Maternal Adaptations

Question 1

What happens to the CVS during pregnancy?

Answer 1

Oxygen consumption increases

• foetal oxygen requirements
• increasing maternal metabolic rate

Question 2

What happens to the plasma volume?

Answer 2

Increases

- increased afterload

Question 3

What happens to the stroke volume?

Answer 3

Increases

Question 4

What happens to the systemic vascular resistance?

Answer 4

Decreases due to vasodilation caused by progesterone

Question 5

What happens to the heart rate?

Answer 5

Increases by 10-20 bpm

Question 6

What happens to the cardiac output?

Answer 6

Increases

Question 7

What times throughout pregnancy are women with pre-existing heart disease most at risk?

Answer 7

Labour

Question 8

What are the ECG changes seen in pregnancy?

Answer 8

Atrial + ventricular ectopics
Left axis shift
ST depression + T wave inversion in inferior + lateral leads

Question 9

What happens to urinary output?

Answer 9

Increases due to increased renal blood flow due to vasodilation by progesterone

Question 10

What can occur in pregnancies to the renal system?

Answer 10

Ureter compression
UTIs
Urinary incontinence

Question 11

Why does ureter compression occur?

Answer 11

Growth of the foetus

Question 12

What is the effect of ureter compression?

Answer 12

Hydronephrosis - back flow of urine

Question 13

Why do UTIs occur?

Answer 13

Stasis and increased pressure due to foetal position

Causes backflow to the kidneys

Question 14

Why does urinary incontinence occur?

Answer 14

Pelvic floor muscles weakened

Question 15

What can be found in the urine of pregnant women?

Answer 15

Glucose
Calcium
Protein
Bicarbonate

Question 16

What happens to plasma osmolarity?

Answer 16

Decreased

Question 17

What happens to progesterone levels?

Answer 17

Increased

Question 18

What are the effects of progesterone?

Answer 18

Relaxes smooth muscle
Slows gastric emptying
Vasodialtion

Question 19

What happens to oestrogen levels?

Answer 19

Increased

Question 20

What are the effects of oestrogen?

Answer 20

Breast tissue growth
Water retention
Increased protein synthesis

Question 21

What other hormone is produced?

Answer 21

Relaxin

Question 22

What is the effect of relaxin?

Answer 22

Softens the cervix and pelvic ligaments in preparation for birth

Question 23

What happens to prolactin levels?

Answer 23

Increased

Question 24

What are the effect of prolactin?

Answer 24

Stimulate breast development

Promotes lactation

Question 25

What can occur in pregnancy due to the GI system?

Answer 25

Acid reflux | Constipation

Question 26

Why does acid reflux occur?

Answer 26

Relaxation of the lower oesophageal sphincter due to progesterone

Question 27

Why does constipation occur?

Answer 27

Slowing of peristalsis due to progesterone

Question 28

How does immunity change in pregnancy?

Answer 28

Shifts from T helper 1 (cell mediated immunity) to T helper 2 (humoral immunity)

Question 29

What is the effect of hCG on maternal immunity?

Answer 29

Reduces levels of - IgA - IgG - IgM

Question 30

What happens to the respiratory system?

Answer 30

Increased oxygen demand - increases respiratory drive

Question 31

What happens to the tidal volume?

Answer 31

Increases

Question 32

What happens to respiratory rate?

Answer 32

Stable

Question 33

What is the ABG pattern in pregnancy?

Answer 33

pH 7.4-7.45 pO2 increased pCO2 decreased Mild respiratory alkalosis

Question 34

What are the early changes to the respiratory system?

Answer 34

Increase in subcostal angle Increase transverse diameter Increase circumference of chest

Question 35

What are the later changes to the respiratory system?

Answer 35

Elevation of the diaphragm

Question 36

What happens to glucose levels in pregnancy?

Answer 36

Increase in insulin resistance due to placental lactogen Hyperplasia of pancreatic B cells - increase insulin levels

Question 37

What is gestational diabetes?

Answer 37

Diabetes first diagnosed in pregnancy

Question 38

How is gestational diabetes diagnosed?

Answer 38

Glucose tolerance test at 28 weeks - fasting glucose > 5.6 - 75g sugar - 2 hours - glucose >7.8

Question 39

What is the effect of gestational diabetes on foetus?

Answer 39

Foetal macrosomia = larger baby Post delivery foetal hypoglycaemia - hyperinsulinaemia still present

Question 40

What are the effects of gestational diabetes on the pregnancy?

Answer 40

Increased risk of stillbirth Increased risk of requiring induction of labour Polyhydraminos = excess amniotic fluid Shoulder dystocia

Question 41

What is pre-eclampsia?

Answer 41

Raised blood pressure and proteinuria in pregnancy

Question 42

How is pre-eclampsia diagnosed?

Answer 42

>140/90 on 2 separate occaisions >4 hours apart Proteinuria

Question 43

What causes pre-eclampsia?

Answer 43

Impaired trophoblast differentiation + invasion causing insufficient placental bloodflow

Question 44

What are risk factors for pre-eclampsia?

Answer 44

``` >40 History of pre-eclampsia Pre-pregnancy obesity Diabetes Pre-existing hypertension Family history ```

Question 45

What do you give patients with pre-eclampsia risk factors?

Answer 45

75mg aspirin OD

Question 46

What are the symptoms of pre-eclampsia?

Answer 46

``` Headache Visual disturbance RUQ pain Seizures Hyperreflexia Oedema ```

Question 47

What are the effects of the foetus with pre-eclampsia?

Answer 47

IUGR = intrauterine growth constriction | Still birth

Question 48

How is pre-eclampsia managed?

Answer 48

Anti-hypertensives If hyper reflexive - magnesium sulphate Main treatment = delivery

Question 49

Why do you get anaemia in pregnancy?

Answer 49

Plasma volume increases 50% | Red cell mass only increases 20%

Question 50

How is anaemia in pregnancy managed?

Answer 50

Ferrous sulphate