Maternal Adaptation: CV, Pulmo, Renal

Question 1

When do Cardiovascular changes become apparent during pregnancy?

Answer 1

By the first 8 weeks

Question 2

What happens to the systemic vascular resistance?

Answer 2

Decrease

Question 3

What happens to Cardiac Output, Heart Rate, Pulse rate, Volume, and Preload?

Answer 3

They all increase! (Doesn’t memorizing this make it easier?)

Question 4

By how much does the pulse rate increase?

Answer 4

10 bpm

Question 5

When does the volume increase?

Answer 5

10th-12th week

Question 6

Where is the heart displaced during pregnancy?

Answer 6

To the left, upward, and rotated on its LONG axis

Question 7

Chest radiograph may show the heart as
A. Cardiomegaly
B. Apex moved medially
C. (-) benign pericardial effusion
D. with a larger cardiac silhouette

Answer 7

D. with a larger cardiac silhouette.

May be mistaken for cardiomegaly BUT IT’S NEVER CARDIOMEGALY.

Question 8

True or False: Accdg. to 2D Echo, there is minimal regurgitation.

Answer 8

True. And accdg. to the ECG, there is a slight left-axis deviation.

Question 9

Which cardiac sound exhibits no definite change in aortic and pulmonary elements?

Answer 9

S2

Question 10

Which cardiac sound is exaggerated with splitting and increasing loudness?

Answer 10

S1

Question 11

Which cardiac sound changes by 20% and may suggest pathology

Answer 11

Diastolic Murmur

Question 12

Which cardiac sound is loud and easily heard?

Answer 12

S3

Question 13

Which cardiac sound changes by 90% and disappear shortly after birth?

Answer 13

Systolic Murmur

Question 14

Which heart sound changes by only 10% and is correlated with breast vasculature?

Answer 14

Soft diastolic murmur

Question 15

Where is the ventricular muscle mass greater at term? (Right or Left?)

Answer 15

Left

Question 16

Physiological growth and pathological hypertrophy are encompassed by what cardiac quality?

Answer 16

Cardiac Plasticity

Question 17

What happens to the mean arterial pressure and the vascular resistance?

Answer 17

Decrease. Kaya lumalaki ang Cardiac Output kasi walang resistance, malakas pa ang pagbomba.

Question 18

What happens to the blood volume and metabolic rate?

Answer 18

Increase. Naturally after the increase in CO.

Question 19

During the late pregnancy, is the cardiac output increased or decreased? Why?

Answer 19

Decreased due to large uterus compressing the IVC and aorta. Uterine blood flow is decreased by 1/3

Question 20

How much higher is fetal oxygen saturation in labor? In what position of the mother?

Answer 20

10%. Left recumbent position.

Question 21

By how much is maternal CO increased?

Answer 21

approx. 40%

Question 22

True or False: Increased HR and inotropic contractility implies that Cardiovascular reserve is increased in multifetal gestation.

Answer 22

False. CV reserve is DECREASED. There’s more than one fetus being supported.

Question 23

3 Peaks in CO during pregnancy

Answer 23

28-32 weeks (7-8 months) AOG, labor, post-partum

Question 24

2 important hemodynamic fxns that do NOT change

Answer 24

capillary wedge and central venous pressure

Question 25

True or False: Pregnancy is a continuous high-output state.

Answer 25

False

Question 26

Significant decreased gradient b/w colloid osmotic pressure and pulmonary wedge pressure increases the risk of what pulmonary condition?

Answer 26

Pulmonary Edema

Question 27

When does arterial pressure decrease to nadir (lowest point)?

Answer 27

24-26 weeks (6th month)

Question 28

True or false: systolic pressure decreases more than the diastolic pressure

Answer 28

False. Diastolic pressure decreases more than the systolic pressure.

Question 29

Syndrome that affects fetal heart patterns by compressing great vessels and lowering uterine arterial pressure

Answer 29

Supine hypOtension syndrome

Question 30

RAA hormonal regulation

Answer 30

dure to estrogen and progesterone

Question 31

Cardiac natriuretic peptides secreted by myocytes

Answer 31

atrial and B-type

Question 32

Prostaglandins increased in late pregnancy

Answer 32

E2 (natriuretic), prostacyclins (PGI2) are

Question 33

Main changes in pulmonary system during pregnancy

Answer 33

Diaphragm elevated by 4 cm, Residual Volume is decreased, and Tidal Volume is increased. Vital Capacity remains the same.

Question 34

By how much does the subcostal angle widen as the transverse diameter increases?

Answer 34

by 2 cm

Question 35

The thoracic circumference increases by how much?

Answer 35

6 cm

Question 36

What happens to the minute ventilatory volume (total volume of gas exhaled per minute)

Answer 36

Increased

Question 37

What happens to minute oxygen uptake? Airway conductance?

Answer 37

Increased

Question 38

What happens to alveolar ventilation (amt of air reaching the alveoli and available for exchange w/ blood per unit time)?

Answer 38

Increased

Question 39

``` Arrange the ff accdg to magnitude of increase: Tidal Volume RR Minute Ventilation Alveolar Ventilation ```

Answer 39

Alveolar Ventilation > Minute Ventilation > Tidal Volume > RR

Question 40

What hormone causes total pulmonary resistance?

Answer 40

Progesterone

Question 41

``` Which among the ff CHANGES during pregnancy? A. Vital Capacity B. Residual Volume C. Lung Compliance D. Total Lung Capacity ```

Answer 41

D. Total Lung Capacity. It decreases.

Question 42

True or False: The kidney width increases by 1-1.5 cm

Answer 42

False. The kidney LENGTH increases by 1-1.5 cm

Question 43

What does the increase in renal blood flow and interstitial volume contribute to the kidney volume?

Answer 43

3% increase

Question 44

Renal condition wherein there is a dilation of renal pelvises, calyces, and ureter in 80% of women

Answer 44

Physiological hydronephrosis

Question 45

True or False: There is a decrease in the vasopressin release and thirst osmotic threshold, causing hormones to be disposed more rapidly

Answer 45

True