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Repro > Lecture 14 - Maternal Adaptations > Flashcards

Lecture 14 - Maternal Adaptations Flashcards

1
Q

Maternal adaptations

A

Volume support

  • volume expansion
  • vasodilation

Nutrition

  • increased respiration
  • insulin resistance
  • increased absorption

Waste clearance

  • increased GFR
  • hepatocelullar stimulation

Childbirth
- increased coagulation
-

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2
Q

Hormones that control changes

A

Beta HCG - oestrogen and progesterone release

Oestrogen - increases release of prolactin

Progesterone - increases appetite and fat deposition

Relaxin

HPL- insulin resistance

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3
Q

What does a baby need to survive in vivo

A

Glucose
Oxygen
Amino acids
Immunoglobulin

Clearance of:
CO2
Urea

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4
Q

Immunological changes of the mother

A

Foetus is recognised by the maternal immune system
Incited allo-response is not cytotoxic

Mother in immunosuppressed state

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5
Q

Respiratory changes

A

Increased O2 supply needed to meet metabolic demand
Increased CO2 clearance

Therefore: more frequent and deeper breaths
Increased minute ventilation
Increase tidal volume
Respiration rate stays the same

effects:
pH more alkali
ERV - (3rd trimester) decreases as the uterus compresses the lungs
TLC - decreases as diaphragm is elevated

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6
Q

What causes the respiratory changes

A

Progesterone

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7
Q

Dyspnea in pregnancy

A

Shortness of breath in pregnancy due to hyperventilation

May have other causes:
Cardiac
Anaemia
DVT and PE
Asthma 
Pulmonary oedema
Pneumonia
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8
Q

Cardiovascular changes

A

Increased HR
Increased stroke volume
Therefore increased cardiac output

Decreased TPR - maintain BP

Increased procoagulants
Decreased anticoagulants except protein S
Reduced fibrinolysis

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9
Q

What causes a decrease in TPR?

A

Progesterone causes arteriole vasodilation

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10
Q

Normal BP in pregnancy

A

140/90

Due to increased cardiac output

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11
Q

Procoagulants

A

Fibrinogen
Factor VIII
vWF

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12
Q

Effects of increasing procoagulants

A

Can lead to thromboembolic diseases such as DVT and PE

Can’t give warfarin as teratogenic

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13
Q

Pre - eclampsia

A

Due to placental insufficiency - hypoperfusion and ischaemia

  • hypertension
  • proteinuria
Symptoms:
Headache
Visual disturbances
RUQ pain - liver microclotting 
Oedema

Can lead to:

  • eclampsia - seizure
  • intrauterine growth restrictions
  • foetal respiratory distress syndrome
  • preterm labour
Treatment:
Maintain BP
Diuretics and fluid restriction
Antihypotensives - Ang II receptor blocker 
MgSO4 - neuroprotection
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14
Q

How is stroke volume increased

A

Progesterone and oestrogen stimulates renin release from the kidney which ultimately increases angiotensin II

Angiotensin II acts on the adrenal glands to produce aldosterone which causes increase absorption of NA+ and water in the DCT

Increased plasma volume

Therefore:

Increased venous return
Increased preload - EDV
and increased contractility

Increased stroke volume

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15
Q

Consequences of increased blood volume (RAAS)

A

Peripheral oedema

Dilutional anaemia - plasma volume increases more than RBC volume

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16
Q

Mild cardiac hypertrophy

A

Rotation of cardiac axis and displaced apex beat

Split S1 sound - early closure of mitral valve
Loud S3 sound - passing filling of LV

17
Q

IVC compression

A

Growing uterus may compress the IVC - reducing venous return and preload

Post delivery:
IVC no longer compressed
Preload increases
CO increases as SV increases

CO decreases to Perla our values 1 hour after delivery

18
Q

Why are women with aortic stenosis at risk of cardiac arrest during pregnancy?

A

Aortic stenosis increases afterload

During pregnancy:
IVC compressed decreasing preload
Contractility decreases

Too much stress on the heart

19
Q

Dilution anaemia

A

Increased plasma volume due to clotting factors and increased water retention

Less RBC increase - dilutional anaemia

More Hb produced - using up iron and folate

Give women iron tablets

20
Q

Renal changes

A

Increased GFR

Increases EPO production
Increases renin production
Increases calcitriol production - increase Ca2+ absorption in gut

Reduced mobility of ureters - progesterone

21
Q

How is GFR increased

A

Systemic vasodilation

Increases renal blood flow

22
Q

Effects of increased GFR

A

Creating and urea clearance increases
Reduced plasma osmolarity - more filtered

Glycosuria - decreased PCT reabsorption as tubules have less time to act

Increased urine output - urinary frequency (Also compression of bladder by uterus)

23
Q

Hydronephrosis and hydroureter

A

Vasodilation and obstruction
Decreased ureteric mobility

Increased size of renal pelvis and calyces - hydronephrosis

Increased size of ureters - hydroureter

24
Q

Reduced mobility of ureters

A

Urine stasis

Increased risk of UTIs

25
Q

GI changes

A

Slow transit time: increased absorption
Reduced peristalsis
Smooth muscle relaxation

Pica

26
Q

Effects of reduced peristalsis and smooth muscle relaxation by progesterone

A

Constipation - increased water absorption as decreased large bowel motility

Bloating

GORD - decreased LOS tone

Heartburn - due to GORD

Gallstones - decreased gall bladder contractility causing biliary stasis

Morning sickness

27
Q

Raised LFTs

A

Due to placental synthesis

28
Q

Endocrine changes

A

Thyroxine production upregulated
Insulin resistance
Increased calcitriol

29
Q

Thyroxine production

A

Foetus reliant on maternal thyroxine
Oestrogen stimulates thyroxine binding globulin production by the liver

beta HCG has a similar alpha sub unit to TSH and directly binds - increasing thyroxine production (mildly)

30
Q

Calcitriol production

A
  1. There is a small decrease in calcium as baby needs it for bone formation
  2. Stimulates PTH to increase
  3. PTH and the placenta increases the production of the vit D activation enzyme by the kidney
  4. More calcitriol is produced
  5. More calcium absorption from the gut
31
Q

Insulin resistance

A

HPL causes insulin resistance and conversion of lipids to fatty acids for gluconeogenesis

Pancreas secretes more insulin due to hyperglycaemia

Oestrogen stimulates the liver to produce glucose by glycogenolysis and gluconeogenesis

32
Q

Gestational diabetes

A

Hyperglycaemia due to insulin resistance

Excessive demand for insulin not met by pancreas

Hyperglycaemia - baby absorbs more glucose

Foetus requires insulin to absorb glucose into its cells. Insulin related to insulin like growth factor.

Increased insulin increases growth factor and therefore the baby grows more causing macrosomia

Can cause shoulder dystocia - brachial plexus damage

33
Q

MSK changes

A

Baby is heavy and changes centre of gravity of mother

Increased lordosis and kyphosis
Forward flexion of neck
Stretching of abdominal muscles - strain on spine causing back pain

Increased mobility of the sacroiliac joints and pubic symphysis
Anterior tilt of spine

Fluid retention can compress median nerve in the carpal tunnel

Relaxin causes muscles to become loose and stretchy

34
Q

Skin changes

A

Increased oestrogen:

  • spider angioma
  • palmar erythema

Increased MSH:
Dark patches on face, umbilicus, abdominal line, perinuem and nipples

35
Q

Linea nigra

A

Dark abdominal line to umbilicus

Repro (20 decks)

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