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Life Cycle > Maternal changes > Flashcards

Maternal changes Flashcards

1
Q

How may pregnancy precipitate maternal illness?

A
  • exacerbate a pre-existing condition

- uncover a hidden or mild condition

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2
Q

What are the main changes that occur during pregnancy for the woman?

A
  • increased uterine size
  • increased metabolic requirements (of uterus)
  • structural and metabolic demand of foetus
  • foetal waste removal
  • production of amniotic fluid
  • preparation of delivery and puerperium
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3
Q

Which hormones mediate the maternal changes during pregnancy?

A

PLACENTAL PEPTIDES
hCG, hPL, GH

MATERNAL STEROIDS
placenta takes over oestrogen and progesterone production at ~ wk 7

PLACENTAL/FOETAL STEROIDS
progesterone, oestradiol, oestriol

PITUITARY PEPTIDES
GH, thyroid hormones, PL, CRF

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4
Q

What is the general effect of placental steroids during pregnancy?

A 
Profound vasodilation 
Uterine quiescence (inhibits contraction during pregnancy)

effects on:

  • RAAS (increased)
  • Respiratory centre (increased RR and minute ventilation)
  • GI tract (reduced motility)
  • blood vessels
  • uterine myometrial contractility
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5
Q

How much weight gain occurs during pregnancy?

A

TOTAL: 12.5-13kg

failure to gain or sudden change needs to be monitored

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6
Q

What are the maternal differences to energy balance during pregnancy?

A

INCREASED ENERGY
increased output: respiration and CO
increased storage: for foetus, labour and puerperium

FAT/PROTEIN GAIN (4-5kg)

  • increased consumption
  • reduced use
  • mainly laid down in ANTERIOR ABDO WALL
  • utilised in late pregnancy and puerperium
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7
Q

What happens to the BMR during pregnancy?

A

BMR = basal metabolic rate
INCREASED generally

MID GESTATION: +350kcal/day
LATE GESTATION: +250kcal/day

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8
Q

What occurs to the MATERNAL reserves of glucose during the 1st trimester?

A
  • beta cell hyperplasia
  • hyperinsulinaemia
  • fasting hypoglycaemia (relative)
    laid down as glycogen stores and used by muscle
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9
Q

What occurs to the FOETAL reserves of glucose during the 2nd trimester?

A
  • hPL, E2 and cortisol: INS resistance in mother
    (less GLU into stores)
  • increased glucose available in serum (more crosses placenta)
    => this can cause GDM
  • INS
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10
Q

How do placental steroids affect the RAAS system during pregnancy?

A

[E2 and P]

  • sodium retention
  • osmostat reset
  • decreased thirst threshold
  • reduced plasma oncotic pressure (hypoalbuminaemia)
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11
Q

What effects does oedema caused by RAAS activation have during pregnancy?

A
  • leakage: swollen ankles
  • softening of lungs
  • softening of connective tissue ligaments (prepare for labour)
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12
Q

How is maternal respiration affected during pregnancy?

A

INCREASED O2 CONSUMPTION

  • hypercapnia in central respiratory centre
  • thoracic anatomy: ribs displaces upwards and flare outwards
  • breathing more deeply
  • increased minute volume (+40%)
  • arterial PO2 increases (+10%)
  • arterial PCO2 decreases (-15-20%)
    FACILITATES GAS TRANSFER TO FOETUS
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13
Q

What maternal blood changes occur during pregnancy?

A
  • increased maternal blood volume (+40%)
  • increased red cell mass (+18%) due to elevated EPO
    BUT HAEMODILUTION overall
  • increased white blood cells and reduced platelets
  • oestrogen stimulate clotting factor synthesis from liver
    => HYPERCOAGUBLE blood
  • increased iron absorption efficiency from gut
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14
Q

How may foetal hypoxia occur in utero?

A

smoking increases maternal carboxy-Hb

permanent change to Hb

reduced O2 binding capacity

but increased binding of CO to HbF

= foetal hypoxia

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15
Q

What maternal changes in the heart occur during pregnancy?

A

EXPANDING UTERUS

  • left axis deviation of heart
  • ECG changes and altered heart sounds

INCREASED CARDIAC OUTPUT

  • increased HR and SV
  • +40% by 28 weeks (max.)
  • CO increase for maternal muscle and foetal supply
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16
Q

Why does the maternal stroke volume increase during pregnancy?

A

oestrogen/progesterone stimulate RAAS

Aldosterone axis promotes water retention

increased plasma volume

=> INCREASED SV

17
Q

What maternal changes in the vascular system occur during pregnancy?

A

REDUCED PERIPHERAL RESISTANCE

  • increased CO
  • vasodilation

NEOANGIOGENESIS (+ increased flow)

  • uterus, placenta, muscle, kidneys and skin
  • spider naevi: extra capillaries in skin to assist heat loss
18
Q

What maternal changes in the GI tract occur during pregnancy?

A

[Steroid effect]

  • increased appetite and thirst
  • reduce GI motility (constipation)
  • relaxed lower oesophageal sphincter (acid reflux)
19
Q

What is folate involved in the synthesis of?

A
  • DNA production (S phase)
  • global growth
  • RBC synthesis
20
Q

What maternal changes in the urinary system occur during pregnancy?

A

DILATION+RELAXATION OF URINARY TRACT
increased UTI due to urinary stasis

INCREASED BLOOD FLOW TO KIDNEY

  • increased GFR
  • increased clearance of creatinine, urea and uric acid
21
Q

What maternal changes in the uterus occur during pregnancy?

A

huge increase in muscle mass and blood flow

muscle fibres grow in SPIRAL formation

when they contract, they will push baby out of birth canal

22
Q

What are the different types of C-section used in delivery?

A

USCS: upper segment
rare performed in modern medicine
increased risk of bleeding
reduced healing time

LSCS: lower segment
less bleeding
heals better

23
Q

What maternal changes in the cervix occur during pregnancy?

A

Main function: retain pregnancy

  • increased vascularity
  • softening and expansion prep from 8 wks (breakdown and oedema of connective tissue)
  • gland proliferation (increased mucosa, mucus and anti-infective functions)
  • mucus plug: created by columnar glandular epithelium cells
24
Q

What processes occur post-delivery to return maternal physiology to normal?

A

Dramatic and rapid fall in steroids on delivery of the placenta

Most endocrine-driven changes return to normal rapidly

Uterine muscle rapidly looses oedema but contracts slowly: never returns to pre-pregnancy size

Removal of steroids permits action of raised prolactin on breast

Cardiovascular adaptation will return to normal within 2 weeks post-delivery

Life Cycle (29 decks)

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