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3002 > 84 Effect of pregnancy on maternal physiology > Flashcards

84 Effect of pregnancy on maternal physiology Flashcards

1
Q

Uterus grows to occupy most of the pelvis by __ weeks, palpable abdominally from __ weeks

A

Uterus grows to occupy most of the pelvis by 16 weeks, palpable abdominally from 13 weeks

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2
Q

At term the uterus reaches what level?

A

Level of the xiphoid process (thorax widens as the ribs flare to accommodate organs)

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3
Q

What happens to structures on posterior abdominal wall during pregnancy?

A

Compressed when lying down

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4
Q

Changes to centre of gravity resulting in what during pregnancy?

A

Development an accentuated lumbar lordosis

=> Backache

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5
Q

Result of relaxin release during pregnancy?

A

Causes softening of ligaments

=> Sacroiliac and pubic symphysis pain

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6
Q

Anatomical changes to mother during pregnancy?

A
  • Fist sized organ grows to occupy most of the pelvis by 16 weeks, palpable abdominally from 13 weeks
  • At term uterus reaches the level of the xyphoid process (thorax widens as the ribs flare to accommodate organs)
  • Compression of structures on the posterior abdominal wall especially when lying down
  • Changes centre of gravity develop an accentuated lumbar lordosis. Leads to –> Backache
  • Relaxin causes softening of ligaments. Leads to–> Sacroiliac and symphysis pubis pain
  • Weight gain averages 12.5kg
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7
Q

Cause for 12.5kg weight gain in pregnancy?

A
  • 6kg uterus, foetus and breast
  • 3kg fat reserves for lactation
  • Remainder is fluid
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8
Q

Result for pressure on IVC from foetus?

A

• Impedes venous return from LLs
• Impairs function of valves
=> Varicose veins

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9
Q

Cause for physiological anaemia in pregnancy?

A

Haematopoiesis is increased up to 30%
BUT
Increase in plasma volume (up to 50%) means that RBC count, haematocrit and haemoglobin conc are all reduced

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10
Q

Changes to WBC, platelets count and clotting factors during pregnancy?

A
  • Small increase in WBC
  • Unchanged platelet count, but more reactive
  • Increase in clotting factors with thromboembolism risk
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11
Q

Circulatory adaptations to TPR during pregnancy?

A

• Uteroplacental circulation is characterised by high volume, low resistance flow
- Due to uterine spiral arteries and arterioles inability to vasoconstrict

• Pregnancy hormones = Reduce sensitivity to pressor agents (e.g. angiotensin) to vasoconstrict. => peripheral vasodilation occurs and TPR reduces

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12
Q

Result of peripheral vasodilation in pregnancy women?

A

Heat intolerance

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13
Q

Reduced TPR triggers what?

A

Triggers the renin-angiotensin-aldosterone system increasing blood volume

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14
Q

Effect of oestrogen in maintaining normal (low) blood pressure in foetus?

A

Vasodilation:

Oestrogen increases vascular endothelial growth factor (VEGF) and NO production in endothelial cells

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15
Q

What does VEGF mean?

A

Vascular endothelial growth factor

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16
Q

What do endothelial cell release in order to help maintain the low BP in the foetus?

A

Prostacyclin (prostaglandin I2 or PGI2)

  • vasodilator
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17
Q

Changes to CO during weeks 6 -28 of pregnancy?

A

(CO = HR x SV)
Increases by 30-50%

  • Increase in HR to 80-90/min
  • Increase SV by ~ 10%
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18
Q

Which organs receive increased blood flow during pregnancy?

A

Uterus, breast and skin

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19
Q

Why is CO sensitive to posture during late pregnancy?

A
  • Can fall because of IVC obstruction by uterus

* Resulting in hypotension/fainting when lying flat

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20
Q

At which point does the CO return to pre-pregnancy condition postpartum?

A

By 6 weeks

21
Q

How is BP measured in pregnant women?

A

Measured semi-recumbent using Korotkoff phase 5 for diastolic

Related to changes in circulating plasma volume and peripheral resistance

22
Q

Changes toBP in second trimester?

A

BP normally falls in second trimester

  • Systolic falls ~5-10mmHg
  • Diastolic falls ~10-15mmHg
23
Q

What is pre-eclampsia?

A

Placental problem involving an increase in BP,

proteinuria and oedema

24
Q

Potential cause for pre-eclampsia?

A

May involve failure of the 2nd wave of trophoblast invasion that normally impairs the capacity of maternal spiral arterioles to constrict (12-16 weeks)

25
Q

Consequences of pre-eclapsia?

A

• Poor placental perfusion can cause foetal growth
restriction

• Increased vascular resistance in placenta causes:
– Decreased blood to placenta
– Hypertension in mother
– Renal arteriolar endothelial damage causes oedema, glomerular damage and proteinuria (‘acute atherosis’)

26
Q

What is eclampsia?

A 
Extreme hypertension (e.g. 180/120)
• Increased intracranial pressure, seizures, coma 
• Significant risk of cerebral haemorrhage
27
Q

Maternal mortality of eclampsia?

A

~ 8-36%

28
Q

Interventions to treat eclampsia?

A
  • Magnesium sulphate
  • Antihypertensives
  • Rapid delivery
  • Careful fluid balance
29
Q

Changes to respiratory system in mother during pregnancy?

A 
• Progesterone increases sensitivity of central CO2 receptors
• More ventilation
• Increase in tidal
volume by ~ 40%
• Ventilation rate unchanged
30
Q

Changes to renal system during pregnancy?

A
  • Kidneys deal with foetal urea => increased renal function
  • Increased glomerular filtration rate (GFR), as a result of increased CO, by ~30-50%
  • Decreased plasma urea, creatinine and uric acid
  • Bladder is compressed leading to frequent and urgent urination
  • Ureters are dilated that can predispose to infection
31
Q

Why is uric acid the most useful renal marker in pregnancy?

A

It rises before creatinine in response to renal impairment (e.g. pre-eclampsia)

32
Q

Changes to total body water (TBW) during pregnancy?

A

TBW increases by ~6-8L

• Extracellular fluid (ECF) increases by ~3L, split between
plasma and interstitial fluid (ISF)

33
Q

Changes to osmolality during pregnancy? Why?

A

Osmolality falls by ~10 mOsm/kg

• Decreased urea and creatinine

34
Q

3 main changes to GI system in pregnant women?

A
  1. Morning sickness, nausea/ vomiting - esp. first 12-14 wks
  2. Constipation
  3. Gastric acid reflux, heartburn
35
Q

Cause for morning sickness?

A
  • Parallels HCG levels

* Worse in multiple pregnancy & hydatidiform mole

36
Q

Cause of constipation in pregnant women?

A
  • Pressure of uterus on rectum and lower colon

* Decreased motility, progestogenic effect on smooth muscle

37
Q

Cause for gastric acid reflux in pregnant women?

A
  • Relaxation of lower oesophageal sphincter
  • Relaxation of GI smooth muscle (progestogenic effect)
  • Pressure of uterus
  • Worse lying down
  • Aspiration risk during endotracheal intubation
38
Q

What are the nutritional requirements of a pregnant women?

A 
• Weight gain at term is ~7-14kg
– Foetus 3.5kg
– Placenta and amniotic fluid 1.5kg
– Increased breast tissue 0.5-1kg
– The rest is fat and extracellular fluid (ECF)
  • Daily calorific requirement increases by ~15%
  • 200-300 kcal/day
39
Q

What happens in early pregnancy?

A
  • Rate of growth of foetus relatively slow to 20 weeks
  • ~3kg fat laid down to provide energy source for final trimester when growth is very rapid
  • Maternal tissues more sensitive to insulin in early stages of pregnancy
  • Increased protein synthesis
40
Q

When does growth of foetus peak?

A

Between 30-36 weeks

41
Q

What happens in later pregnancy?

A
  • Relative insulin resistance, predisposing to ‘high-normal’ glucose levels
  • Increased lipolysis supplying mother with source of energy
  • Increase in circulating triglycerides stored in mammary tissue
  • Increased requirement for protein
42
Q 
Gestational diabetes:
• Spectrum?
• Risk factors?
• Predictor for?
• Associations?
A

• Spectrum from normal to ‘impaired glucose tolerance’ to actual diabetes
• Risk factors:
– Race
– Obesity
– Family history
• Can be a predictor of future type 2 diabetes
• Associated with foetal macrosomia (increased insulin resistance; high glucose) and complications

43
Q

Vitamin requirements of pregnant women?

A
  • Folic acid needed for neural tube fusion (pre-conception)
  • Vegetarians may need to increase B12 intake
  • High levels of vit A may lead to foetal abnormalities
  • Vit D supplementation is recommended
44
Q

Mineral requirements of pregnant women?

A

Calcium;
• Maternal gut absorption increases
• Active transport across the placenta
• Increase in release from maternal bone

45
Q

Role of zinc in pregnancy?

A
  • Important role in many metabolic processes
  • Protein synthesis
  • Nucleic acid synthesis
  • Synthesis/activity of insulin
  • Increased dietary need, especially in vegans
46
Q

Role of iron in pregnancy?

A
  • Globally, high incidence of maternal iron deficiency
  • If dietary iron low, may need supplements
  • Supplementation with normal iron stores is undesirable, may increase oxidative stress
47
Q

Placenta secretions?

A
  • hCG has key role in maintaining pregnancy

* Other placental proteins and steroids

48
Q

Endocrine secretions from the mother?

A
  • Increased growth hormone release
  • Decreased FSH and LH
  • Increased prolactin
  • Increased parathyroid hormone
  • Pituitary increases in size (production of prolactin and ACTH and oxytocin)
  • Thyroid increases in size due to hCG (similar in structure to TSH)
49
Q

Postnatal changes to mother?

A

• Uterine involution complete by 6 weeks
• Amenorrhoea if breast feeding
– Duration related to frequency and duration of suckling
– May be associated with hot flushes and vaginal dryness
• Systemic changes largely reversed by 6 weeks
– Coagulation system changes may take longer
– Glucose tolerance normalises very rapidly

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