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Reproductive System > Maternal Adaptations in Pregnancy > Flashcards

Maternal Adaptations in Pregnancy Flashcards

1
Q

What immunological changes occur in pregnancy?

A

Mother in an immunosuppresed state otherwise the fetus will be recognised as ‘foreign’ by the mother

There is an increase in TH2 cells (regulatory) which inhibits cytotoxic TH1 cells

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2
Q

Why do respiratory changes occur in pregnancy?

A

Baby needs: Increased O2 delivery and Increased CO2 clearance

Mother needs: continued O2 delivery to organs, Increased O2 supply to meet metabolic demands, Increased CO2 clearance

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3
Q

How does the mother accommodate for increased respiratory needs in pregancy? What induces this effect?

A

Increased Ventilation by increasing Tidal Volume

Induced by progesterone acting directly on the respiratory centre which sensitises the chemoreceptors to CO2 changes

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4
Q

What would you expect to see on ABG in a pregant woman?

A

ABG would show respiratory acidosis this is normal

If you saw ‘normal’ ABG this would be abnormal

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5
Q

Why does dyspnea occur in 60-70% of pregnant women?

A

Due to hyperventilation and decreased PaCO2

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6
Q

What changes to glucose and amino acids occur in pregnancy?

A
  • fat is laid down in the mother to help meet the demands of pregnancy
  • reduction in maternal blood glucose and amino acid concentrations
  • dimished maternal responsiveness to insulin
  • increased in maternal free fatty, ketones and TAG as an alternative source of fuel
  • increased insulin release in response to a normal meal
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7
Q

Which hormone causes an increase in maternal insulin resistance?

A

hPL - Human Placental Lactogen

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8
Q

Which hormone increases appetite in the first half of pregnancy and diverts glucose → fat synthesis

A

Progesterone

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9
Q

What is gestational diabetes?

A

Glucose Intolerance that is 1st recognised in pregnancy but does not persist after delivery

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10
Q

Why does gestational diabetes occur?

A

Occurs when the resistance to insulin is not met with a compensatory rise in maternal insulin leading to maternal hyperglycaemia

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11
Q

What are the risks associated with gestational diabetes?

A
  • Increased birth weight → shoulder dystocia
  • Congenital defects
  • Stillbirth
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12
Q

How are the mothers energy needs met in late pregnancy?

A

Metabolising peripheral fatty acids

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13
Q

What cardiovascular changes occur in early and late pregnancy?

A

Early: increased stroke volume

Late: increased heart rate

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14
Q

What effect does progesterone have on the maternal cardiovascular system?

A

Increasing levels of progesterone causes smooth muscle relaxation → vasodilation →drop in mean arterial blood pressure

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15
Q

How is Stroke Volume increased in pregnancy?

A
  1. Oestrogen and Progesterone stimulate the kidney to release renin
  2. Rening converts angiotensinogen ⇒ angiotensin I
  3. ACE from the lungs converts angiotensin I ⇒ angiotensin II
  4. Angiotensin II acts on adrenal glands to release aldosterone
  5. Aldosterone acts on the kidnyes to stimulate reabsorption of NaCl and H2O
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16
Q

Why do women often get swollen ankles and hands in pregnancy?

A

Increased RAAS causes peripheral odema

17
Q

How does BP change throughout pregnancy

A

Trimester 1 and 2 = lower blood pressure

Returns to normal by 3rd trimester

18
Q

Why is pregnancy a pro-thrombotic state?

A

Increased clotting factors and fibrinogen as well as decreased fibrinolysis

19
Q

Pro-thrombotic state in pregnancy can lead to thromboembolic disease, which drug would you use to treat this?

A

Heparin

You cannot give warfarin as this can cross the placenta and is teratogenic

20
Q

Why can you sometimes see physioligcal anaemia in pregnancy?

A
  • In pregnancy, see increased blood volume but the RBC mass does not increase to the same extent
    • Causes a dilutional anaemia
  • Can also occur due to low iron/ folate
21
Q

What renal changes do you see in pregnancy?

A
  • Increased GFR (~50%) due to systemic vasodilation increasing renal blood flow
    • causes increased creatinine clearance
    • Serum levels of urea and creatinine fall
  • Decreased PCT absorption → high GFR = less time for glucose absorption
    • Gives glucosuria
  • Increased size of kidneys and ureters
    • Decreased speed of urine passage
  • Loss of tone and perilsatalis of ureter can cause urine backflow → hydronephrosis
22
Q

What GI changes occur in pregnancy?

A

Progesterone causes relaxation of smooth muscle throughout GI tact leading to:

  • Decreased LOS tone → GORD
  • Decreased small bowel motility → constipation
  • Decreased lage bowel motility → constipation from increased water absorption
  • Decreased gall bladder contractiliy → gallstones
23
Q

Why would you see a rise in ALP in liver function tests of a pregnant woman?

A

The placenta synthesises ALP

24
Q

What happens to maternal levels of Ca2+ and why?

A
  • Placenta contributes to synthesis of 1.25 dihydroxycholecalciferol D3 (calcitriol)
  • Increases maternal calcium absorption
  • More Ca2+ is available for the fetus → maximal bone growth
25
Q

How do levels of thyroid hormone change in pregnancy?

A
  • The uterus takes up the mothers free thyroxine
  • Mother increases thryroxine production as hCG has a similar effect to TSH
  • Increased T4 levels at week 10
26
Q

What musculoskeletal changes occur in pregnancy?

A
  • Change in center of gravity
    • increased lordosis and kyphosis
    • Forward flexion of the neck
  • Abdominal muscles stretch
    • impedes posture
  • Increased mobility of sacroiliac joint and pubic symphisis
  • Fluid retention can compress structures e.g. median nerve → carpal tunnel
27
Q

What is pre-eclampsia?

A

A condition of placental insufficiency characterised by hypertension and proteinuria

28
Q

What risk factors pre-dispose to pre-eclampsia?

A
  • Chronic / gestational hypertension
  • Pre-existing renal disease
  • Diabetes
  • Obesity
  • Family History
  • 1st pregnancy
  • Extremes of age
  • Previous pre-eclampsia
  • Multiple pregnancies
  • IVF
29
Q

What are some of the mild symptoms of pre-eclampsia?

A
  • elevated blood pressure
  • elevated protein urine
  • weight gain exceeding 2lbs/ week
  • Water retention/ swelling
30
Q

What are some of the signs and symptoms of sever pre-eclampsia?

A
  • Headache
  • Changes in vision
  • Nausea and vomiting
  • Pain in abdomen/ back
31
Q

What are the complications of pre-eclampsia?

A

Can develop to eclampsia

  • Seizure
  • Cerebral Hemorrhage
  • Renal failure
  • Hepatic failure/ rupture
  • Pulmonary oedema
  • DIC / thrombocytopenia

In the fetus:

  • growth restriction
  • fetal distress
  • premature delivery
  • stillbirth
32
Q

How would you treat pre-eclampsia?

A
  • stabilise BP
  • Monitor blood results
  • Monitor baby
  • MgSO4 for neuroprotection from seizures
  • Fluid restrict mother + monitor output
  • Deliver baby

Reproductive System (18 decks)

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