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GGE > Gametes - Maternal Physiology > Flashcards

Gametes - Maternal Physiology Flashcards

1
Q

insulin during pregnancy

A

mothers becomes less sensitive to insulin

Brought about by hCS (also known as Human Placental Lactogen, hPL)

FAs for her own metabolism and glucose spared for baby

Too much insensitivity - gestational diabetes

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2
Q

weight gain expected during pregnancy for each BMI category

A
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3
Q

underweight BMI (< 18.5) weight gain

A

28-40 pounds

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4
Q

normal weight BMI (18.5-24.9) weight gain

A

25-35 pounds

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5
Q

overweight BMI (25-29.9) weight gain

A

15-25 pounds

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6
Q

obese BMI > or = 30

A

11-20 pounds

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7
Q

what are obesity and excessive weight gain in pregnancy associated with

A

gestational diabetes

macrosomia - large baby

pre-eclampsia

caesarean section

post-operative complications

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8
Q

AA essential during pregnancy

A

leucine

(IGF-1 and IGF-2 also)

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9
Q

distribution of weight during pregnancy

A

6kg - maternal tissues

5kg - foetal tissues

7kg - water

3kg - fat

1kg - protein

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10
Q

how is weight gain distributed throughout pregnancy

A
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11
Q

water content at term

A

foetus + placenta + amniotic fluid = 3.5L

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12
Q

where is this increase in total body water seen

A

increase in volume of blood, plasma, RBC

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13
Q

when does the increase in TBW start

when does it reach max vol

what is it caused by

A

increases from week 6/8

max vol@ 32 weeks - 45% increase

→ oestrogen action on renin/angiotensin/aldosterone

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14
Q

pregnancy is a condition of

A

Chronic Volume Overload

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15
Q

if you’re not pregnant but experience fluid overload, how does your body respond

A

(ADH stops you getting rid of fluid) → ADH is inhibited

AMP promotes water loss → AMP is increased

⇒ Pressure Diuresis

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16
Q

haemotological changes in pregnancy - RBCs

A

RBC production is increased by 33% - possibly hormonally mediated

this increases the O2-carrying capacity of blood

the increase in plasma is greater and faster than RBC, so there is no increase in viscosity of blood

⇒ Hb conc falls from 14 g/dL → 12 g/dL

⇒ Dilution Anaemia (Hb and Hct decrease)

[true anaemia = Hb < 12 g/dL, Hct < 32%]

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17
Q

Haemotological changes in pregnancy - leukocytes

WBC count in each trimester and labour

explain the change in WBC count

A

bone marrow is hyperplastic

peripheral WBC rises progressively during pregnancy

1st trimester - 9500/mm3

2nd and 3rd trimester - 10,500/mm3

labour - 20-30,000/mm3

rise is due to PMNs - polymorphonuclei (eosinophils, basophils etc)

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18
Q

haematological changes in pregnancy - platelets

A

platelets progressively decline but remain within normal range

likely due to increased destruction

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19
Q

what cells regulate the localised immunity in the uterine environment

A

T regulatory cells

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20
Q

Haematological changes in pregnancy - coagulation

increase in levels of…

no change in…

decline in levels of…

A
  • increased levels of coagulation factors (more likely to develop embolism) - decreases blood loss at delivery

fibrinogen (Factor I)

Factors VII → X

  • no change in prothrombin (Factor II), Factor V and Factor XII
  • decline in platelet count, Factor XI and XIII

bleeding time and clotting time are unchanged in normal pregnancy

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21
Q

pregnancy is a

A

hyper-coaguable state

22
Q

COAGULATION

increased levels of

A

fibrinogen - Factor I

Factor VII

Factor X

23
Q

COAGULATION

no change in

A

prothrombin - Factor II

Factor V

Factor XII

24
Q

COAGULATION

decline in

A

platelet count

Factor XI

Factor XIII

bleeding and clotting time are unchanged in normal pregnancy

25
clinical implications of the haematological changes in pregnancy
1. increased circulatory need of the enlarging uterus and the foeto/placental unit (increase of 45%) 2. fills of the ever-increasing venous reservoir 3. protects the parturient (woman in labour, about to give birth) from the bleeding at the time of delivery 4. parturients become **hypercoaguable** as the gestation progresses
26
how long does it take for blood volume to return to normal
8 weeks
27
CV changes in pregnancy
1. increased metabolic demands 2. expansion of vascular channels 3. increase in steroid hormone
28
CO =
HR x stroke volume
29
change in maternal CO
30-40% increase
30
CO during pregnancy
6-7L/min (to allow for O2 delivery to foetus) CO remains maximal until delivery/labour
31
what causes this increase in CO how long is this increase in CO maintained for
increase in CO ⇒ increase in SBP fluid and vol increased ⇒ increased CO **oestrogen and progesterone** maintained until 4 days post-partum
32
what does CO in pregnancy depend on
varies depending on the uterine size + maternal position
33
haemodynamic parameters during pregnancy
34
why does CO increase
it facilitates maternal and foetal **exchanges** of **respiratory gases, nutrients and metabolites** it **reduces the impact of maternal blood loss** at delivery
35
how does pulse (HR) change during pregnancy
1st trimester - resting pulse increases by 8 beats/min by term, increased by 15-20 BPM
36
how does BP change during pregnancy systolic vs diastolic
**systemic BP overall decreased** * systolic BP changes little (even though there's an increase in CO) * diastolic reduced by 5-10 mmHg * Venous pressure in upper body unchanged, venous pressure in the lower body increased ⇒ BP affected by position of mother
37
what dynamic factor contributes to diastolic BP
peripheral resistance vessels dilate to ensure you have the blood supply to support the foetus
38
basis for the haemodynamic changes of pregnancy
**increased O2 demand → increased CO** * vasodilation at placenta and increased vascularisation increased blood flow to foeto-placental unit decreased systemic vascular resistance (SVR) * diastolic BP decreases
39
overview of CVS changes during pregnancy
40
anatomical and changes of the heart in pregnancy
apex displaced upwards and to the left heart size is increased by 12% left axis deviation of 15% (approx) - linked with hypertrophy of ventricle - indicative of heart failure diaphragm moves upwards by 4cm
41
ECG changes during pregnancy
benign dysrhythmia reversal of ST, T and Q waves left axis deviation
42
changes in heart sounds in pregnancy
split 1st heart sound - early closure of mitral valve intensity of 2nd sound may become louder systolic functional murmurs may develop due to tricuspid regurgitation
43
peripheral vasodilation during pregnancy
increased blood flow to the skin - especially hands and feet - lead to a feeling of warmth increased congestion of nasal mucosa leading to nasal congestion (because of peripheral vasoD) epistaxis is common (increased risk of nose bleeds)
44
supine hypotension is caused by
**compression of inferior vena cava** decreased venous return decreased cardiac output lowered BP
45
movement of diaphragm during pregnancy
at term diaphragm can be elevated up to 4cm resp system may be compromised - (70% contribution by diaphragm) diaphragm movement reduces thoracic cavity vol mobility reduced respiration becomes mainly thoracic widened subcostal angle, increasing transverse diameter of the chest
46
tidal vol during pregnancy
increased by 30-40%
47
respiration rate during pregnancy what is it influenced by
increased by 15% at term influenced by **progesterone**
48
minute ventilation during pregnancy formula
increased at term by 50% minute ventilation = resp rate x tidal vol respiration reserve decreases because of anatomical movement upwards
49
effect of elevation of diaphragm on: 1. total lung vol 2. residual vol 3. FRC - functional residual capacity 4. FEV1 or FEV1:forced vital capacity
1. total lung vol decreases by 5% 2. residual vol decreases by 20% 3. FRC decreases by 20% 4. no change in FEV1 or the ratio of FEV1 to forced vital capacity
50
risk of compressed lungs
more susceptible to noxious gases
51
change in minute ventilation and its subsequent impact on O2 consumption PA and Pa levels arterial pH
minute vol increases by 30-40% by late pregnancy O2 consumption increases only 15-30% ⇒ higher PAO2 (alveolar) and PaO2 (arterial) ⇒ fall in PACO2 (what drives respiration) and PaCO2 arterial pH remains unchanged increased bicarbonate excretion via kidneys
52
what causes dyspnea during pregnancy
late 1st or early 2nd trimester likely due to: * reduced PaCO2 levels * awareness of increased tidal vol of pregnancy

GGE (33 decks)

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