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REPRODUCTION > 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 pregnancies sometimes do?

A
  • Exacerbate a pre-exisiting condition e.g congential heart disease, asthma
  • Uncover ‘hidden’ or mild conditon e.g diabetes
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3
Q

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

A
  • Increase in size of the uterus
  • Hence increased metabolic requirements of uterus to supply the expanding organ
  • Structural and metabolic requirements of foetus
  • Removal of foetal waste products
  • Provision of amniotic fluid
  • Preparation for delivery and puerperium (post-natal period)
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4
Q

In what systems do changes occur?

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
    • hCG (keeps the CL alive), hPL, GH
  • Maternal steroids
    • placenta takes over ovarian (CL) production around wk 7
  • Placental and foetal steroids
    • progesterone, oestradiol, oestriol
  • Maternal and foetal pituitary hormones
    • GH, thyroid hormones (to keep up with the metabolic demands), prolactin, CRF (corticotrophin releasing factor)
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6
Q

What are placental peptides?

A
  • hCG (keeps CL alive - until 7 weeks - secretes the hormone progesterone)
  • hPL
  • GH
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7
Q

When does the placenta take over ovarian production?

A

At week 7 - when the corpus luteum dies

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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
  • Prolaction
  • CRF (corticotrophin releasing factor)
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10
Q

What do placental steroids affect?

A
  • RAAS system
  • Respiratory system
  • GI tract
  • Blood vessels
  • Uterine myometrial contractillity
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11
Q

How does your weight change when you are pregnant?

A

Total weight gain = 12.5 - 13kg

Ideally keep less than 13kg - failure to gain or sudden change requires monitoring

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12
Q

Why do we need to increase energy output?

A

To cope with increased respiration and cardiac output

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13
Q

Why does energy storage need to be increased?

A
  • For foetus
  • For labour and puerperium
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14
Q

Why is there a gain in fat and protein stores (4-5kg)?

A
  • increased consumption and reduced use
  • mainly laid down in anterior abdominal wall
  • utilised later in pregnancy and puerperium
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15
Q

How does the basal metabolic rate change during pregnancy?

A
  • Rises by 350kcal a day mid gestation (75% foetus and uterus)
  • Rises by 250kcal a day late gestation (25% respiratory)
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16
Q

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

A
  • Increased availabillity in 2nd trimester
  • Glucose is transferred across the placenta as foetal energy source via facillitated diffusion
  • Foetus will store some glucose in liver
    • hPL will cause insulin resistance in mother
      • Increased availabillity in serum
      • More glucose crosses the placenta
        • But can cause diabetes!
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17
Q

During the 1st Trimester how is glucose activated from 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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18
Q

How is glucose activated from the fetal reserves?

A
  • hPL causes insulin resistance
  • ie less glucose into stores
  • =increased availability in serum
  • glucose (more crosses placenta)
  • but can cause diabetes
19
Q

What is the total water gain and from where?

A

Total water gain = 8.5L

  • E2 and P act on the RAAS system
20
Q

What is the effect of E2 (oestrogen) and P (progesterone) on the RAAS system?

A
  • Sodium retention
  • Resetting of osmostat
  • Decreased thirst threshold
  • Decrease in plasma oncotic pressure (albumin) albumin levels fall due to dilutional effect = lower oncotic pressure
21
Q

Why do pregnant women breathe more deeply?

A
  • Oestrogen and progesterone affect the respiratory centre in your brain
    • This gives you an increased sensitivity to CO2
  • Bigger + Deeper breathing - minute volume goes up by 40%
  • Bigger and deeper breathing = PO2 in arteries to go up, and PCO2 to fall due to removal of extra CO2
    • Allows for efficient diffusion
      • High O2 levels present in mother transferred to baby and low CO2 levels in mother allow for diffusion of CO2 from foetus to mother
22
Q

What happens to the plasma volume in maternal blood?

A

Goes up by 40-50%

  • Serum plasma will go up, not red cell mass
    • Can get haemodilution = apparent aneamia as Hb concentration falls
23
Q

What effect does oestrogen have on clotting factors?

A
  • More clotting factors - blood becomes hypercoagulable = increased fibrinogen for placental seperation
  • Increased clotting factors is said to prevent you from bleeding to death during birth
  • However increased risk of thrombosis
24
Q

What is the difference between the affinity of Hb in foetal and adult blood?

A
  • Foetal haemoglobin has a much higher affinity for oxygen than adult haemoglobin
  • This allows for increased oxygen binding
25
Q

What does smoking do?

A
  • Smoking increases the carboxyhaemoglobin levels in the mother
  • This has a higher affinity for oxygen than foetal Hb
  • Causes reduced binding of foetal haemoglobin and fetal hypoxia
26
Q

What are the cardiovascular changes which occur during pregnancy?

A
  • Expanding uterus
    • Pushes heart around
    • Changes ECG and heart sounds
  • Increased cardiac output
    • Increased HR and stroke volume
    • begins as early as 3 wks to max 40% at 28 weeks
    • For maternal muscle and fetal supply
27
Q

Why does cardiac output increase?

A

For maternal muscle and fetal supply

28
Q

What are the cardiovascular changes in vessels during pregnancy?

A
  • Increased cardiac output and vasodilation (due to steroids) = reduced TPR
  • Increased flow to areas of the body
  • Neoangiogenesis
29
Q

Why does neoangiogenesis occur during pregnancy?

A

Extra capillaries in skin to assist in heat loss

30
Q

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

A

Pre-eclampsia

  • narrowing of maternal spiral arteries due to release of pro-inflammatory mediators which cause endothelial cell dysfunction = vasoconstriction, hypertension, glomerular damage
31
Q

How do steroids affect the GI tract during pregnancy?

A
  • Appetite + thirst
  • Reduced GIT motillity
  • Relaxed LOS (lower oesophageal sphincter)
32
Q

What happens when there is a reduced GIT motillity in pregnanct women?

A

Constipation

33
Q

What happens when the LOS relaxes in pregnant women?

A

Acid reflux

Large uterus = small frequent meals

34
Q

What dietary supplement is recommended for pregnant women?

A

Folic acid

  • causes DNA production and growth of RBCs
35
Q

What is deficiency of folic acid linked to?

A

Linked to spina bifida - neural tube defect

36
Q

What happens to the urinary tract in pregnant women?

A
  • Pregnancy results in relaxation of the urinary system including the kidneys, ureters and bladder.
  • This can result in the stasis of urine/ or urine to be left behind which can result in urinary tract infections.
37
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
38
Q

Explain the changes of the bladder during pregnancy?

A

n pregnancy there is an increased urinary frequency due to an increased pressure on your bladder.

This mainly occurs in the third trimester when the fetus descends into the pelvis.

39
Q

What are the changes in uterine size?

A
  • Increased muscle mass
  • Hypertrophy of uterine muscle - not an increase in cells but hypertrophy of myometrium
  • Increase in BF to placenta and uterus
40
Q

Why are C-sections carried out on the lower uterine segment?

A

Less muscular and more fibrous so will bleed less

41
Q

Primary function of the cervix?

A

To retain the pregnancy

42
Q

What are the changes of the cervix?

A
  • tissue softens from 8 weeks
    • changes in connective tissue
    • begins gradual preparation for expansion
  • proliferation of glands
    • mucosal layer becomes half of mass
    • great increase in mucus production
      • protective..ie anti-infective
43
Q

What are 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 rapidly looses oedema but contracts slowly: never returns to pre-pregnancy size
  • Removal of steroids permits action of raised prolactin on breast

REPRODUCTION (11 decks)

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