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Gyncology > changes during pregnency > Flashcards

changes during pregnency Flashcards

1
Q

what the cause of the changes during pregnency ?

A

because both of the coprus lutem and the placenta secreting hormones and growth factors into maternal corculation that trigger the cascade of event .

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2
Q

why there is changes during pregnancy ?

and when the most physiological changes happen in which trimester?

A

to prepare the mother to support the fetal growth

most of changes completed in the first trimester

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3
Q

when the women think that she’s pregnant ?

A

when cessation of the menstural cycle after 6 weeks بعني بعد شهر وشوي
and the mornig sickness begin in 6-12th week

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4
Q

after implantation of the fetus there is sort of maternal adabtation happened based on what ?

A

1- increase the precusor of hormones production and fetal placental metabolism —- to increase the diet intake as glucose

2- incraese the transport–increase the CO
3- increase thr exchanges between the fetus and the mother —-
4- the removal of waste product

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5
Q

what’re htte waste product of the fetus ?

A

CO2
heat
metabolic by product

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6
Q

what’s happen to the maternal blood volume ?
why?
when ?

A

the volume of the blood will expand to allow adequate perfusion of the organ

the rapid expansion happen 6-8 weeks and plateau is 32-34

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7
Q

how much the extarcellilar expation ?

A

it between 8-10 kg of the average of maternal weight gain

water increase 6.5-8.5 by end of pregnancy

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8
Q

what’s happen if the plasma volume increased?

A

leads to increase the renal perfusion and cardic output and also result in physiological anaemia

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9
Q

the fetus tissue needs large proportion of the sodium ?

A

by Angiotensin-renin mechanism

and antidiruttic hormones oppose the natriurtic factor

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10
Q

what happen ro plasma osmolarity ?

A

it decreases by 10 mOsmole /kg if non - pregnent she will have diruesis but the pregnant lady apear to tolerate this

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11
Q

oncotic and osmotic pressure will..

A

decresae
oncotic depond on the albumin
while the osmotic depond on the fluid which pass through the capillaries

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12
Q

what’s the cause of fluid retention ?

الرجل المورمه

A

1-na retention because of AR mechanism and Anti dirutic

2-decrease the oncotic pressure and osmotic
3- thirst thershold decrease

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13
Q

whats happen to the fallowing ?

  • heamatocrite
  • hemoglobin
  • serum albumin
  • strok voulme
  • renal blood flow
A
  • decrese heamatocrite
  • decreases hemoglobin
  • decreases serum albumin
  • increase strok voulme
  • increase renal blood flo
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14
Q

why pregnant ladygiven iron supplements ?

A

because of increse the plasma volume and the RBC s mass will also increase
and the store iron will transport to the fetus and lead to physiological anemia
orherwise the iron store will be depleted

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15
Q

why do we give folic acid to the pregnent lady ?

A

because of the increase in the clearance of the folate clearances

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16
Q

what happened to the platelets during the pregnency ?

A

it remains stable during pregnancy but it lower that the non pregnant lady
لان اذا زادت راح تؤدي مشاكل تخثريه

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17
Q

what happen to the coagulation factors ?

  • antithrombin 3
  • von willbrand factor which careies factor 8
A

the colagulation factor which 1978 and Factor12 and( x50 fibrinogen )increases during pregnancy and return to normal level 4 weeks after delivery.

anitthrombin unchange
von willbrank factor increases

protein s decrese
protein C increase

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18
Q

whats the things that increase and decrease during pregnancy ?

A

Hg and hematocrit folate and uric acid urea and creatinine and protein s decrease

ESR ,fibrinogen , coagulation factors1987 ,protein c , d-dimer and alkaline phosphate increase

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19
Q

whats happen to the immune system and why ?

A

-it decreases to permit the implantation to fetus allograft due to the reduce of the cytotoxic T cells
-while B cells unaltered
-NK cells increase in early pregnancy and decrease in the late gestation
-but the white blood cells don’t show dilutional decrease
unlike the race the WBCs increase in the 3rd trimester

20
Q

whats happen to the pregnant brain?

A
  • lack of estrogen and increase the oxytocin which have amnesia effect in the late and early gestation
  • progesterone will have the sedative effect and increase the metabolism
  • more sensitive to the anesthesia
  • more sensitive to the pain because increase the level of the endorphin and activity of the opiate receptor increases
21
Q

why the maternal RBCs will have mich of 2,3diphosphoglycerate ?

A

because these 2,3DPG will bind with deoxygenated hemoglobin and cause the releaee of the O2 and make the curve shifted to the righ
( so that mother transport O2 to the fetus by placenta)

and because fetus has hemoglobinF with 2 beta chain will have hight affenth to O2 so the curve shift to the left
( by this way the fetus will cuaght more oxygen from the fetus )

22
Q

why pregnant lady have respiratory alkalosis?

A

because of progestron stumulate the respiration and lead to decrease the PO2

23
Q

what the prevented mechanism of the respiratory alkalosis ?

A

it’s the activity of the carbonic anhydrase enzyme that convert the carbonic acid ito the carbonate and releasing of H+ to restore the ph and the kidney execreted the bicarbonate

24
Q

how the thoracic cavity thange?

A

the progestron incrase the ventilations and the uterus will push the diphram 4cm up and the lower cagrib will expand 5cm

all ventilations increase the residual decrease

25
Q

whats happen to the cardic output during the pregnancy ?

A

the cardic output increase 5th week of gestation due to the increase of the heart rate and the stroke volume

the increase of cardic output is associated withe decrease in the peripheral vascular resistance

cardic output will increase during delivery but it fall 2 weeks after the delivery

26
Q

why CO increase during the delivery ?

A

because of auto transfusion by the utrine contarction 400-500ml of blood will sequeezes from the uterus to the maternal circulation

27
Q

does the palptation and the ectopic beats and and sinuses tachycardia is normal?

A

yes

28
Q

what the parameters that didn’t change during the pregnancy ?

A

1- mean right arterial pressure

2- jagular venous pressure

29
Q

what’s happen to the fallowings pressure during the pregnancy:

  • diastolic pressure
  • mean arterial pressure
  • periphral resistance
A

all will decrease

30
Q

why the pregnant lady suffering from reflex and conctepation ?

A

progestron relax the muscles and so decrese thre gastric emptying and induce the placenta to secret the gastrin

so pregnant lady have hight risk of acid aspiration during the anesthesia and sedation

31
Q

why the alkaline phosphate increases during pregnancy ?

A

because both of placenat and fetus produce it .

32
Q

what the most imporatant changes of the liver during the pregnancy ?

A

he liver start to produce large quantities of the fibrinogen and cloting factor 1987

33
Q

what happen to the cholesterols level ?

A

it increases 50 % in the 3 rd pregnancy then fall after delivery

34
Q

how the structure of the kidney change during the pregnancy ?

A

kidney will enlarge in size by 1-2cm

and the ureter and the pelvis will dilated

35
Q

why some pregnant women have stasis or hydronephosis on the right side

*hydronephrosis means is the swelling of a kidney due to a build-up of urine. It happens when urine cannot drain out from the kidney to the bladder

A

because of the dextrorotation of the uterus so pregnant women will liable to UTI

36
Q

Why the pregnant more liable to UTI?

A

because the dextrorotation of the uterus that cause hydronephrosis and stasis of the right side of the uterus

37
Q

what happen to the GFR during the pregnancy ?

A

GFR will raise in the end of the 1st trimester by 50% where the renal blood flow increase in the 2nd trimester

then on the 3rd trimester the GFR will decrease by 20%

38
Q

why happen to the creatinine and urea and sodium

A

the creatinine and urea increase the clearance so decrease their serum level > while the sodium is balanced maintained

39
Q

Is glycosuria normal during pregnancy?

A

yes, its because it might related to increase in the GFR rate

40
Q

Ia the urine of the pregnant lady alkaline or acid ?

A

alkaline

41
Q

what happen to the uterus during pregnancy ?

A

the uterus enlarge and become globular in shape
and because of E&P it will lead to hyperplasia and hypertrophy of myometrium (change from 50g to 1kg)

increase the uterine blood flow X40
and hypertrophy of the BV

42
Q

where the site of C section ?

A

its in the uterovesical pouch

43
Q

what happen to the thyroid hormone ?

A

because the HCG having homology with TSH so the maternal TSH will suppressed

but because of thyroid binding globulin is increase the T3&T4 increase its production

44
Q

why some pregnant women having enlarge thyroid gland ?

A

because of iodine deficiency because the iodine is needed to synthesize the thyroid hormone

45
Q 
what happen to the fallowing endocrine system:-
1- prolactin 
2-corticosteroid 
 3-human growth factor 
4-TSH in early gestation 
5- T4 in late pregnancy
A

1&2 will increase
3 surpassed
4&5 decrease

46
Q

why there is insulin resistance during pregnancy

A

because of the level of estrogen and cortisol and placental lactogen

Gyncology (15 decks)

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