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Repro > Maternal Changes in Pregnancy > Flashcards

Maternal Changes in Pregnancy Flashcards

1
Q

What are the causative factors in the changes in pregnancy?

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

What can pregnancy do for other conditions?

A
  • Exacerbate a pre-existing condition

- Uncover “hidden” or mild condition

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3
Q

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

A
  • Increase in size of the uterus
  • Increased metabolic requirements of uterus
  • Structural and metabolic requirements of fetus
  • Removal of fetal waste products
  • Provision of amniotic fluid
  • Preparation for delivery and puerperium
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4
Q

What systems are their changes in during pregnancy?

A
  • Energy balance
  • Respiratory system
  • Cardiovascular system
  • Gastrointestinal system
  • Urinary system
  • Endocrine system
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5
Q

Which hormones cause most of the changes in the maternal body?

A
  • Placental peptides
  • Maternal steroids
  • Placental and fetal steroids
  • Maternal and fetal pituitary hormones
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6
Q

What are the placental peptide?

A

hCG - keeps the corpus luteum alive
hPL
GH

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7
Q

When does the placenta take over ovarian production?

A

At week 7

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8
Q

What are the placental and fetal steroids?

A

Progesterone
Oestradiol
Oestriol

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9
Q

What are the maternal and fetal pituitary hormones?

A

GH
Thyroid hormones
Prolactin
CRF

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10
Q

What do the placental steroids affect?

A
  • Renin/angiotensin system
  • Respiratory centre
  • GI tract
  • Blood vessels
  • Uterine myometrial contractility
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11
Q

Breakdown for total weight gain during pregnancy

A

13kg

  • Fetus plus placenta = 5kg
  • Fat and protein = 4.5 kg
  • Body water = 1.5 kg
  • Breasts = 1 kg
  • Uterus = 0.5 - 1kg
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12
Q

When does weight gain need monitoring?

A
  • Failure to gain or sudden change needs monitoring
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13
Q

Why does energy output during pregnancy need to be increased?

A
  • To cope with increased respiration and cardiac output
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14
Q

Why does energy storage during pregnancy need to be increased?

A
  • For fetus

- For labour and puerperium

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15
Q

Why does the body gain 4-5kg in fat and protein stores?

A
  • Increased consumption and reduced use
  • Mainly laid down in anterior abdominal wall
  • Utilised later in pregnancy and puerperium
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16
Q

How much does the basal metabolic rate (BMR) rise by during mid gestation per day?

A

350 kcal per day

75% fetus and uterus

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17
Q

How much does the BMR rise during late gestation per day?

A

250 kcal per day

25% respiratory

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18
Q

How does the need for glucose increase in the 2nd trimester?

A
  • Increased availability
  • Active transprot across placenta as fetal energy source
  • Fetus stores some in liver
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19
Q

During the 1st trimester, how is glucose activated from the maternal reserves?

A
  • Pancreatic beta cells increase in number
  • Plasma insulin increases
  • Fasting serum glucose decreases (laid down as stores and used by muscle)
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20
Q

During the 2nd trimester, how is glucose activated from the fetal reserves?

A
  • hPL causes insulin resistance i.e. less glucose into stores
  • Increased availability in serum glucose (more crosses placenta) but can cause diabetes
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21
Q

What is the total weight gain and from where?

A
  1. 5L
    - Placenta
    - Amniotic fluid
    - Oedema
    - Uterine muscle
    - Mammary gland
    - Plasma volume
    - Fetus
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22
Q

What acts on the renin angiotensin system?

A

E2 and Progesterone

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23
Q

How does E2 and progesterone affect the RAAS?

A

Sodium retention, resetting of the osmostat, decrease thirst threshold, decrease in plasma oncotic pressure (albumin).

24
Q

Why do pregnant women breathe more deeply?

A
  • This increases the respiratory centre sensitivity to CO2.
  • The thoracic antomy changes and the ribcage is displaced upwards and the ribs flare outwards.
  • This increases the minute volume increases 40%.
  • The arterial PO2 increases 10%; PCO2 decreases 15-20%
  • This facilitates gas transfer so the baby receives more O2 from the maternal blood.
25
Q

What happens to the plasma volume in maternal blood?

A

It goes up to 40-50%

26
Q

How many litres of blood does a pregnant woman have?

A

6.5 litres compared to normal 4.5 litres

27
Q

Why does the litres of blood increase?

A

There is more serum plasma, not more red cell mass. The haemoglobin concentration will go down as there is a decrease of red cell mass.

28
Q

What is haemodilution?

A

Apparent anaemia as concentration of Hb falls

29
Q

What is the oestrogenic effect that happens on the liver?

A

Thrombosis

30
Q

Why does blood become hypercoagulable?

A

There is changes in white cells (up) and clotting factor which increases fibrinogen for placental separation, but increased risk of thrombosis.

31
Q

What are the cardiovascular changes on the heart during pregnancy?

A
  • Expanding uterus that pushes the heart round and changes

- Increases cardiac output so increased heart rate and stroke volume

32
Q

When does cardiac output start to increase?

A

Begins as early as 3 weeks to max 40% at 28 weeks

33
Q

Why does cardiac output increase?

A

For maternal muscle and fetal supply

34
Q

What are the cardiovascular changes in the vessels during pregnancy?

A
  • Increased cardiac output and vasodilation by steroids = reduced peripheral resistance.
  • Increased flow to areas of the body
  • Neoangiogenesis
  • Dilation of vessels by progesterone
35
Q

Where does blood flow increase to during pregnancy?

A
  • Uterus
  • Placenta
  • Muscle
  • Kidney
  • Skin
36
Q

Why does neoangigoensis occur in pregnancy?

A

Extra capillaries in skin (spider naevi) to assist in heat lost.

37
Q

What condition can occur in pregnancy because of the change in the CVS in vessels?

A

Pre-eclampsia

38
Q

How do steroids affect the GI tract during pregnancy?

A
  • Appetite and thirst
  • Reduced GIT motility
  • Relax lower oesophageal sphincter
39
Q

What happens when there is reduced GIT motility in pregnant women?

A

Constipation

40
Q

What can occur if the LOS relaxes in pregnant women?

A

Acid reflux

Large uterus -> small frequent meals

41
Q

What dietary supplement is recommended for pregnant women?

A

Folic acid

5mg/day up to week 12

42
Q

What does folic acid do in pregnant women?

A

Causes DNA production, growth, blood cells in the uterus, placenta and fetus

43
Q

What happens if pregnant women have a folic acid deficiency?

A

Linked to spina bifida - neural tube defect

44
Q

What happens to the urinary tract in pregnant women?

A

It dilates and relaxes which increases the chance of UTI and may persist.

45
Q

What happens to the kidney in pregnant women?

A

Increased blood flow to the kidney which increases filtration rate and increased clearance of:

  • creatinine
  • urea
  • uric acid
46
Q

Describe the changes in the bladder pressure during pregnancy

A
  • Early pregnancy: the uterus enlarges but it is within the pelvis compressing the bladder - frequent urination
  • Mid-pregnancy: the uterus is lifted out of the pelvis - micturition normal
  • At term: the head of the fetus descends into the pelvis -> frequent urination
47
Q

What can the bladder not do?

A

It cannot determine the difference between pressure inside or outside the body

48
Q

Describe the changes in uterine size

A
  • Increase in muscle mass
  • hypertrophy of the uterine muscle - not an increase in cells but hypertrophy of the myometrium
  • Increase in blood flow to the placenta and uterus = 1/6 of total
49
Q

Describe the formation of the lower uterine segment

A

The amniotic sac expands, uterus hypertrophies. There is expansion of the lower cervix, isthmus, and is less muscular. This forms the lower uterine segment.

50
Q

Why are C-sections done at the lower uterine segment?

A

It is less muscular and more fibrous so it will bleed less.

51
Q

What is the primary function of the cervix?

A

To retain the pregnancy

52
Q

Describe the changes in the cervix

A
  • Increase in vascularity
  • Tissue softens from 8 weeks
  • Proliferation of glands
53
Q

Why does the cervix tissue soften?

A
  • Changes in connective tissue

- Begins gradual preparation for expansion

54
Q

Why is there proliferation of glands in the cervix?

A
  • The mucosal layer becomes half of mass
  • Great increase in mucus production
  • Protective - i.e. Anti-infective
55
Q

What are some of the changes after pregnancy?

A
  • Dramatic and rapid fall in steroids on delivery of the placenta
  • Most endocrine-driven changes return to normal rapidly
  • Uterine muscle (undergoes atrophy) rapidly looses oedema but contracts slowly - never returns to pre-pregnancy size
  • Removal of steroids permits action of raised prolactin on breast

Repro (11 decks)

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