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Reprooooooooo > Maternal changes in pregnancy > Flashcards

Maternal changes in pregnancy Flashcards

1
Q

What are the causative factor which cause a major change in multiple systems?

A
  • High levels of steroids
  • Mechanical displacement
  • Fetal requirements
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2
Q

What do we have to do in order to diagnose an abnormality during pregnancy?

A

In order to diagnose an abnormality in pregnancy, we need to detect changes in the changes

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3
Q

What could pregnancy do to maternal conditions?

A
  • Exacerbate a pre existing condition

- Uncover a hidden or mild condition

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4
Q

What are the changes designed to cope with several main events?

A
  • Increase in size of the uterus
  • Increased metabolic requirements of the uterus
  • Structural and metabolic requirements of fetus
  • Removal of fetus waste products
  • Provision of amniotic fluid
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5
Q

What are the hormones causing the most of the changes?

A
  • Placental peptides
    • hCG, hPL, GH
  • Maternal steroids
  • Placental and fetal steroids
    • Progesterone,oestradiol, oestriol
  • Maternal and fetal pituitary hormones
    • GH, thyroid hormones, prolactin, CRF
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6
Q

What do placental steroids have an effect on?

A
  • Renin angiotensin system
  • Respiratory centre
  • GI tract
  • Blood vessels
  • Uterine myometrial contractility
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7
Q

Weight during pregnancy

A

Weight gain happens during pregnancy

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8
Q

Why is there a need to increase energy output?

A

To cope with increased respiration and cardiac output

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9
Q

Why is there a need for increased storage?

A
  • For fetus

- For labour and puerperium

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10
Q

How much fat and protein need to be gained and how?

A

Need to gain fat and protein stores by 4-5kg

-Increased consumption and reduced use

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11
Q

Where is the fat and protein store mainly laid in the pregnant mother?

A

Store mainly laid down in anterior abdominal wall

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12
Q

When is a increased availability for glucose required?

A

Increased availability needed in 2nd timester

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13
Q

How is the glucose transported to the fetus?

A

Transported across placenta as facilitated diffusion as fetal energy source

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14
Q

Where does the fetus store some of the glucose?

A

Fetus stores some glucose in the liver

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15
Q

What happens in the 1st trimester to the maternal glucose reserves?

A
  • beta cells increase in number
  • Plasma insulin increases
  • Fasting serum glucose decreases
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16
Q

What happens in the 2nd trimester to fetal glucose reserves?

A
  • hPL causes insulin resistance
  • There’s less glucose in storage and therefore increased availability in serum glucose
    • However this can cause diabetes
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17
Q

What do oestrogen and progesterone act on to increase water gain during pregnancy?

A

Act on renin angiotensin system causing an increase in plasma volume

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18
Q

How many litres do mothers gain during pregnancy and what contributes to this?

A 
Gain about 8-9 litres
Contributed by:
-Fetus
-Placenta
-Amniotic fluid
-Oedema
-Uterine muscle
-Mammary gland
-Plasma volume
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19
Q

What happens to oxygen consumption during pregnancy ?

A

Oxygen consumption increased

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20
Q

How does oestrogen and progesterone cause an increase in respiration?

A
  • Increases respiratory centre sensitivity to CO2

- Thoracic anatomy changes, ribcage is displaced upwards and ribs flare outwards

21
Q

By what percentage does minute volume increase during pregnancy?

A

-Minute volume increases by 40%

22
Q

What happens to arterial pO2 and pCO2 during pregnancy?

A

Arterial pO2 increases and arterial pCO2 decreases

23
Q

Therefore what does high oxygen facilitate with?

A

High oxygen will facilitate gas transfer between the mother and the baby

24
Q

What happens to maternal plasma volume during pregnancy?

A

Increase in maternal plasma volume

25
Q

During pregnancy what is there an increased efficiency of in the maternal blood?

A

-Increased efficiency of Iron absorption from gut

26
Q

What is haemodilution?

A

Is the apparent anaemia as concentration of Hb falls as plasma volume increases

27
Q

What other changes happen in maternal blood during pregnancy?

A

Changes in white cells and clotting factors

28
Q

Why does blood become more hypercoagulable?

A

Due to increased fibrinogen for placental separation

There’s an increased risk of thrombosis

29
Q

What does increased Hb in fetal blood allow?

A

-Increased Hb allows increased O2 binding, therefore oxygen is given up by maternal Hb more easily

30
Q

What does smoking result in to the fetal blood?

A

Smoking increases maternal carboxy-Hb which is more permanent and reduces increased binding of oxygen leading to fetal hypoxia

31
Q

How does an expanding uterus effect the CVS?

A
  • Pushes the heart round

- Changes ECG and heart sounds

32
Q

Why is there an increased cardiac output during pregnancy?

A
  • Due to increased heart rate and stroke volume

- For maternal muscle and fetal supply

33
Q

What does an increased cardiac output and vasodilation by steroids result in?

A

Increased cardiac output and vasodilation by steroids result in reduced peripheral resistance

34
Q

What occurs to the CVS to assist in heat loss?

A

Neoangiogenesis occurs including extra capillaries in skin to assist in heat loss

35
Q

Effect of steroids on GI tract

A

steroids:

  • Increase appetite and thirst
  • Reduce GIT motility causing constipation
  • Relax LOS causing acid reflux
36
Q

Why do we need more folic acid during pregnancy?

A

Involved in DNA production, growth, blood cells for uterus placenta and fetus

37
Q

What is a deficiency in folic acid linked to?

A

Linked to spina bifida

38
Q

What does progesterone effect in the bladder?

A

Progesterone effects smooth muscle in bladder

39
Q

What happens to the urinary tract during pregnancy and what does this increase?

A

Urinary tract dilates and relaxes however there’s increased UTI

40
Q

During pregnancy there’s increased blood flow to kidneys, what does this therefore do and result in?

A

Increased blood flow to the kidneys cause an increased filtration rate. This results in an increased clearance of:

  • Creatinine
  • Urea
  • Uric acid
41
Q

In early pregnancy, why is there an increased frequency of urination?

A

In early pregnancy the uterus is enlarging but it is within the pelvis compressing the bladder increasing the frequency of urination

42
Q

In mid-pregnancy, what leads to micturition being normal?

A

Mid-pregnancy the uterus is lifted out of the pelvis leafing to micturition being normal

43
Q

At term, why is there an increased frequency of urination again?

A

At term the head of the fetus descends into the pelvis increasing frequency of urination again

44
Q

Why is there a change in uterine size during pregnancy?

A
  • Due to huge increase in muscle mass

- Huge increase in blood flow

45
Q

What is the primary function of the cervix?

A

Primary function is to retain pregnancy

46
Q

What happens to the vascularity of the cervix during pregnancy?

A

There’s an increase in vascularity

47
Q

When do the tissues in the cervix start softening and how?

A

Tissues soften from 8 weeks

  • Changes in connective tissue
  • Begins gradual preparation for expansion
48
Q

What happens to the glands in the cervix during a pregnancy and how?

A

Proliferation of glands:

  • Mucosal layer becomes half of mass
  • Great increase in mucus productions
49
Q

After delivery of the baby what returns to normal in the mother?

A
  • Dramatic and rapid fall in steroids on delivery of the placenta
  • Most endocrine-driven changes return to normal rapidly
  • Uterine muscle rapidly lose oedema but contracts slowly
  • Removal of steroids permits action of raised prolactin on breast

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