
Q

why does pregnancy increase maternal peripheral insulin resistance?

A

switches to gluconeogenesis and alternative fuels e.g. fatty A
(save glucose for foetus)

39
Q

how are changes to carbohydrate metabolism achieved?

A

human placental lactogen (like growth hormone)

also prolactin, oestrogen / progesterone, cortisol

40
Q

how does blood glucose change in pregnancy?

A
  1. decrease in fasting blood glucose (to foetus)

2. increase in post-prandial blood glucose (post meal glucose - prolong in circulation for longer for foetus)

Repro (78 decks)

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