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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
Q

What happens in terms of stores in the second trimester?

A

increase in fetal stores

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26
Q

What happens in the second trimester to the maternal stores?

A

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
Q

What does HPL cause?

A

insulin resistance in the mother

28
Q

What drug do you give the mother if diabetic?

A

metformin

29
Q

What can cause ankle puffiness/oedema during pregnancy?

A

oestrogen and progesterone act on RAAS

30
Q

What causes fluid retention in the body?

A

osmostat is reset
increased sodium retention bc of RAAS
decreased thirst threshold
increase in interstitial volume

31
Q

Why is there increased water in the body?

A

more and more organs require more water than usual:

breast tissue, uterine muscle, amniotic fluid, placenta

32
Q

What can oedema be worsened by?

A

reduced efficiency of lymphatics

33
Q

What causes deeper breathing?

A

increase in resp centre sensitivity to CO2

thoracic anatomy changes

34
Q

What changes to the thoracic anatomy cause deeper breathing?

A

ribcage displaced upwards

rib flares outwards

35
Q

Why does the ribcage displaced upwards and

rib flares outwards?

A

bc the uterus and growing fetus pushes on the diaphragm

36
Q

What does the baby push on (of the mother)?

A

pushing on the lungs, the lung capacity decreases and so the mother has to breathe deeper to get more oxygen in

37
Q

What happens to a pregnant woman’s breathing?

A

DEEPER not FASTER

38
Q

What happens as a result of deeper breathing?

A

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
Q

What in blood increases in the mother?

A

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
Q

Does the blood become concentrated or dilute?

A

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
Q

What is high Hb for pregnant lady?

A

14

14 is fine for nonpreggo lady

42
Q

What are the changes in clotting factors in a pregnant woman?

A

more fibrinogen

43
Q

What is fibrinogen needed for and what risk does it pose?

A

needed for placental separation

increases risk of thrombosis

44
Q

What is the circulating Hb in foetal blood?

A

15-16

has higher affinity for O2

45
Q

Why is smoking bad for pregnancies?

A

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
Q

During pregnancy, what causes changes in ECG and heart sounds?

A

expanding uterus pushes heart around

47
Q

How does the heart increase its CO in a pregnant woman?

A

increased heart rate and stroke volume

it begins as early as 3 weeks, and increases by about 40% at 28 weeks

48
Q

Why is an increased cardiac output needed?

A

supply the maternal muscle

supply the fetus through the placenta

49
Q

In what situations, can the mother not increase CO?

A

hypertrophic cardiomyopathies, stenotic valves, complex repairs of congenital heart diseases

50
Q

What does oestrogen and progesterone cause on blood vessels?

A

vasodilation

51
Q

What does vasodilation in a pregnant woman do?

A

this increases blood flow to uterus, placenta, muscles, kidney, and skin

52
Q

What is seen as a result of cardiovascular changes in a pregnant woman?

A

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
Q

What happens in a gut of a pregnant woman?

A

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
Q

What causes acid reflux in a pregnant woman?

A

lower oesophageal sphincter relaxed

growing uterus

55
Q

What dietry supplement is given to pregnant women?

A

folic acid (400 micrograms per day up to week 12)

56
Q

What is folic acid needed for?

A

DNA production
growth
blood cell synthesis

57
Q

What is folic acid deficiency linked with?

A

spina bifida (neural tube defect)

58
Q

When should folic acid be taken?

A

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
Q

What happens to the urinary system in a pregnant woman?

A

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
Q

What happens to the kidney in a pregnant woman?

A

Overall big CO
so increased blood flow to kidneys
increased GFR
increased creatinines, urea, uric acid clearance

61
Q

Why does a pregnant woman need to pee lots?

A

uterus and baby’s head compresses bladder

62
Q

What is a normal cervix like (in non preggo woman)

A

long
dense tissue
lots of collagen fibres

63
Q

What happens to the cervix during pregnancy?

A

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
Q

After birth, what does the reduction in steroids lead to?

A

allows prolactin to act on breasts

so production of milk (lactation)

WEEK 3 SEM 4 (6 decks)

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