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OBS > Maternal Adaptations to Pregnancy > Flashcards

Maternal Adaptations to Pregnancy Flashcards

1
Q

What does not affect weight gain in pregnancy

A

smoking

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2
Q

Fetus is dependant on mother for

A

glucose
calcium
Thyroxine.

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3
Q

Insulin resistance in mother is max @

A

24-28 wks of pregnancy

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4
Q

in pregnancy there is Fasting ____ and PP ______

A

fasting hypoglycemia and PP hypreglycemia

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5
Q

Vit D req in pregnancy

A

10 mcg / 400 IU

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6
Q

RDA of calcium in Pregnancy

A

1200 mg

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7
Q

Fat metabolism in pregnancy

A

Hyperlipidemia .

all are inc. = LDL, HDL. VLDL, Cholesterol, Lipoprotein, Apolipoprotein.

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8
Q

Shape of Non Pregnant Uterus

A

Pear.

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9
Q

Shape of Pregnant uterus.

A

Globular to Spherical (12 w) to Ovoid

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10
Q

Braxton hicks contraction.

A

Sporadic, Infrequent contractions in second trimester.

False Labour pain.

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11
Q

VEGF and PGF in Normal and PIH.

A

Inc in Normal preg and dec in PIH

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12
Q

microRNAs that cause remodelling of spinal arteries.

A

mir - 34 and mir 17-92

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13
Q

Predictors of PIH

A

VEGF - dec
PGF - dec
S-Flt1 - inc
NO - dec

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14
Q

Appearance of Cervical mucus on slide.

A

Beaded appearence

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15
Q

Flora of Vagina.

A

Lactobacilli - Doderlein bacteria.`

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16
Q

pH of vagina in pregnancy

A

3.5

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17
Q

only organism that can survive acidic media.

A

Candida.

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18
Q

Most common vaginitis in pregnancy

A

Candidiasis.

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19
Q

Theca lutein cyst is seen in

A

Inc HCG conditions - Molar P, Choriocarcinoma, Twin Preg.
Placentomegaly.
Hyperthyroidism and Preeclampsia.

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20
Q

KFC in colostrum .

A

Dec K- Potassium
F- Fat.
C- Carbs

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21
Q

Extra caloric req in preg.

A

+ 350 kcal/day

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22
Q

Extra Caloric req in lactation.

A

+ 650 kcal/day.

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23
Q

Blood volume ___ during pregnancy.

A

Inc by 40-45 %

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24
Q

Plasma volume ___ during pregnancy.

A

Inc by 40 %

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25
Q

RBC volume ___ during pregnancy

A

Inc by 20%

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26
Q

Viscosity ____ during preg.

A

Dec coz of hemodilution = Physiological Anemia.

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27
Q

Hb Mass ____ during preg

A

Inc. so Inc oxygen carrying capacity.

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28
Q

Hb Concentration ___ during preg.

A

Decreases.

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29
Q

Total plasma protein ___ during preg.

A

Inc

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30
Q

Plasma protein concentration ___ during preg.

A

dec.

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31
Q

Globulin ___ during preg.

A

Inc.

SHBG and Thyroid binding globulin - inc

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32
Q

Albumin ___ during preg.

A

Dec.

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33
Q

WBC ___ during preg

A

Inc

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34
Q

TLC during Preg

A

15000

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35
Q

DLC during preg

A

Neutrophils and T lymphocytes - Inc

Monocytes- Dec

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36
Q

Pregnancy is a _____ state

A

Diabetogenic. Immunocompromised state. Hypercoagulable state.

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37
Q

Humoral Immunity _____ in preg

A

Inc - TH2

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38
Q

Cell mediated immunity ____ in preg

A

Dec - TH1

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39
Q

IL- that inc in pregnancy

A

4, 10, 13

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40
Q

Clotting factors that dec in Pregnancy

A

Factor 11 and 13

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41
Q

Inflammatory markers ____ during preg.

A

Inc - ESR and CRP

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42
Q

Fibrinolytic Activity ____ during preg

A

Dec - More clots.

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43
Q

TPA - tissue plasminogen activator ___ during preg.

A

Inc.

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44
Q

Bleeding time and clotting time ____ during preg.

A

Unchanged.

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45
Q

parameters of iron metabolism____ during preg.

A

Dec Exception- Serum transferrin and TIBC - Inc

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46
Q

RDA of Iron during pregnancy

A

4-6 mg / day

47
Q

Anemia Mukt bharat Programme.

A

60 mg elemental iron + 500 mcg folic acid

48
Q

Iron Salt in Anemia mukt programme.

A

Ferrous sulphate.

49
Q

Iron salt in Mala D and Mala N

A

Ferrous fumarate.

50
Q

Hyperemesis gravidarum

A

Excessive vomiting plus Wt loss, Dehydration, Alkalosis, Hypokalemia, Starvation ketosis.

51
Q

Mx of Mild Morning sickness

A

Vit B6
Doxylamine.
Doxylamine + Pyridoxine (b6)
Diphenhydramine.

52
Q

Mx of Moderate Vomiting.

A

Promethazine.
Prochlorperazine.
Metoclopramide.
Ondansetron.

53
Q

Mx of Severe vomiting.

A

IV fluids + Thiamine.

IV metoclopramide / Promethazine / Promethazine / Ondansetron.

54
Q

Mx of Intractable vomiting.

A

Enteral or parenteral nutrition.

55
Q

Resp changes in Preg.

A

RV- Residual Volume - Dec.
ERV- Exp reserve Volume - Dec
TV- Tidal volume - Inc.
Minute Ventilation- Inc.

56
Q

Transverse diameter ___ during preg.

A

inc by 2 cms.

57
Q

Circumference of chest ___ during preg.

A

Inc by 6 cms.

58
Q

Subcostal angle ___ during preg.

A

Inc from 68 to 103 degree

59
Q

Functional residual capacity ___ during pregnancy.

A

Dec.

FRC= RV + ERV

60
Q

Inspiratory capacity ____ during pregnancy

A

Inc.

IC= IRV + TV

61
Q

Total lung capacity ___ during preg.

A

Normal or Slightly dec.

62
Q

Proteinuria >300 mg/dl in pregnancy

A

PIH

63
Q

GFR ___ during Pregnancy

A

Inc

64
Q

S. urea, S. uric acid, S. Creatinine ___ during pregnancy

A

Dec.

65
Q

Size of liver ___ during pregnancy

A

Normal / unchanged

66
Q

All liver enzymes _____ During Pregnancy

A

Decrease.

Excpt- Alkaline phosphatase.

67
Q

Serum alkaline phosphatase ___ during pregnancy

A

Increase

68
Q

Serum alkaline phosphatase is synthesised by ____ during pregnancy

A

Liver and placenta

69
Q

Cholestasis of pregnancy aka

A

recurring jaundice of pregnancy

70
Q

Icterus gravidarum aka

A

Recurring jaundice or Cholestasis of pregnancy

71
Q

Icterus gravidarum is seen in

A

3rd trimester

72
Q

Cholestasis / Icterus gravidarum - Pathogenesis

A

Improperly cleared bile acids leads to accumulation causing preterm labour, RDS, fetal distress

73
Q

Cholestasis - Obstetric MX

A

TOP @ 38-39 wks

74
Q

Cholestasis of pregnancy - Medical Mx

A

Anti histamines for pruritus

DOC for bile acid removal- Ursodeoxycholic

75
Q

Why is Cholestyramine C/I in cholestasis of pregnancy

A

It reduces absorption of vit k causing Hemorraghic problems

76
Q

MCC of acute liver failure in pregnancy

A

Acute fatty liver of pregnancy

77
Q

Acute fatty liver of Pregnancy- Pathogenesis.

A

Defective Long chain fatty acid oxidation .
Gene defective is LCH AD
Long chain 3 Hydroxyacyl CoA Dehydrogenase.
Accumulation leads to Acute liver injury and Hemoconcentration leading to Ascites and pulmonary edema with renal failure and fetal death.

78
Q

Clinical features of Acute fatty liver of pregnancy

A

Nausea vomiting in 3rd trimester
1 week later jaundice.
inc - BP, Proteinuria and edema.

79
Q

Acute fatty liver of pregnancy- Investigative findings.

A 
inc bilirubin - <10
Inc SGOP, SGPT <1000
Inc alkaline phosphatase
dec Clotting factors.
inc BT, CT, PTT
inc S. Urea, S. Creatinine, S. Uric Acid.
80
Q

Acute fatty liver - Mx

A

TOP - Immediate.

Mode of delivery- Vaginal > CS

81
Q

Acute liver injury - Complications in recovery phase.

A

Pancreatitis and diabetes insipidum.

81
Q

Acute liver injury - Complications in recovery phase.

A

Pancreatitis and diabetes insipidum.

81
Q

Acute liver injury - Complications in recovery phase.

A

Pancreatitis and diabetes insipidus.

81
Q

Acute liver injury - Complications in recovery phase.

A

Pancreatitis and diabetes insipidum.

81
Q

Acute liver injury - Complications in recovery phase.

A

Pancreatitis and diabetes insipidum.

82
Q

Cholestasis - best Investigation

A

inc Serum Bile acids.
mild jaundice - <4-5
SGOT and SGPT - normal or slightly elevated <250 IU/l
Alkaline phosphatase in inc.

83
Q

Hormones produced by adrenal glands.

A

Mineralocorticoid- Aldosterone.
Glucocorticoid- Cortisol.
Androgens- Testosterone.

84
Q

All hormones produced by Adrenal glands ____ during pregnancy excpt..

A

Inc…

Excpt DHEA and DHEA-S

85
Q

Inc Na+ and K+ _____ is seen in pregnancy

A

Retention.

86
Q

Hormones produced by Antr Pituitary

A

LH, FSH, TSH, GH, ACTH, Prolactin.

87
Q

Hormones produced by Antr pituitary _____ during pregnancy

A

Inc

Excpt- LH and FSH - due to inc Negative feedback by progesterone and estrogen.

88
Q

Platelet count _____ during pregnancy

A

Decreases.

Known as Benign gestational thrombocytopenia.

89
Q

MCC of Hypothyroidism in pregnancy in developing countries.

A

Iodine deficiency

90
Q

MCC of hypothyroidism in pregnancy in developed countries

A

Hashimoto thyroiditis.

TH1 mediated ds.

91
Q

RDA of iodine in pregnancy

A

250 mcg / day

92
Q

Iodine req ____ during pregnancy

A

Ince

93
Q

Thyroid binding globulin ____ during preg

A

inc .

94
Q

Free T3 and Free T4 levels ____ during pregnancy

A

Normal coz of Inc Thyroid binding globulins.

95
Q

Size of thyroid ___ during pregnancy

A

Inc.

96
Q

T3 and T4 levels ____ during pregnancy .

A

inc.

97
Q

Dose of Thyroxine should be ______ in preg.

A

increased by 30-50 %

98
Q

Size on Pituitary _____ during pregnancy

A

Inc by 135 %

99
Q

SHEEHAN syndrome.

A

Postpartum necrosis of Anterior pituitary due to Excessive blood loss due to PPH

100
Q

Globulin, FIbrinogen, Leukocytes and Transferrin levels _____ during pregnancy

A

Inc

101
Q

Acute fatty liver of acid : S. Bilirubin level.

A

<10 mg/dl

102
Q

Cholestasis of liver during pregnancy : S. Bilirubin level

A

< 5 mg/dl

103
Q

Colostrum contains all in excess except

A

KFC

104
Q

Fibrin stabilizing factor ____ during pregnancy

A

Dec

105
Q

____ cells predominate in vagina during pregnancy

A

Intermediate cells

106
Q

Inspiratory capacity _____ during pregnancy

A

Increases .

IC = IRV + TV

107
Q

Arterio-venous Oxygen gradient ____ during pregnancy

A

Dec

108
Q

Theca lutein cyst is seen in

A

Twin preg.
Hyperthyroidism.
Diabetes.

109
Q

What causes Theca lutein cyst

A

inc HCG

110
Q

Hyperemesis gravidarum is not associated with

A

post dated pregnancy .

OBS (13 decks)

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