Maternal Adaptation: Reproductive System, Metabolism, Hematology Flashcards
How much volume can a gravid uterus contain?
5-20L
Mass of a gravid uterus
1100g
Shape of a non-pregnant uterus
pear-shaped
Thickness of a gravid uterus
2 cm
True or False: Enlargement of the uterus is due to hyperplasia
False. It is due to hypertrophy. No myocytes are produced
When do estrogen and progesterone play a part in the hypertrophy of the uterus?
before the 12th week
True or False: Before the 12th week, uterine hypertrophy is caused by mechanical distention naturally-occurring during pregnancy
False. It is due to hormonal changes
True or False: >12 weeks, uterine hypertrophy is caused by hormonal changes
False. It is due to mechanical distention
In a non-pregnant female, which parts of the reproductive system attach near the apex?
Broad ligament, round ligament, fallopian tubes
What accumulates and provides strength and stretchability to the outer muscular layer of the uterus?
fibrous tissue
Aside from fibrous tissue what else is increased in the muscular layer of the uterus?
elastic tissue
Arrangement of uterine muscular layer
Outer “Hood” > Middle > Inner
Most important muscular layer of the uterus; contains vessels arranged in a figure 8 and act as ligatures to prevent hemorrhage during delivery
Middle Muscular
What does the inner muscular layer of the uterus surround?
Fallopian Tube and Internal Os
Size and shape of the uterus by the 12th week
spherical
Size and shape of the uterus by the 1st week
flat and pear-shaped
Size and shape of the uterus beyond the 12th week
ovoid
Where does the growing embryo displace the intestines?
Laterally and superiorly
Patients complain of pain in which abdominal quadrant during pregnancy?
RUQ
Kinds of positions of the uterus
Dextrorotation, Standing, Supine
What is the danger posed by the dextrorotation of the uterus during pregnancy?
Exposure of uterine vessels (specifically, arteries) as they are pushed anteriorly during a Cesarean section
Implication of the standing uterus
Continuous with the pelvic inlet; presses against the abdomen in women with 3 or more pregnancies; lax abdominal wall (nabanat na eh)
Which vessels does the supine uterus occlude?
IVC and aorta
How do you manage the effects of a supine uterus?
Have the mother lie on her side to ease back pain and vessel occlusion
What do you call contractions during the 1st trimester?
Braxton-Hicks contractions
Are contractions during the 1st trimester a cause for concern?
No. These are painless and irregular and are also known as “false labor”
By what trimester can contractions be detected by bimanual examination (use of both hands; palpation)
2nd trimester
How much of the total blood flow does the uterus receive in non-pregnant women?
1% only
How much of the total blood flow does the uterus receive in pregnant women? (near term)
almost 20% (450-650mL)
Consistency of the cervix in pregnant women?
soft (like lips)
Consistency of the cervix in non-pregnant women?
doughy (like the nose)
True or False: cervical glands undergo both hyperplasia and hypertrophy
True. As opposed to myocytes of the uterus which only undergo hypertrophy
How much of the entire cervical mass do the hypertrophied, hyperplasic cervical glands occupy?
Almost half
True or False: There is an inversion of proliferating columnar glands in the cervix
False. EVERSION.
Contents of the cervical mucus plug
immunoglobulins and cytokines (prevent infection)
When the mucus plug is expelled along with blood during delivery, what is it called?
bloody show
For how long does the corpus luteum maintain progesterone in the endometrium?
6-7 weeks
In benign tumors, do we wait until 8 weeks to remove it from the ovaries?
Yes, to be sure it will not affect any fetus in case the woman is pregnant (it is always safer to let the 6-7 weeks pass)
In malignant tumors, do we wait until 8 weeks to remove it from the endometrium?
No. It’s malignant!
Where does the decidual reaction take place?
On and beneath the ovaries
What is the average diameter of the vascular pedicle (ovarian blood vessels) in pregnant women? In non-pregnant women?
2.6 in pregnant. 0.9 in non-pregnant
When was pregnancy luteoma discovered and who discovered it?
1963, Sternberg
microscopic to >20cm cells that regress spontaneously after delivery
pregnancy luteoma
Does the trophoblast have a capacity to convert androgens and androgen-like steroids to estrogen?
Yes. This is demonstrated in the pregnancy luteoma
What causes theca lutein cysts?
Exaggerated follicle stimulation
Which cyst would show as “honeycomb” in appearance? Pregnancy Luteoma? or Theca Lutein Cysts?
Theca Lutein Cysts
True or False: Pregnancy Luteoma is associated with high levels of hCG (seen in trophoblastic disease-causing-tumors or twin pregnancies)
False. Theca Lutein Cysts
What part of the female reproductive system undergoes the least change?
Fallopian tubes
What is Chadwick’s Sign?
Hyperpigmentation and vascularity of vagina and perineum
Approximately what is the size of the baby’s head?
9.6 cm
True or False: There is an increase in cervical secretions within the vagina
True
What sensations do the breasts have during pregnancy?
Tenderness and paresthesia
Which aspects of the breasts enlarge during pregnancy (by the 2nd month) and contribute to its increase in size?
Veins, ducts, erectile ligaments, Glands of Montgomery
By how much is the metabolism of the mother increased at the 3rd month?
10-20% (plus 10% pa ulit in twin pregnancies)
How many additional calories/day is the requirement of pregnant mothers?
300 cal/day (or 80, 000 kcal)
Average weight gain during pregnancy
25-30 lbs or approximately 12.5kg
Where is fat deposited and concentrated during pregnancy?
central area
True or False: Plasma osmolality increases during pregnancy
False. It decreases. That’s why you have more water retention (there is little water movement)
How much water is retained during pregnancy?
6.5L
How much water is retained by the fetus, placenta, and amniotic fluid?
3.5L
Which have the least amount of water retention in pregnant women? How much exactly?
plasma vol., interstitial tissue and breast size. 1.5 L
water retention of ankles and legs (volume?)
1L
True or False: There is a decrease in venous pressure below the uterus during pregnancy
False. There is an increase because IVC and aorta are partially occluded. This also affects edema in legs and ankles
Decrease in interstitial colloid osmotic pressure is apparent at _____ months and/or _____ weeks
8-9 mos. and/or 20-24 weeks AOG
What is more important in determining fetal weight and birthweight? Amount of water or amount of fat?
Amount of water
True or False: There is maternal blood is rich in fat
False. It is rich in protein.
Where are amino acid concentrations richer? In fetal side? Or in maternal side?
Fetal side. Fetus needs lots of protein!
What is the major energy substrate of fetal and placental metabolism?
Glucose
Mother: hypoglycemia or hyperglycemia?
Trick question. Both BUT hypoglycemia only while fasting. Hyperglycemia mostly due to insulin resistance
By how much lower is the insulin action in pregnancy lowered compared to non-pregnant women?
50-70%
Increase in the concentrations of what may aid in increased insulin resistance?
FFA (free fatty acids)
During fasting, plasma levels of FFA, triglycerides, and cholesterol are higher or lower?
Higher, since the body (and fetus) consumes glucose rapidly first before moving on to proteins and protein derivatives
Ketonemia in pregnant women occur when?
When the body’s glucose storage is significantly decreased
When is fat deposition fastest?
Midpregnancy
Should you have a cholesterol test during pregnancy? Why or why not?
No because cholesterol levels are naturally high and you may have a false positive result for a cholesterol-induced disease
Which kind of cholesterol increases at 25 wks, plateaus until 32 weeks, then declines and remains constant?
HDL
When are cholesterol levels at their lowest?
3rd trimester due to rapid growth
What happens to serum Na and K?
Increases
How much Na and K are retained during pregnancy?
1000 mEq Na and 300 mEq K
What happens to glomerular filtration? To tubular reabsorption? To excretion?
Inc., Inc., Unchanged
What happens to serum concentrations of Na and K during pregnancy?
Slightly lower (due to increased plasma volume)
What happens to serum calcium levels during pregnancy?
Decrease (due to lowered plasma albumin concentration and decreased binding)
What happens to levels of ionized calcium during pregnancy?
Unchanged
What causes serum calcium levels to decrease?
Lowered plasma albumin concentration
How much of 30g of calcium by the 3rd term is deposited in the fetal skeleton?
80%
What mediates doubling of maternal intestinal calcium reabsorption?
Vit. D3
What is the recommended amount of calcium intake for ALL women (pregnant or not)?
1000mg-1200mg (about 2 glasses of milk)
What happens to serum magnesium?
Generally decreases (both ionized and bound)
What happens to the threshold of serum phosphate?
Increased due to increase in calcitonin (calcitonin lowers calcium levels)
True or False: Pregnancy is a hypovolemic state
False. Pregnancy is a HypERvolemic state
How much blood is lost in vaginal delivery?
about 500 mL
How much blood is lost in C-section delivery?
1000-1500 mL
At which trimester is the volume expansion at its greatest?
2nd
In which trimester does volume fall?
3rd
True or False: There is a lowered hematocrit and viscosity by the third trimester.
True. Due to hemodilution
Normal and term hemoglobin level
12.5g/dL
Pregnant hemoglobin level
11g/dL
True or False: Erythrocyte and Reticulocyte counts decrease
False. It elevates.
Occurrence in the bone marrow that causes the elevation of erythrocytes and reticulocytes
erythroid hyperplasia
Body’s natural iron store
300 mg
Total iron content of normal adult women
2.0-2.5 g
How much iron does a pregnant woman need?
1000 mg
How much iron is lost through normal routes of excretion?
200 mg
How much iron is transferred to fetus and placenta?
300 mg
What is the threshold for iron that needs to be met? If it falls below this, may indicate iron deficiency.
11-12.5 g/dL
Condition of an anemic baby with heart failure
hydropsfetalis
True or False: Pregnancy is an Immunosuppressed state
True
Which are decreased during immunosuppression?
IL-2, TNF-B, Interferon-y, (absent) interferon-a, T-cytotoxic 1 cells, T-helper 1 cells
Which are increased in immunosuppression?
IL-4, 6, and 13; Th-2; IgA, IgG, Interleukin-1B
Leukocyte count during pregnancy
5k-12k; It’s normal to have as high as 16
Distribution of cell types CD-8 T lymphocytes and CD-4 T lymphocytes
CD-8 increases, CD-4 decreases
True or False: Alkaline Phosphatase activity decreases during pregnancy
False. It increases.
True or False: Pregnancy is a Hypocoagulative state
False. It is a HypERcoagulative state
Increase of which clotting factors during pregnancy?
All except factors XI and XIII
What do you call platelets whose widths and volumes increase?
Young platelets. These are easily destroyed. The increase in destruction of platelets due to inc. in plasma levels = inc. in young platelets.
What happens to regulatory proteins during hypercoagulable state?
Protein C activity decreased, Protein C resistance increased, Protein S concomitant decrease
What happens to levels of antithrombin?
Unchanged
True or False: Pateints with Antiphospholipid Antibody Syndrome (APAS) do not have problems with coagulation/clotting
False. They have problems, and this encourages deep vein thrombosis from vessel-occlusion
