Basics Physiological Changes In Pregnancy

Question 1

Progesterone

Answer 1

Produced by corpus luteum

Prepares endometrium for implantation Decreased myometrial contractility

Question 2

Human Placental Lactogen (hPL)

Answer 2

Produced by syncytiotrophoblast Similar to HGH, prolactin Decreases insulin sensitivity

Question 3

Human Chorionic Gonadotropin (hCG)

Answer 3

Produced by syncytiotrophoblast Similar to LH, FSH, & TSH Maintains corpus luteum

Question 4

Estradiol

Answer 4

Nonpregnant reproductive years Follicle Granulosa

Question 5

Estriol

Answer 5

Pregnancy Placenta

from fetal adrenal DHEAS

Question 6

Estrone

Answer 6

After menopause Adipose

from adrenal steroids

Question 7

functions of progesterone

Answer 7

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.

Question 8

The functions of hCG

Answer 8

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

Question 9

If hCG levels are high

Answer 9

twin pregnancy, hydatidiform mole, choriocarcinoma, or embryonal carcinoma can occur

Question 10

If hCG levels are low

Answer 10

ectopic pregnancy, threatened abortion, or missed abortion can occur

Question 11

PHYSIOLOGIC CHANGES IN PREGNANCY

Answer 11

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

Question 12

murmur along the left sternal border is normal in pregnancy

Answer 12

systolic ejection murmur

Question 13

murmurs are never normal in pregnancy and must be investigated.

Answer 13

Diastolic murmurs

Question 14

Arterial blood pressure in pregnancy

Answer 14

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.

Question 15

Central venous pressure (CVP) in pregnancy

Answer 15

unchanged with pregnancy

Question 16

femoral venous pressure (FVP) in pregnancy

Answer 16

increases two- to threefold by 30 weeks’ gestation.

Question 17

Plasma volume in pregnancy

Answer 17

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

Question 18

Systemic vascular resistance (SVR) in pregnancy

Answer 18

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.

Question 19

Cardiac output (CO) in pregnancy

Answer 19

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

Question 20

CO (cardiac output )is lowest in if mother is in position?

Answer 20

CO is lowest in the supine position because of inferior vena cava compression resulting in decreased cardiac return.

Question 21

Cardiac output is highest in position ?

Answer 21

CO is highest in the left lateral position.

Question 22

Red blood cell (RBC) mass

Answer 22

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.

Question 23

hemoglobin and hematocrit values in pregnancy

Answer 23

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

Question 24

White blood cell (WBC) count

Answer 24

White blood cell (WBC) count increases progressively during pregnancy, with a mean value of up to 16,000/mm3 in the third trimester.

Question 25

Erythrocyte sedimentation rate (ESR)

Answer 25

Erythrocyte sedimentation rate (ESR) increases in pregnancy because of the increase in gamma globulins.

Question 26

Platelet count in pregnancy

Answer 26

Platelet count normal reference range is unchanged in pregnancy.

Question 27

Coagulation factors in pregnancy

Answer 27

Coagulation factors: Factors V, VII, VIII, IX, XII, and von Willebrand factor increase progressively in pregnancy, leading to a hypercoagulable state.

Question 28

Stomach changes in pregnancy

Answer 28

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.

Question 29

Large bowe changes in pregnancy

Answer 29

Colonic motility decreases and transit time increases from the progesterone effect on smooth muscle. This predisposes to increased colonic fluid absorption, resulting in constipation.

Question 30

Tidal volume in pregnancy

Answer 30

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.

Question 31

Minute ventilation in pregnancy

Answer 31

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.

Question 32

Residual volume in pregnancy

Answer 32

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.

Question 33

Blood gases: ABG CHANGES PREGNANACY

Answer 33

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.

Question 34

Kidney six ear in pregnancy ?

Answer 34

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.

Question 35

Ureteral diameter in pregnancy

Answer 35

Ureteral diameter increases owing to the progesterone effect on smooth muscle; the right side dilates more than the left in 90% of patients.

Question 36

Which of the ureter left or right have highest chances of pyleonphritis

Answer 36

Right because it’s dilated more during pregnancy

Question 37

Renal plasma flow, GFR, CREATINE CLEARNECE RATE INCREASE OR DECREASE

Answer 37

Increased

Question 38

BUN , creatinine, Uric acid in pregnancy increases or decrease

Answer 38

Decreased as in pregnancy mother kidney filter more which causes reduced excretion

Question 39

Urine glucose during pregnancy increase or decreased

Answer 39

Urine glucose normally increases; glucose is freely filtered and actively reabsorbed, although the tubal reabsorption threshold falls from 195 to 155 mg/dL.

Question 40

Urine protein remains

Answer 40

Urine protein remains unchanged.

Question 41

Pituitary size in pregnancy

Answer 41

Pituitary size increases up to threefold due to lactotroph hyperplasia and hypertrophy, making it susceptible to ischemic injury (Sheehan syndrome) from postpartum hypotension.

Question 42

(Sheehan syndrome)

Answer 42

Pituitary size increases up to threefold due to lactotroph hyperplasia and hypertrophy, making it susceptible to ischemic injury (Sheehan syndrome) from postpartum hypotension.

Question 43

Adrenal gland size

Answer 43

Adrenal gland size is unchanged, but production of cortisol increases two- to threefold.

Question 44

Cortisol level during pregnancy

Answer 44

Adrenal gland size is unchanged, but production of cortisol increases two- to threefold.

Question 45

Thyroid size in pregnancy

Answer 45

Thyroid size remains unchanged; thyroid binding globulin (TBG) increases, resulting in increased total T3 and T4 (although free T3 and free T4 remain unchanged).

Question 46

thyroid binding globulin (TBG) in pregnancy

Answer 46

Thyroid size remains unchanged; thyroid binding globulin (TBG) increases, resulting in increased total T3 and T4 (although free T3 and free T4 remain unchanged).

Question 47

Total T3 and T4 in pregnancy

Answer 47

Thyroid size remains unchanged; thyroid binding globulin (TBG) increases, resulting in increased total T3 and T4 (although free T3 and free T4 remain unchanged).

Question 48

Free T3 and T4 in pregnancy

Answer 48

Thyroid size remains unchanged; thyroid binding globulin (TBG) increases, resulting in increased total T3 and T4 (although free T3 and free T4 remain unchanged).

Question 49

TSH LEVEL IN PREGNANCY

Answer 49

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