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maternal changes in pregnancy Flashcards

1
Q

what are the main causative factors for physiological changes in maternal women

A
  • high steroid levels (high oestrogen and progesterone)
  • mechanical displacement (huge mass in abdomen)
  • requirements of foetus
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2
Q

maternal changes designed to cope with pregnancy

A
  • An increased size of the uterus
  • Increased metabolic requirements of the uterus
  • Structural and metabolic requirements of the foetus
  • Removal of foetal waste products
  • The production of amniotic fluid
  • Preparation for delivery and puerperium
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3
Q

effect of placental peptides on mother

A

hCG released first
hPL (human placental lactogen) also released

hPL is v similar to growth hormone. it causes woman to become hypertensive and increases glucose in blood (is antiinsulin.

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4
Q

effect of maternal steroids on mother

A

after 7 weeks, CL dies as no longer required, placenta takes over oestrogen + progesterone production (high concs)

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5
Q

what are placental and fetal steroids

A

mainly progesterone and oestrogen

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6
Q

what are maternal and fetal pituitary hormones

A

GH released
increase thyroid hormone production (inc, metabolic rate)
prolactin produced (allows lactation after delivery)
CRF (corticotropin releasing factor) released

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7
Q

effects of high placental steroids

A

high steroids can act on different receptors other than their own - so can affect multiple systems:

  • Affect the RAAS system (thus blood pressure)
  • Affect respiratory centre
  • GI tract
  • Blood vessels (cause massive vasodilation)
  • Uterine myometrial contractility
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8
Q

why do we need to increase energy levels in pregnancy

A
  • increased output of energy, through increased respiration and cardiac output
  • store energy for foetus to use
  • for labour and puerperium
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9
Q

how much weight gain occurs in pregnancy

A

12.5-13kg put on

4-5kg in fat and protein stores in anterior abdominal wall.

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10
Q

how does basal metabolic rate change in pregnancy

A

350kcal/day during mid-gestation.

It increases by about 250kcal/day by late gestation.

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11
Q

how is mother adapted to provide child with high glucose

A

mother becomes insulin resistent due to hPL

so can have constant stream of glucose across the placenta by faciltated diffusion

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12
Q

how is mother adapted to provide child with high glucose in first trimester

A

pacreatic beta cells increase in number due to slight insulin resistance .’.
plasma insulin increases .’. more glucose used up as stores/used by muscle
so maternal glucose stores are built.
(fasting serum glucose decreases)

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13
Q

how is mother adapted to provide child with high glucose in second trimester

A

hPL and steroid levels high = high insulin resistance
insulin cannot overcome this resistance .’. less glucose enters sores .’. serum glucose increases .’. glucose conc gradient increases at the placenta
IS NORMAL - NOT DIABETES

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14
Q

why may a pregnant lady develop diabetes in 2nd trimester

A

in 2nd trimester in general, woman becomes insulin resistant .’. hyperglycaemic. IS NORMAL.
but if woman has family history of diabetes, , is overweight or has bad genes this may push her over the edge and she becomes diabetic (gestational diabetes).

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15
Q

how does water content change in a pregnant woman

A

inc in total body water - inc to 8.5L

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16
Q

why is there an inc in total body water in pregnant women

A

due to high E2 and progesterones acting as mineralocorticoids on the RAAS system.
increase retention of Na+ in the kidney .’. water moves along with it = increased water retention = increased plasma volume
reset thirst threshold in the brain

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17
Q

what happens to the extra water content in the pregnant mother

A

is distributed in plasma
some water goes to fetus, placenta and amniotic fluid
also causes oedema in the ankles (extra fluid &reduced venous return - due to mass in chest impeding venous return)
oedema in lungs (dangerous)

18
Q

why may pregnant women get odema in their ankles

A

extra fluid &reduced venous return - due to mass in chest impeding venous return

19
Q

how does oestrogen and progesterone affect respiratory of pregnant woman

A

increased sensitivity of resp centre to CO2 .’. breathe more deeply .’. minute volume increases by 40%

20
Q

what would blood gas of a pregnant woman show

A

bc minute vol increases by 40%, we see:
Arterial PO2 is high.
PCO2 is low.

21
Q

what is the benefit of increased minute vol in pregnant women

A

helps facilitate placental gas transfer.
high PO2 in maternal blood.’. steep gradient for o2 to diffuse into fetal blood
low CP2 in maternal lood = gradient for high fetal CO2 to difuse into maternal blood

22
Q

how doe maternal blood change in pregnancy

A
  • plasma vol increased
  • red cell mass inc (more erythropoiesis)
  • hb decreased (bc although red cell mass = increased, plasma vol has increased by a huge amount)
    so blood has haemodilution - looks like anaemia but isnt.
23
Q

how is mother adapted for increased erythropoeisis in pregnancy

A

maternal gut is also more efficient at absorbing iron
inc in leukocytes
inc in clotting factors

24
Q

why is there inc risk of clotting in pregnat women

A

blood is hypercoagulable.
increased fibrinogen for placental separation
increased risk of thrombosis

25
Q

how is fetal Hb different from adult Hb

A

higher affinity for o2

26
Q

why is smoking extra dangerous for pregnant women

A

increases carboxy-Hb in the mothers blood, this is more permanent and reduces the amount of oxygen the fetus can get hold of (as less in maternal blood). This leads to fetal hypoxia.

27
Q

why is there inc cardiac output in pregnancy

A 
cardiac output (HR x SV)
increased blood volume .'.SV has increased quite a lot
28
Q

does pregnancy cause hypertension

A

CO increases .’. expect bp to increase
BUT bp acc decreases
due progesterone induced vasodilation .’. reduced peripheral resistance
allows inc. flow to uterus, placenta, muscle, kidney and skin

29
Q

what happens to bp in preeclampsia

A

normal increased CO
no relaxation of smooth muscle
so inc bp

30
Q

effect of pregnancy high progesterone on GI

A

smooth muscle of gut relaxes .’. reduced GI motility .’. constipation
lower eosophagal sphincter relaxes .’. reflux .’. heart burn

31
Q

why is it recommended that pregnant women take folic acid

A

needed for DNA production, growth, blood cell production etc. pregnant woman is doing more of this than normal so taken from 3 months before getting pregnant to avoid deficiency

32
Q

effect of pregnancy high progesterone on urinary system

A 
urinary tract (ureters, bladder) dilates and relaxes  .'. inc risk of UTI due to stasis in their system
vasodilation of vessels in kidney .'. more blood into glomerulus .', inc filtration .'. increased urination
enlarged utrus compresses bladder so inc. urination
33
Q

how is urine during pregnancy different to normal urine

A

urinating more so:
creatinine, urea and uric acid concentrations in blood (and hence urine) should be lower
pregnant lady with high levels of these may be suffering from renal impairment!

34
Q

why do pregnant women pee more

A
  • inc filtration in glomerulus

- compression of bladder by uterus

35
Q

why is there less urination in second trimester

A
  • uterus lifts out of pelvis

- some relief as less compression of bladder

36
Q

why is there increased urination in 3rd trimester

A

baby’s head descends down onto bladder compressing it .’. inc frequency of urination

37
Q

how does uterus change in pregnancy

A

by term, uterus massively increases in size
due to effect of oestrogen on myometrium .’. hypertrophy of existing muscle fibres
fibres arranged in spiral manner to help push baby out of uterus.
inc in blood flow to uterus

38
Q

what is the primary function of the cervix during pregnancy

A

keep baby out of uterus and retain the pregnancy
so closed cervix
quiescent and noncontracting myometrium

39
Q

how does cervix change in pregnancy

A

proliferation of glands in cervix

high production of mucus .’. mucus plug

40
Q

how does cervix change during labour

A

myometrium contacting
opened cervix
labour = inc prostoglandins .’. breakdown of collagen/soft tissue .’. cervix soft and squishy .’. baby can slide through

41
Q

how does changes of pregnancy reverse

A

at birth, placenta removed .’. sudden and rapid fall in steroids
so reversal in physiological changes
uterine muscle loses oedema but contracts slowly
steroids continue to fall, it permits the action of prolactin on breast to allow lactation

Repro (13 decks)

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