CC Pregnancy (Reece)

Question 1

Since it makes since that BV increases during pregnancy, use this to explain changes to cardiac PE, BP, and CO.

Answer 1

PE: murmurs everywhere
BP: drops due to increase TPR
CO: increases to a plateau (32 wks)

Question 2

Explain the increase in CO during labor

Answer 2

The blood that was pooling in the placenta goes through contractions
Returns to the heart
Increased BV transient - higher CO

Question 3

Why do pregnant women get edema?

Answer 3

↑Prorgsterone = relax vasc SM

Fluid into extremities: ↑venous pressure + ↓plasma oncotic pressure

Question 4

Changes to coag factors during preg - effects on PTT/PT

Answer 4

↑ factors 1 7 8 9 10
Pregnancy is a hypercoag state
BUT PTT/PT normal

Question 5

How do you manage wedge pressure (pulm) during deliviery if mom has mitral vs aortic stenosis?

Answer 5

MS: ↓wedge b/c expecting increase in blood return during preg
AS: ↑wedge to prevent downstream hemorrhage

Question 6

What change in resp physiology causes some preggo women to feel SOB?

Answer 6

↓Exp reserve volume -> ↓residual volume

Question 7

pH change during peggo

Answer 7

pH same!!

But to do this ↓PCO2 + ↓bicarb

Question 8

Changes to urine in pregnancy

Answer 8

Proteinuria - transient for preggo only

BUT if you had some underlying proteinuria, preg will make it worse (↑U protein faster)

Question 9

What heart issue is a CI to pregnancy?

Answer 9

CAD esp w/ diabetes
All the other worries: HTN, existing diabetes, retinopathy, nephropathy - can be managed
Ideally you’re bypassing pre-preg b/c no way you’re doing it during preg

Question 10

What is the teratogen in diabetes?

Answer 10

Hyperglycemia in setting of pre-existing T1 or 2 (not gestational) - control this, fix the problem
Membrane damage - free radical events to try to increase glucose metabolism
↑Apoptotic cascade (caspase)
Think big birth defects (neural tube)

Question 11

Why don’t you want to get gestational diabetes for your kid?

Answer 11

Higher risk childhood obesity

Question 12

Is transient hyper or hypothyroidism normal in preggo?

Answer 12

Hyper

More protein - binds more TH - but you need to keep the same active amount

Question 13

How do you treat a preggo woman with hyperthyroidism?

Answer 13

Goal in preggo is not to normalize blood values for T3/4
B/c any changes to meds from mom’s thryoid will affect baby’s normal thyroid (no T lowering meds)
Treat the symptoms of hyperT