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WEEK 3 SEM 4 > Maternal changes in pregnancy > Flashcards

Maternal changes in pregnancy Flashcards

1
Q

What causes maternal changes in pregnancy?

A

very high levels of maternal steroid hormones circulating (predominantly produced by the placenta)

physical effects of carrying around a pregnancy for 9 months (extra 6-7 kilos of baby and placenta, increase in blood volume to maintain the fluid etc)

metabolic needs of the fetus and the placenta

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2
Q

What is the puerperium?

A

6 weeks after delivery

after this period, things become normal again

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3
Q

What can pregnancy do to other conditions?

A

exacerbate a pre-existing condition

uncover hidden or mild condition

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4
Q

What are the changes that the body need to cope with during pregnancy?

A

increase uterus size

increased metabolic requirements of the uterus and the fetus

the body needs to be able to remove fetal waste products such as CO2 and other waste products

good fluid balance, enough to make amniotic fluid, provide perfusion to the fetal kidneys etc

deal with the demands of the delivery and after as well

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5
Q

How does the body cope with changes in pregnancy?

A

metabolic rate change

change in CVS, GI, urinary and endocrine

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6
Q

What are maternal steroids?

A

at first changes in steroids by mother- cause corpus luteum change
after week 7 placenta takes over

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7
Q

What are placental peptides?

A

hCG
hPL
growth hormone

released by week 12

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8
Q

What are placental and fetal steroids?

A

progesterone, oestradiol, and oestriol are involved here

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9
Q

What do the placental and fetal steroids affect?

A 
RAAS- bp
resp centre- tidal volume
GI tract- smooth muscle relax- constipation
blood vessels-relaxation
uterine muscle contractility
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10
Q

What are maternal and fetal pituitary hormones?

A

GH
thyroid
prolactin
CRF

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11
Q

What is the total weight gain in pregnant mums?

A

12.5kg to 13kg

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12
Q

In the UK, why is weight of the mother only checked at booking initially when she comes in?

A

because all that is needed is a normal healthy diet, and people with a normal initial weight usually do have a normal healthy diet

the mother does not need to eat food for two people, as the baby is not a full grown human being

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13
Q

What is the cause of weight gain in pregnancy and how much do each things weigh?

A 
fetus + placenta = 5kg
excess fat and protein = 4.5kgs
increase in body water = 1.5kgs
breasts increase in weight = 1kg
uterus size and weight increase = 0.5-1kg
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14
Q

Why does energy output need to increase during pregnancy?

A

cope with your own cardiovascular and respiratory needs (they are in over drive)

increase energy storage for fetus and when mother in labour and puerpium

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15
Q

Why is there an increase in fat and protein stores during pregnancy?

A

4.5kg gain
more consumption
less usage of proteins and fat

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16
Q

Where is the fat and protein laid down?

A

anterior abdominal wall

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17
Q

When is fat and protein used?

A

labour
puerpium

(as metabolic demands increase)

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18
Q

By how much does the basal metabolic rate increase?

A

Rises by 350kcal/day mid gestation, and by 250kcal/day during late gestation

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19
Q

Where does the increase in metabolic rate go to?

A

fetus and uterus mainly

and cardiovasular system and resp system

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20
Q

How much energy does the placenta use?

A

about 1/3rd of the energy by metabolism

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21
Q

How does glucose pass the placenta?

A

facilitated diffusion (through channels)- NO ATP used

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22
Q

What is the difference between levels of glucose in the mother and fetus?

A

stay the same

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23
Q

What happens in terms of stores in the first trimester?

A

INCREASE IN MATERNAL STORES

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24
Q

What happens in the first trimester to the maternal stores?

A

pancreatic B cells increase in number
there is increase in plasma insulin
so more glucose taken into tissues and laid down as stores and used by muscles

due to this, fasting serum glucose decreases

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25
What happens in terms of stores in the second trimester?
increase in fetal stores
26
What happens in the second trimester to the maternal stores?
human placental lactogen causes insulin resistance in the mother SO there is less glucose going into maternal stores SO there is increase in serum glucose and thus more glucose crosses the placenta this can cause diabetes in the mother
27
What does HPL cause?
insulin resistance in the mother
28
What drug do you give the mother if diabetic?
metformin
29
What can cause ankle puffiness/oedema during pregnancy?
oestrogen and progesterone act on RAAS
30
What causes fluid retention in the body?
osmostat is reset increased sodium retention bc of RAAS decreased thirst threshold increase in interstitial volume
31
Why is there increased water in the body?
more and more organs require more water than usual: | breast tissue, uterine muscle, amniotic fluid, placenta
32
What can oedema be worsened by?
reduced efficiency of lymphatics
33
What causes deeper breathing?
increase in resp centre sensitivity to CO2 | thoracic anatomy changes
34
What changes to the thoracic anatomy cause deeper breathing?
ribcage displaced upwards | rib flares outwards
35
Why does the ribcage displaced upwards and | rib flares outwards?
bc the uterus and growing fetus pushes on the diaphragm
36
What does the baby push on (of the mother)?
pushing on the lungs, the lung capacity decreases and so the mother has to breathe deeper to get more oxygen in
37
What happens to a pregnant woman's breathing?
DEEPER not FASTER
38
What happens as a result of deeper breathing?
the minute volume (volume of air per minute in the lungs) increases by 40% This leads to an increase in arterial oxygen by 10% and a decrease in arterial CO2 by 15-20% This increases the gradients between maternal and fetal blood thus facilitating placental gas transfer of CO2 and O2
39
What in blood increases in the mother?
increase blood plasma volume by 45% increase red blood cell mass by 18% increased efficiency of iron absorption from the gut more WBCs changes in clotting factors- make blood hypercoagulable
40
Does the blood become concentrated or dilute?
DILUTE bc blood plasma volume increases MORE than red blood cell mass so there is a fall in Hb conc in the mother= apparent anaemia
41
What is high Hb for pregnant lady?
14 | 14 is fine for nonpreggo lady
42
What are the changes in clotting factors in a pregnant woman?
more fibrinogen
43
What is fibrinogen needed for and what risk does it pose?
needed for placental separation | increases risk of thrombosis
44
What is the circulating Hb in foetal blood?
15-16 | has higher affinity for O2
45
Why is smoking bad for pregnancies?
increases maternal carboxy-Hb - has higher affinity for O2 than normal Hb - SO maternal Hb does not dissociate oxygen for the foetus to take over - leads to foetal hypoxia
46
During pregnancy, what causes changes in ECG and heart sounds?
expanding uterus pushes heart around
47
How does the heart increase its CO in a pregnant woman?
increased heart rate and stroke volume it begins as early as 3 weeks, and increases by about 40% at 28 weeks
48
Why is an increased cardiac output needed?
supply the maternal muscle | supply the fetus through the placenta
49
In what situations, can the mother not increase CO?
hypertrophic cardiomyopathies, stenotic valves, complex repairs of congenital heart diseases
50
What does oestrogen and progesterone cause on blood vessels?
vasodilation
51
What does vasodilation in a pregnant woman do?
this increases blood flow to uterus, placenta, muscles, kidney, and skin
52
What is seen as a result of cardiovascular changes in a pregnant woman?
NEOANGIOGENESIS: several vascular changes may be visible on a woman undergoing pregnancy like spider naevi these are basically additional blood capillaries added to the skin in order to assist heat loss
53
What happens in a gut of a pregnant woman?
steroids affect appetite and thirst reduced gut motility constipation smooth muscle relaxation lower oesophageal sphincter relaxes- acid reflux smaller stomach- uterus growing compresses stomach
54
What causes acid reflux in a pregnant woman?
lower oesophageal sphincter relaxed | growing uterus
55
What dietry supplement is given to pregnant women?
folic acid (400 micrograms per day up to week 12)
56
What is folic acid needed for?
DNA production growth blood cell synthesis
57
What is folic acid deficiency linked with?
spina bifida (neural tube defect)
58
When should folic acid be taken?
pre-conceptually (before conception) − there is no waiting for the pregnancy test to be positive − by the time you miss period, embryo already formed for 2 weeks and neural tube is forming already − if mother folic acid deficient= then mother no transfer folic acid to child
59
What happens to the urinary system in a pregnant woman?
smooth muscles dilate and relax more reflux up urinary tract more chance of UTI if infection ascends- lead to pyelonephritis (inflammation of the kidney) = lead to sepsis in the mother (which is harmful for the baby)
60
What happens to the kidney in a pregnant woman?
Overall big CO so increased blood flow to kidneys increased GFR increased creatinines, urea, uric acid clearance
61
Why does a pregnant woman need to pee lots?
uterus and baby's head compresses bladder
62
What is a normal cervix like (in non preggo woman)
long dense tissue lots of collagen fibres
63
What happens to the cervix during pregnancy?
increase in vascularity looks a little bit blue (bc venous vascularity in it) becomes softer glands proliferate increased mucus production cervical mucus plug which is protective and anti infective
64
After birth, what does the reduction in steroids lead to?
allows prolactin to act on breasts | so production of milk (lactation)

WEEK 3 SEM 4 (6 decks)

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