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Repro > Lecture 15 - Maternal Physiology > Flashcards

Lecture 15 - Maternal Physiology Flashcards

1
Q

What are some hormones that drive the physiological adaptations seen during pregnancy?

A

HCG
Oestrogen
Progesterone
Relaxin
hPL (Human Placental Lactogen)

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2
Q

What produces the hormones that drive the physiological adaptations seen in pregnancy?

A

Corpus luteum

Placenta

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3
Q

How does the immune system change during pregnancy?

A

Immunosuppressed state

Since the fetus is half paternal/foreign

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4
Q

What changes in respiration need to occur during pregnancy?

A

Increased O2 supply
Increased CO2 clearance

So increased ventilation

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5
Q

What lung volumes/capacities change during pregnancy and why?

A

Tidal Volume increases

Expiratory Reserve Volume and Total Lung Capacity decrease since the uterus compresses the diaphragm

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6
Q

What affect on the body does increasing Tidal volume have?

A

Inc PaO2 + Dec PCO2

Resp alkalosis (gets compensated by renal bicarb)

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7
Q

What is Dyspnea of Pregnancy?

A

The feeling of shortness of breath during pregnancy but not actually increasing respiratory rate

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8
Q

What are some pathological issues that may actually lead to shortness of breath and not be the normal Dyspnea of pregnancy?

A

Cardiac issues
Anemia
DVT/PE
Asthma
Pneumonia/ARDS
Pulmonary oedema

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9
Q

What does mom need to do to ensure baby receives all of the nutrients it needs?

A

Increase volume of circulation/delivery
Prepare for potential blood loss during delivery

Volume expansion
Inc clotting mechanisms

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10
Q

How does the mother increase blood delivery?

A

Increase Cardiac output

Reduce systemic vascular resistance

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11
Q

What is the equation for cardiac output?

A

CO = Heart rate x Stroke volume

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12
Q

How is cardiac output increased during pregnancy?

A

Inc SV (inc blood volume)
+
Inc HR

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13
Q

What leads to the reduced systemic vascular resistance in pregnancy?

A

Progesterone being produced relaxes smooth muscle leading to vasodilation

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14
Q

What substances increase in the blood leading to increased clotting?

A

Increased procoagulants
Decreased anticoagulants
Reduced fibrinolysis

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15
Q

How is Sv increased in pregnancy?

A

Oestrogen and progesterone causes peripheral vasodilation

This leads to RAAS activation due to drop in BP

This leads increased fluid volume increasing SV.

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16
Q

What negative effect often happens as a result of RAAS system activation in pregancy?

A

Peripheral oedema (ankle swelling)

Dilutional anaemia

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17
Q

Why does dilutional anemia occur in pregnancy?

A

The increase in plasma volume is much more than the increase in RBC number

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18
Q

What is a pregnant woman at increased risk of due to being in a hypercoagulable state?

A

DVT
PE

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19
Q

What is the most common cause of anaemia in pregnancy?

A

Iron deficiency anaemia

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20
Q

How does iron deficieny anaemia usually affect the size of RBCs?

How can this be different in pregnancy?

A

Iron deficiency anamiea (normally) = Microcytic

Iron deficieny anaemia in pregancy = can be Normocytic or Macrocytic

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21
Q

How can Hb levels differ in pregnancy to normal?

A

Can be slightly lower than the normal range and be ok

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22
Q

What are some complications of anaemia of pregnancy?

A

Inc morbidity for mom andn baby (baby not getting enough O2)
Preterm delivery
Maternal fatigue
Infant iron deficieny anaemia

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23
Q

What changes need to occur in the mother’s renal system and why?

A

Increase GFR

Need to increase the clearance of wastes

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24
Q

How is GFR increased during pregnancy?

How are serum urea and creatinine levels affectd?

A

Systemic vasodilation due to progesterone production
This increases renal blood flow whihc increases GFR

Creatinine and urea levels in serum decreased (in urine increased)

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25
Q

How is absorption in the PCT affected during pregnancy?

What affect does this have?

A

Decreased PCT absorption

Get glucosuria due to lower glucose threshold

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26
Q

What happens to the kidneys and ureters in pregnancy and why?

What does this increase the risk of?

A

Smooth muscles relax due to progesterone

Stasis of urine can occur which can lead to hydroureter and hydronephrosis and increased UTI risk

27
Q

What changes occur in the mother’s GI system in pregancy and why?

A

Transit time in gut is slower

This is to increase/maximise the absorption of nutrients like vitamins and minerals

28
Q

What are some symptoms that a pregnant lady can expierence related to the GI tract?

A

GORD (decreased Lower oesophageal tone due to progesterone)

Constipation (slower transit time)

Gallstones (decreased gall bladder contractility)

29
Q

How can constipation occur in a pregnant woman that isn’t caused by slower transit time?

A

The uterus can displace the bowel causing a mechanical obstruction

30
Q

How many LFTs be affected in pregnancy and why?

A

ALP levels increased due to placental synthesis

31
Q

What endocrine changes need to happen to ensure mother can give baby glucose and lots of calcium while keeping metabolism under control?

A

Thyroid regulation
Parathyroid activation
Insulin resistance

32
Q

What affect does oestrogen have on the thyroid in pregancy?

A

Makes liver make more Thyroid Binding Globulin

More thyroid binding globulin leads to more TSH being made which leads to more thyroxine (T3 and T4) being made

33
Q

Why is pregnancy considered a euthyroid state?

A

Levels of free thyroid hormones remain the same since the levels of thyroid binding globulin increase

34
Q

How does increased parathyroid activation increase calcium levels?

A

Inc PTH
Means kidney produces more enzymes to activate inactive Vit D
More active VIt D means more Ca2+ and phosphate absorption in GI tract

Kidney excretion of PO4- increases

35
Q

How is glucose metabolism affected in mother in pregnancy?

A

Insulin resistance leads to increased plasma glucose and insulin levels so blood glucose levels for fetus are higher

36
Q

What hormone leads to insulin resistance in the mother?

A

hPL (Human placental lactogen)

37
Q

How can gestational diabetes Mellitus occur?

A

When mother already has risk factors for diabetes and the effects of normal insulin resistance in pregancy leads to gestational diabetes

38
Q

How are glucose levels and insulin levels affected in pregancy?

A

Both elevated

39
Q

What is gestational diabetes?

A

Diabetes that develops during pregnancy

Hyperglycaemia that falls above the normal range during pregancy

40
Q

What are the risk factors for developing gestational diabetes?

A

BMI > 30kg/m^2

Previous macrosomic baby

FHx of DM

Ethnicity with high prevalence of diabetes

41
Q

How do you diagnose/investigate Gestational Diabetes Mellitus?

A

Oral GLucose Tolerance test (give glucose drink then measure after 2 hrs)

Diagnose:
Fasting plasma glucose > 5.6mmol/L
Or
2hr plasma glucose of >7.8mmol/L

42
Q

What are some complications that can occur to the mother with gestational diabetes?

A

Risk of:
-pre-eclampsia
-polyhydramnios
-premature labour

43
Q

Why can GDM lead to polyhydramnios and premature labour?

A

Hyperglycaemia in baby inc urine output

The increased amniotic fluid volume cna lead to early labour

44
Q

What are some labour ccompiations that can occur with Gestational DM?

A

Shoulder dystocia
Failure to progress

45
Q

What are some complications that can occur to the fetus with Gestational DM?

A

Macrosomia
Congenital abnormalities:
-cardiac
-renal
-neural tube defects (cerebral palsy)
Hypoxia nd sudden intrauterine death

46
Q

What are some complications that can occur to the neonate where there was gestational DM?

A

Hypoglycaemia (high insulin levels but not the elevated glucose anymore)

Resp distress
Jaundice

47
Q

What changes to MSK and skin occur in pregancy?

A

Everything more loose and stretchy to cop with:
-additional weight
-COG changes
-preparing for childbirth

48
Q

Why can bac pain, shoulder pain and tension headaches occur in pregnancy?

A

Changes in MSK

Progesterone relaxes muscles and ligament s

Inc Lordosis and kyphosis
Forward neck Flexion

Stretch abdominal muscles (impeded posture and strain paraspinal muscles)

49
Q

Why can pelvic pain occur in pregancy?

A

Anterior tilt of pelvis
Increased mobility of sacroiliac joints and pubic symphysis

50
Q

Why can carpal tunnel occur with pregnancy?

A

Fluid retetnion can compress structures such as the median nerev

51
Q

What pigment is increased in production in pregnancy?

A

More melanin

52
Q

What skin changes can be seen in pregnancy?

A

Chloasma/melasma of face
Line nigra
Palmar erythema
Spider naevi (vascular spiders)

53
Q

What is linea nigra?

A

Line of pigmentation where the rectus muscles join

54
Q

What is the definition of Pre—eclampsia?

A

Pregnancy induced hypertension of >140/90mmHg with proteinuria with or without maternal organs dysfunction AFTER WEEK 20

55
Q

What is considered severe pre-eclampsia?

A

Severe hypertension that doesnt respond to treatment

56
Q

What are the risk factors for pre-eclampsia?

A

40>yrs old
Nulliparity
Last pregnancy over10yrs ago
FHx
Previous Pre-eclampsia
BMI>30kg/m2
Pre-existing vascular disease

57
Q

What is the pathophysiology of pre-eclampsia?

A

Insuffienct invasion of trophoblasts leading to shallow invasion of SPIRAL ARTERIES meaning they stay thin and have a high resistance

This leads to hypoperfusion and ischaemia to fetus

58
Q

What are the symptoms of pre-eclampsia?

A

Head ache (cerebral oedema due to inc BP)
Vision disturbances
Epigastric pain
Oedema of hands and feet
Vomiting
SOB

59
Q

What are some complications of pre-eclampsia to the mother?

A

Eclampsia
Cerebral haemorrhage
Renal failure
Pulmonary oedema

HELLP syndrome

60
Q

What is eclampsia and why can it occcur due to preeclampsia?

A

Seizures

Due to the inc BP cerebral oedema and cerebral haemorrhages can occur

61
Q

What is HELLP syndrome?

A

Haemolysis
Elevated Liver enzymes
Low Platelets

(DIC)

62
Q

What Fetal complications can occur due to pre-eclampsia?

A

Asymetrical growth restriction
Oligohydromanios
Plancental infarct
Fetal distress
Premature delivery
Stilll birth

63
Q

What examinations are done to asses pre-eclampsia?

A

Check for papiloedema (raised ICP)

Tendon reflex’s (Hyper-reflexia) indicates CNS function and seizure/eclampsia likelihood

64
Q

How is eclampsia managed?

A

Give magnesium sulphate

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