Maternal adaptations to pregnancy Flashcards
During pregnancy, both pulmonary and systemic vascular resistance _______.
- decrease
What is the trend in arterial blood pressure during pregnancy?
- decreases to a nadir at mid-pregnancy and rises thereafter
Elevation in this hormone may also cause hydronephrosis and hydroureter during pregnancy.
- progesterone
Why are women hypercoagulable during pregnancy?
- coagulation factors are increased (except for 11, 13)
What is the change in cardiac output with pregnancy? What maneuver helps you notice this change the best?
- 35-50% increase in CO during pregnancy
- best seen when a woman is on her left lateral supine position
During pregnancy all liver enzymes are unchanged except:
- Alk Phos increases (d/t placental isoenzyme)
What is the recommended weight gain during pregnancy for someone with the following BMI:
a. <18.5
b. 18.5-24.9
c. 25-29.9
d. >30
a. <18.5 = 12.5-18 kg
b. 18.5-24.9 = 11.5-16 kg
c. 25-29.9 = 7-11.5 kg
d. >30 = 5-9 kg
Why can’t diabetes be diagnosed with a urine dip during pregnancy?
- GFR increases so glucosuria is not necessarily abnormal
Physiological dyspnea during pregnancy is likely due to what hormonal change?
- secondary to progesterone increase
What is the medical treatment for mastitis?
- Dicloxacillin
This is defined as pigmentation of the linea alba.
- linea nigra
Increased pigmentation during pregnancy is a result of an increase in what hormone?
- increase in melanocyte stimulating hormone
If a pregnant patient presents with pruritus without a rash, what should you be concerned about?
- Intrahepatic cholestasis of pregnancy
What is the difference in blood loss between an average vaginal delivery and a Cesarean section?
- vaginal delivery = <500cc
- C-section = 1000 cc
Group 3 lesions include what 3 conditions?
- pulmonary hypertension
- Aortic coarctation with valve involvement
- Marfan Syndrome with aortic dilation ( > 4 cm)
A 26-year-old female calls your office 4 days after delivery of her first baby. She complains of fever, chills and breast redness. She is breastfeeding. What diagnosis should you be concerned about?
- Mastitis
This is defined as a butterfly pigmentation of the face.
- chloasma gravidarum
What is the cause of low TSH concentrations during pregnancy?
- Rising levels of serum hCG
What cause the physiological anemia during pregnancy?
- increase in plasma (40-45%) > increase in erythrocytes (33%)
During pregnancy, inspiratory volumes (e.g. VC, IC) ________; while expiratory volumes (e.g. RV, RC, FRC) ________.
- inspiratory volumes = increase
- expiratory volumes = decrease
What change is seen with lung residual volume during pregnancy?
- decreases
By 6 weeks post-partum the patient should have lost how many pounds?
10 lbs
What is Chadwick’s sign?
characteristic violet color of the vagina during pregnancy d/t hyperemia
What are the total iron requirements of pregnancy?
- 1,000 mg
If a patient presents with mastitis and an abscess what is the treatment?
- I&D
- systemic antibiotics
What is the most common surgical emergency in pregnancy and during which trimester are you most likely to see it?
- appendicitis
- rupture during 3rd trimester
What anatomical change occurs to the appendix during pregnancy?
- it is displaced upward and laterally
What 3 hormones contribute to increases in uteroplacental blood flow?
- estrogen
- progesterone
- nitric oxide
What are the 2 common treatments for iron deficiency?
- oral supplementation + vitamin C
- iron infusions
What are the normal values for pH, PaO2, PaCO2, HCO3 during pregnancy?
- pH = 7.45 (higher than normal)
- PaO2 = 100 (higher than normal)
- PaCO2 = 30 (lower than normal)
- HCO3 = 20 (lower than normal)
What is the leading cause of maternal mortatility?
- cardiac disease
A pregnant women presents with frequent vomiting. Her labs results are as follows:
- high serum hCG level
- low TSH level
- normal T3/T4
What condition are you concerned for?
- Hyperemesis gravidarum
Uterine hypertrophy is stimulated primarily from what hormone?
- Estrogen
What murmur can be head in 90% of women?
- systolic murmur
On average, what is the total weight gain during the course of a single pregnancy for a healthy woman?
11 kg