Basics Physiological Changes In Pregnancy Flashcards
Progesterone
Produced by corpus luteum
Prepares endometrium for implantation Decreased myometrial contractility
Human Placental Lactogen (hPL)
Produced by syncytiotrophoblast Similar to HGH, prolactin Decreases insulin sensitivity
Human Chorionic Gonadotropin (hCG)
Produced by syncytiotrophoblast Similar to LH, FSH, & TSH Maintains corpus luteum
Estradiol
Nonpregnant reproductive years Follicle Granulosa
Estriol
Pregnancy Placenta
from fetal adrenal DHEAS
Estrone
After menopause Adipose
from adrenal steroids
functions of progesterone
In early pregnancy it induces endometrial secretory changes favorable for blastocyst implantation.
In later pregnancy its function is to induce immune tolerance for the pregnancy and prevent myometrial contractions.
The functions of hCG
Maintain corpus luteum production of progesterone until the placenta can take over maintenance of the pregnancy
Regulate steroid biosynthesis in the placenta and fetal adrenal gland as well Stimulate testosterone production in the fetal male testes
If hCG levels are high
twin pregnancy, hydatidiform mole, choriocarcinoma, or embryonal carcinoma can occur
If hCG levels are low
ectopic pregnancy, threatened abortion, or missed abortion can occur
PHYSIOLOGIC CHANGES IN PREGNANCY
Striae gravidarum: “stretch marks” that develop in genetically predisposed women on the abdomen and buttocks
Spider angiomata and palmar erythema: caused by increased skin vascularity
Chadwick sign: bluish or purplish discoloration of the vagina and cervix caused by increased skin vascularity
Linea nigra: increased pigmentation of the lower abdominal midline from the pubis to the umbilicus
Chloasma: blotchy pigmentation of the nose and face
murmur along the left sternal border is normal in pregnancy
systolic ejection murmur
murmurs are never normal in pregnancy and must be investigated.
Diastolic murmurs
Arterial blood pressure in pregnancy
Systolic and diastolic values both decline early in the first trimester, reaching a nadir by 24–28 weeks and then gradually rising toward term (but never returning quite to prepregnancy baseline). Diastolic falls more than systolic, as much as 15 mm Hg. Arterial blood pressure is never normally elevated in pregnancy.
Central venous pressure (CVP) in pregnancy
unchanged with pregnancy
femoral venous pressure (FVP) in pregnancy
increases two- to threefold by 30 weeks’ gestation.
Plasma volume in pregnancy
Plasma volume increases up to 50% with a significant increase by the first trimester. Maximum increase is by 30 weeks. This increase is even greater with multiple fetuse
Systemic vascular resistance (SVR) in pregnancy
SVR equals blood pressure (BP) divided by cardiac output (CO). Because BP decreases and CO increases, SVR declines by 30%, reaching its nadir by 20 weeks. This enhances uteroplacental perfusion.
Cardiac output (CO) in pregnancy
CO increases up to 50%, with the major increase by 20 weeks. CO is the product of heart rate (HR) and stroke volume (SV), and both increase in pregnancy. HR increases by 20 beats/min by the third trimester. SV increases by 30% by the end of the first trimester
CO (cardiac output )is lowest in if mother is in position?
CO is lowest in the supine position because of inferior vena cava compression resulting in decreased cardiac return.
Cardiac output is highest in position ?
CO is highest in the left lateral position.
Red blood cell (RBC) mass
increases by 30% in pregnancy; thus, oxygen- carrying capacity increases. However, because plasma volume increases by 50% the calculated hemoglobin and hematocrit values decrease by 15%. The nadir of the hemoglobin value is at 28–30 weeks’ gestation. This is a physiologic dilutional effect, not a manifestation of anemia.
hemoglobin and hematocrit values in pregnancy
Red blood cell (RBC) mass increases by 30% in pregnancy; thus, oxygen- carrying capacity increases. However, because plasma volume increases by 50% the calculated hemoglobin and hematocrit values decrease by 15%. The nadir of the hemoglobin value is at 28–30 weeks’ gestation. This is a physiologic dilutional effect, not a manifestation of anemia
White blood cell (WBC) count
White blood cell (WBC) count increases progressively during pregnancy, with a mean value of up to 16,000/mm3 in the third trimester.
Erythrocyte sedimentation rate (ESR)
Erythrocyte sedimentation rate (ESR) increases in pregnancy because of the increase in gamma globulins.
Platelet count in pregnancy
Platelet count normal reference range is unchanged in pregnancy.
Coagulation factors in pregnancy
Coagulation factors: Factors V, VII, VIII, IX, XII, and von Willebrand factor increase progressively in pregnancy, leading to a hypercoagulable state.
Stomach changes in pregnancy
Gastric motility decreases and emptying time increases from the progesterone effect on smooth muscle. This increase in stomach residual volume, along with upward displacement of intraabdominal contents by the gravid uterus, predisposes to aspiration pneumonia with general anesthesia at delivery.
Large bowe changes in pregnancy
Colonic motility decreases and transit time increases from the progesterone effect on smooth muscle. This predisposes to increased colonic fluid absorption, resulting in constipation.
Tidal volume in pregnancy
Tidal volume (Vt), the volume of air that moves in and out of the lungs at rest, increases with pregnancy to 40%. It is the only lung volume that does not decrease with pregnancy.
Minute ventilation in pregnancy
Minute ventilation (V̇e) increases up to 40% with the major increase by 20 weeks. V̇e is the product of respiratory rate (RR) and Vt. RR remains unchanged, with Vt increasing steadily throughout the pregnancy into the third trimester.
Residual volume in pregnancy
Residual volume (RV), the volume of air trapped in the lungs after deepest expiration, decreases up to 20% by the third trimester. This is largely due to the upward displacement of intraabdominal contents against the diaphragm by the gravid uterus.
Blood gases: ABG CHANGES PREGNANACY
Blood gases: The rise in Vt produces a respiratory alkalosis, with a decrease in Pco2 from 40 to 30 mm Hg and an increase in pH from 7.40 to 7.45. An increased renal loss of bicarbonate helps compensate, resulting in an alkalotic urine.
Kidney six ear in pregnancy ?
The kidneys increase in size 1.5 cm because of the increase in renal blood flow; this hypertrophy does not reverse until three months postpartum.
Ureteral diameter in pregnancy
Ureteral diameter increases owing to the progesterone effect on smooth muscle; the right side dilates more than the left in 90% of patients.
Which of the ureter left or right have highest chances of pyleonphritis
Right because it’s dilated more during pregnancy
Renal plasma flow, GFR, CREATINE CLEARNECE RATE INCREASE OR DECREASE
Increased
BUN , creatinine, Uric acid in pregnancy increases or decrease
Decreased as in pregnancy mother kidney filter more which causes reduced excretion
Urine glucose during pregnancy increase or decreased
Urine glucose normally increases; glucose is freely filtered and actively reabsorbed, although the tubal reabsorption threshold falls from 195 to 155 mg/dL.
Urine protein remains
Urine protein remains unchanged.
Pituitary size in pregnancy
Pituitary size increases up to threefold due to lactotroph hyperplasia and hypertrophy, making it susceptible to ischemic injury (Sheehan syndrome) from postpartum hypotension.
(Sheehan syndrome)
Pituitary size increases up to threefold due to lactotroph hyperplasia and hypertrophy, making it susceptible to ischemic injury (Sheehan syndrome) from postpartum hypotension.
Adrenal gland size
Adrenal gland size is unchanged, but production of cortisol increases two- to threefold.
Cortisol level during pregnancy
Adrenal gland size is unchanged, but production of cortisol increases two- to threefold.
Thyroid size in pregnancy
Thyroid size remains unchanged; thyroid binding globulin (TBG) increases, resulting in increased total T3 and T4 (although free T3 and free T4 remain unchanged).
thyroid binding globulin (TBG) in pregnancy
Thyroid size remains unchanged; thyroid binding globulin (TBG) increases, resulting in increased total T3 and T4 (although free T3 and free T4 remain unchanged).
Total T3 and T4 in pregnancy
Thyroid size remains unchanged; thyroid binding globulin (TBG) increases, resulting in increased total T3 and T4 (although free T3 and free T4 remain unchanged).
Free T3 and T4 in pregnancy
Thyroid size remains unchanged; thyroid binding globulin (TBG) increases, resulting in increased total T3 and T4 (although free T3 and free T4 remain unchanged).
TSH LEVEL IN PREGNANCY
Thyroid size remains unchanged; thyroid binding globulin (TBG) increases, resulting in increased total T3 and T4 (although free T3 and free T4 remain unchanged). So TSH level remains unchanged
