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MD3002 Physiology > Effect of Pregnancy on Maternal Physiology > Flashcards

Effect of Pregnancy on Maternal Physiology Flashcards

1
Q

How much weight do mothers gain on average during pregnancy?

A
  1. 5 kg
    - 6kg - uterus, foetus, breast
    - 3 kg fat reserves for lactation
    - Remainder is fluid
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2
Q

How can pregnancy cause varicose veins?

A

Pressure on IVC can impede venous return from lower limbs and may impair function of valves (combined with relaxation of vessels and valves via hormonal effects)

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3
Q

Why do pregnant women often need to urinate more often?

A

Weight of foetus on bladder

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4
Q

What hormone causes softening of ligaments?

A

Relaxin

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5
Q

What problems can relaxin cause?

A
  • Sacroiliac and pubic symphysis pain due to relaxig of ligaments -> increased movement of joints
  • Pregnancy related pelvic girdle pain (PGP)
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6
Q

What can happen to the abdomen during pregnancy?

A
  • Diastasis recti (rectus abdominis splits and does not join back together)
  • Striae gravidarum (stretch marks)
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7
Q

What changes can happen to the skin in pregnancy?

A
  • Linea negra
  • Melasma
  • Increased estrogen (palmer erythema, spider naevi)
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8
Q

What cardiovascular adaptations happen during pregnancy?

A
  • Blood volume increase
  • Blood composition
  • TPR decrease
  • CO increase
  • Blood pressure
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9
Q

What happens to the plasma volume in pregnancy?

A

Increases 50%

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10
Q

What happens to haemotopoiesis in pregnancy?

A

Increased by up to 30% but increase in plasma volume means that red cell count, haematocrit and haemoglobin concentration are all reduced (physiological anaemia)

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11
Q

What circulatory adaptations in blood volume and composition happen?

A
  • Small increase in WBC
  • Increased platelet production, but increased destruction so no overall change in count
  • Increased clotting factors present thromboembolism risk
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12
Q

How can pregnancy cause heat intolerance?

A

Pregnancy hormones can reduce sensitivity to pressor agents such as angiotensin, hence peripheral vasodilation (reduce TPR)

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13
Q

How can estrogen cause vasodilation?

A

Increases vascular endothelial growth factor (VEGF) and nitric oxide (NO) production in endothelial cells
- Endothelial cells release (prostaglandin I2 or PGI2)

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14
Q

How can pregnancy cause an ejection systolic murmur?

A

Reduced TPR triggers the RAAS system increasing blood volume

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15
Q

How much does CO increase in in weeks 6-28?

A

30-50%

  • HR increase from 70 to 80-80/min
  • SV by ~10%
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16
Q

When does CO return to normal?

A

6 weeks post-partum

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17
Q

How can CO be effected by posture?

A

CO can fall because of IVC obstruction by uterus resulting in hypotension/fainting when lying flat (reduced venous return)

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18
Q

What happens to the BP in the second trimester?

A

Usually falls
- Systolic: 5-10 mmHg
- Diastolic: 10-15 mmHg
(before birth rises to pre-pregnancy levels)

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19
Q

What is pre-eclampsia?

A
  • Placental problem involving an increase in BP, proteinuria, epigastric pain, brisk reflexes, head ache and oedema,
  • May involve failure of second wave of trophoblasts to invade wich normally impair the capacity of material spiral arterioles to constrict (12-16 wks)
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20
Q

How common is pre-eclampsia?

A

8% of pregnancies

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21
Q

What are the risk factors for pre-eclampsia?

A
  • Previous pregnancy with pre-eclampsia
  • > 40
  • Family histry
  • Obesity
  • Primigravida
22
Q

What can increased vsscular resistance in the placenta cause|?

A
  • Decreased blood to placenta
  • Hypertension in mother
  • Renal arteriolar damage causes oedema, glomerular damage and proteinuria (acute atherosis)
23
Q

What is the treatment for pre-eclampsia?

A
  • Only cure is delivery
  • Antihypertensives
  • Monitor
24
Q

What is eclampsia?

A
  • Seizures, coma, increased intracranial pressure
  • Significant risk of cerebral haemorrhage
  • Extreme hypertension (eg 180/120)
25
Q

What is the maternal mortality rate of eclampsia?

A

8-36%

26
Q

What interventions can be done to treat eclampsia?

A
  • Magnesium sulphate (vasodilator)
  • Antihypertensives
  • Rapid delivery
  • Careful fluid balance
27
Q

How is the respiratory system effected by pregnancy?

A
  • Progesterone increases sensitivity of central CO2 receptors
  • More ventilation
  • Increase tidal volume ~ 40%
  • Ventilation rate unchanged
28
Q

How is the renal system affected by pregnancy?

A
  • Increased urea (from foetus), increased renal function
  • Increased GFR as a result of increased CO
  • Decreased plamsa, urea, creatinine and uric acid
29
Q

What is the most useful renal marker during pregnancy?

A

Uric acid as it rises before creatinine in response to renal impairment (e.g. pre-eclampsia)

30
Q

How can ureters be affected by pregnancy?

A

Can be dilated which can predispose to infection

31
Q

When is morning sickness most frequent?

A

first 12-14 weeks

32
Q

What is thought to be the cause of morning sickness?

A

HCG levels increase (can be due to twins or hyaditiform mole)

33
Q

What is thought to be the cause of constipation during pregnancy?

A
  • Pressure of uretus on rectum and lower colon

- Decreased motility, progesterone effect on smooth muscle

34
Q

What is GAstric acid reflux thought to be due to during pregnancy?

A
  • Relaxation of lower esophageal sphincter
  • Relaxation of GI SM (progesterone)
  • Pressure of uretus
  • Worse lying down
  • Aspiration risk during endotracheal intubation
35
Q

How much does daily calorific requirment increase by during pregnancy?

A

~ 15% (200-300 kcal)

36
Q

How much fat is laid down in 1st trimester to provide energy for later when growth of foetus is very rapid?

A

~ 3 kg

37
Q

What stages of pregnancy are maternal tissues more sensitive to insulin?

A

Early stages (increased protein synthesis)

38
Q

When does the growth rate of foetus peak?

A

30 - 36 weeks

39
Q

What happens metabolically later in pregnancy?

A
  • Relative insulin resistance predisposing to ‘high-normal’ glucose levels
  • Increased lipolysis supplying mother with source of energy
  • Increase in circulating triglycerides stored in mammary tissues
  • Increased requirement for protein
40
Q

What are the risk factors for gestational diabetes?

A
  • Race (black)
  • Obesity
  • FH
41
Q

What is gestational diabetes a precursor for?

A

Can be a precursor for actual type 2 diabetes

42
Q

What is gestational diabetes associated with?

A

Foetal macrosomia (increased inulin resistance, high glucose) complications

43
Q

What are the vitamin and mineral requirments for pregnant women?

A

Vitamins

  • Folic acid for neural tube fusion (pre-conception)
  • Vegetarians may need to increase B12 intake
  • High levels of vit A may lead to foetal abnormalities
  • Vit D supplementation is recommended
Minerals 
- Calcium: 
Maternal gut absorption increases 
Active transport across lacenta 
Increase in release from maternal bone

Zinc + Iron

44
Q

What does zinc help with in pregnancy ?

A
  • Important in many metabolic processes
  • Protein synthesis
  • Nucleic acid synthesis
  • Synthesis/activity of insulin
  • Increased dietary need, especially vegans
45
Q

What are the functions of iron in pregnancy?

A
  • Globally, high incodence of maternal iron deficiency
  • If dietary iron low, may need supplements
  • Supplementation with normal iron stores is undesirable, may increase oxidative stress
46
Q

What are some secretions from the placenta in pregnancy?

A
  • hCG has a key role in maintaining pregnancy

- Other placental proteins and steroid s

47
Q

What are some endocrine secretions from the mother during pregnancy?

A
  • Increased growth hormone releae
  • Decreased FSH and LH
  • Increased prolactin
  • Increased parathyroid hormine
  • Pituitary increases in size (production of prolactin adn ACTH and oxytocin)
  • Thyroid increases in size die to hCG (similar in structre to TSH)
48
Q

After how long does the uterus go back to normal?

A

6 weeks `

49
Q

What can lead to Amenorrhea and what can be associated with it?

A
  • Duration related to frequency of duration and suckling

- May be associated with hot flushes and vaginal dryness

50
Q

What can take longer than 6 weeks to restore to normal after pregnancy?

A

Coagulation system

51
Q

What normalises extremely rapidly after pregnancy?

A

Glucose tolerance

52
Q

What is Amenorrhea?

A

Absence of menstruation

MD3002 Physiology (24 decks)

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