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Midwifery Year 1 MCQ > Adaptation to Pregnancy > Flashcards

Adaptation to Pregnancy Flashcards

1
Q

What is decidualisation?

A

A process that results in significant changes to cells of the endometrium, including morphological and functional changes to endometrial stromal cells, including vascular changes to maternal arteries

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2
Q

Which hormones promote decidualisation?

A

Progesterone and oestrogen (produced by the corpus luteum initially, and then the placenta)

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3
Q

Enlargement of the uterus happens in three stages; what are they?

A

Hyperplasia (an increase in the number of cells), hypertrophy (Increase in the size of the cells) and stretch.

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4
Q

What are the dimensions and weight of the uterus when it is not pregnant?

A

7.5 x 5 x 2.5cms, and 50-80g.

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5
Q

What are the dimensions, weight and capacity of the uterus at term?

A

30 x 22 x 20cms, 1000g, and approx. 5 litre capacity.

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6
Q

The myometrium has three distinct layers; what are they?

A

The inner circular, middle oblique (or spiral) and outer longitudinal layers.

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7
Q

Which myometrial layer plays an important function in homeostasis following the birth of the placenta?

A

The middle oblique layer.

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8
Q

When blood flows to the uterus in labour, what percentage perfuses the placenta, and what percentage perfuses the myometrium?

A

80% perfuses the placenta, 20% perfuses the myometrium.

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9
Q

By what percentage does the heart enlarge by during pregnancy?

A

12%

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10
Q

What causes distension of the heart chambers during pregnancy?

A

Distension is partly due to myometrial hypertrophy, but mostly due to diastolic filling in parallel with increasing blood volume.

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11
Q

How early can physiological systolic/diastolic murmurs be detected?

A

12 weeks.

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12
Q

The cardiovascular load increases rapidly in the first trimester. What is the average increase in heart rate and stroke volume?

A

The heart rate increases by approx. 15bpm, and stroke volume increases to about 30% above baseline levels.

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13
Q

When does cardiac output peak?

A

By the end of the second trimester.

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14
Q

What would you expect a woman’s hear rate to be when non-pregnant, 20 weeks pregnant and at term?

A

Non-pregnant = 70bpm
20 weeks pregnant = 78bpm
Term = 85bpm

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15
Q

What term is used to describe an increase in total blood volume?

A

Hypervolaemia.

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16
Q

Total blood volume increases by what percentage in singleton pregnancies?

A

30-50%.

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17
Q

When is the earliest that an increase in total blood volume will start to be seen during pregnancy?

A

6 weeks.

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18
Q

By what percentage does plasma increase during pregnancy?

A

50%.

19
Q

Plasma volume increase is related to the weight of the baby, and whether it is a multiple pregnancy: true or false?

A

True

20
Q

At how many weeks of pregnancy is an optimal blood volume achieved?

A

32 weeks.

21
Q

Why is an increased plasma volume physiologically advantageous during pregnancy?

A

It reduces the viscosity of blood, therefore improving capillary flow and placental perfusion.

22
Q

Red cell volume increases during pregnancy by what percentage?

A

18-20%.

23
Q

A disproportionate increase in red blood cell volume to plasma volume causes what?

A

Haemodilution: the physiological anaemia of pregnancy.

24
Q

Define cardiac output.

A

Cardiac output = stroke volume x heart rate.

25
Q

What three factors affect blood pressure?

A

Cardiac output, blood viscosity and total peripheral resistance.

26
Q

How does blood pressure change during pregnancy?

A

There is little change in systolic pressure. Diastolic pressure falls markedly, reaching its lowest point at mid-pregnancy, rising to non-pregnancy levels by term.

27
Q

What is the mean increase in blood pressure associated with uterine contractions?

A

10mmHg

28
Q

What causes varicose veins?

A

Poor venous return and increased venous pressure in the lower limbs contributes to increased distensibility of the veins and increased pooling of blood.

29
Q

Women are in a hypocoagulable state during normal pregnancy: true or false?

A

False. Women are in a hypercoagulable state during normal pregnancy.

30
Q

An increased tendency to clot during pregnancy is caused by multiple factors. List four of them.

A
  1. There is reduced plasma fibrinolytic activity.
  2. There is an increase in plasma fibrinogen concentration.
  3. Coagulation factors VII, VIII and X are increased.
  4. There is a decrease in some endogenous anticoagulants.
31
Q

Hypercoagulability, combined with a physiological vasodilation during pregnancy, contributes to a sixfold increase in the risk of what?

A

Thromboembolism.

32
Q

How does an increased cardiac output affect the respiratory system during pregnancy?

A

It increases pulmonary blood flow.

33
Q

What percentage of pregnant women experience dyspnoea?

A

70%

34
Q

The enlarging uterus displaces the diaphragm by how many centimetres?

A

4cm

35
Q

Displacement of the diaphragm and rib cage decreases the total lung capacity by how much?

A

5%

36
Q

How do the kidneys change during pregnancy?

A

They increase in weight and lengthen by 1cm.

37
Q

What effect does progesterone have on the urinary system?

A

Progesterone dilates the calyces and renal pelvis, and affects the smooth muscle in the ureters, altering their shape.

38
Q

What is vesicoureteral reflex?

A

Urine flowing in the wrong direction.

39
Q

How can pregnancy cause vesicoureteral reflex?

A

The enlarged uterus can compress the ureters at the pelvic brim, and displace them at their junction with the bladder.

40
Q

The enlarging uterus displaces the stomach; what effect can this have?

A

The mechanical force applied to the stomach changes the angle of the gastro-oesophageal junction, leading to greater oesophageal reflux.

41
Q

Nausea and vomiting during pregnancy have often been associated with what digestive system changes?

A

Decreased gastric tone and motility, and relaxation of the oesophageal sphincter.

42
Q

Reduced motility in the intestines during pregnancy can cause what?

A

Constipation.

43
Q

The condition of having extreme cravings is known as what?

A

Pica.

Midwifery Year 1 MCQ (10 decks)

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