II: Pregnancy - Mother Flashcards
During pregnancy, TBW increases from __ to __.
6.5L; 8.5L
____ induces apoptosis of endometrial T cells to promote immune survival of the embryo
hCG
____ inhibits uterine contractions and may modulate immune system to prevent fetal rejection
Progesterone
____ is used in pregnancy tests and appears positive ___ days after fertilization
hCG; 9
____ promotes placental angiogenesis and uterine vascular remodeling via stimulating IGF production
hPGH
____ promotes prolactin production by lactotrophs
Estrogen
_____ are the major placental cells responsible for protein and steroid hormone production
Syncytiotrophoblasts
_____ contribute to insulin resistance during pregnancy; ____ is thought to be the primary driver
hPGH, hPL; hPGH
_____ increases the number of oxytocin receptors
Estrogen
_____ may contribute to sinus congestion
Estrogen
_____ promotes hepatic protein synthesis
Estrogen
_____ stimulates insulin secretion and islet cell numbers to increase lipolysis and free fatty acids
hPL
BNP increases most in the ___ trimester, especially in the case of pre-eclampsia
3rd
Cardiac output is lowest in the _____ positions.
Standing, supine
Decreases in SVR are mediated by _____ effects on smooth muscle and ____ production
Progesterone; NO
During delivery, when does cardiac output peak?
10-30 minutes after delivery
During pregnancy, _______ immunity is suppressed while _____ immunity is unchanged or enhanced
Cell-mediated; Humoral
During pregnancy, BP _____ until 22-24 weeks.
Decreases
During pregnancy, BP is at baseline at _____ weeks.
0, 36
During pregnancy, cardiac contractility _____ and cardiac compliance _____.
Increases; increases
During pregnancy, cardiac output ______, mainly due to increases in ______.
increases; stroke volume
During pregnancy, clotting factors ______ and fibrinolytic factors ______.
Increase; Decrease
During pregnancy, filtration fraction at the kidney ______.
decreases
During pregnancy, GFR ______ by __%; creatinine and BUN ______.
increases; 50%; decrease
During pregnancy, heart rate ______ during the ____ trimester.
Increases 10-20 bpm; 3rd
During pregnancy, PaO2 _____ and PaCO2 _____.
Increases; Decreases
During pregnancy, pH ____ and bicarbonate _____.
Increases; decreases
During pregnancy, preload ______, end diastolic volume _____, and afterload ______.
Increases; Increases; decreases
During pregnancy, RBC mass _____.
Increases
During pregnancy, serum levels of angiotensin II ______ and aldosterone.
Increase; increase
During pregnancy, serum sodium ____ 3-4mM, and plasma osmolarity ____ 6-8mOsm
decreases; decreases
During pregnancy, systemic vascular resistance is ______.
Decreased
During pregnancy, the white blood cell count _____.
Increases
During pregnancy, tidal volume _____.
increases
During pregnancy, venous pressure _____.
Increases
During pregnancy, which type of valvular heart disease lesions are better tolerated?
Regurgitant
DVT is more common on the ____ side.
left
hCG peaks at weeks ___ gestation.
9 to 10
How much does required caloric intake increase during pregnancy?
200kcal/day (1st/2nd), 300kcal/day (3rd)
Hydronephrosis is more common on the ____ side.
right
Hyperpigmentation of skin during pregnancy can be attributed to ____ stimulation of ______
hCG; melanocyte-stimulating hormone (MSH)
Hyperthyroidism early in pregnancy is mediated by ____.
hCG
In pregnancy, gallbladder volume ______ and risk of gallstones ______.
Increases; increases
In pregnancy, mothers have ______ risk of peptic ulcer disease and ____ risk of GERD.
decreased; increased
Increased Free T4 during the first trimester is an effect of ______.
hCG
Increased Total T4 in pregnancy is an effect of ______
estrogen
Insulin sensitivity is ______ early in pregnancy.
increased
Loss of _____ of blood is normal during delivery.
500-1000ml
Name 4 exam findings characteristic of the heart in pregnancy.
Left-displacement of PMI, systolic ejection murmur at left sternal border, S3 murmur, Exaggerated split S1 (increased preload)
Name 4 possible complications of GDM for the mother.
C-section, Pre-eclampsia, infection, risk of developing T2DM
Name a common developmental/birth complication assoicated with GDM.
Shoulder dystocia
Name the 3 major steroid hormones produced by the placenta
Progesterone, Estrogen, 1,25-dihydroxy-vitamin D
Name the 4 major polypeptide hormones produced by the placenta
hPGH, hPL, hCG, CRH
Nausea and vomiting during pregnancy most closely correlates with ____ levels.
hCG
Pyelonephritis is more common on the ____ side.
right
The hyperthyroid phase of post-partum thyroiditis (___ months following pregnancy) should be treated with ______.
2-4; Beta-blockers
The hypothyroid phase of post-partum thyroiditis (___ months following pregnancy) should be treated with ______.
4-8; Levothyroxine
What are the signs of fetal Graves Disease?
Tachycardia, IUGR
What birth defect may be associated with preexisting hypertension?
IUGR
What histologic changes can be seen in the heart during pregnancy?
Ventricular hypertrophy
What is normal net weight gain during pregnancy?
25-35 pounds
What is the appropriate treatment in the context of maternal hyperthyroidism caused by Graves Disease?
Propylthiouracil (PTU)
What is the leading preventable cause of mental retardation?
Iodine Deficiency
What is the most common cause of maternal (not gestational) hyperthyroidism?
Graves Disease
What is the most common cause of maternal hypothyroidism?
Hashimoto Thyroiditis
What is the pathophysiologic cause of post-partum thyroiditis?
Anti-TPO antibodies
What is the treatment/management for DVT in pregnancy?
LMWH up to 36 weeks; Unfractionated heparin until delivery
Which lung volumes decrease during pregnancy?
RV, TLC, FRC
Which lung volumes increase during pregnancy?
TV, IC
Which pregnancy signs due to estrogen effects may mimic liver disease?
Spider angiomata, palmar erythema
