Maternal Physio 2 Flashcards
1
Q
Cardiovascular system
Changes apparent during the
A
First 8 weeks
2
Q
Cardiovascular system
CO increased as early as
A
5th week
3
Q
Cardiovascular system
Brachial systolic BP, diastolic BP and central systolic BP are significantly lower
A
6-7 weeks from the LMP
4
Q
Cardiovascular system
Plasma blood volume expansion begins, and preload is increased
A
10-20 weeks
5
Q
Cardiovascular system
Heart
A
Elevated diaphragm
Left upward displacement
Larger cardiac silhouette
Increase cardiac silhouette
6
Q
Cardiovascular system
Cardiac sounds
A
1st heart sound - exaggerate splitting
2nd heart sound - no changes
3rd heart sound- loud
7
Q
Cardiovascular system
Physiologic hypertrophy
A
Cardiac plasticity
8
Q
Cardiovascular system
90% of pregnant women, they also heard
A
Systolic murmur that was intensified during inspiration
9
Q
Cardiovascular system
Ventricular function during pregnancy is normal, as estimated by the
A
Braunwald ventricular function graph
10
Q
Cardiovascular system
Cardiac function and
Myocardial function
A
Eudynamic
Normal
11
Q
Cardiovascular system
Remodeling in
Nonpregnat and
Pregnant
A
Longitudinal remodeling
Spherical remodeling
12
Q
Cardiovascular system
Cardiac output
Decrease
A
Mean arterial pressure
Vascular resistance
13
Q
Cardiovascular system
Cardiac output
Increase
A
Blood volume
Basal metabolic rate
14
Q
Cardiovascular system
Cardiac output
At rest
Lateral recumbent position
Increase
A
Early pregnancy
15
Q
Cardiovascular system
Cardiac output
Supine woman
Large uterus compresses venous return
A
Late pregnancy
16
Q
Cardiovascular system
Cardiac output
Maternal cardiac output is augmented by almost another 20% because of greater stroke volume and heart rate
A
Multiple pregnancy
17
Q
Cardiovascular system
Cardiac output
Implies reduced cardiovascular reserve in multiple gestations
A
Increased HR
Inotropic contractility
18
Q
Cardiovascular system
Cardiac output
Increase moderately
A
1st stage of labor
19
Q
Cardiovascular system
Cardiac output
With vigorous expulsive efforts
A
2nd stage of labor
20
Q
Cardiovascular system
Hemodynamic function in late pregnancy
A
Normal pregnancy is not a continuos “high output” state
21
Q
Cardiovascular system
Circulation and blood pressure
Changes in posture affect
A
Arterial BP
22
Q
Cardiovascular system
Circulation and blood pressure
When sitting is lower than lateral recumbent supine position
A
Brachial artery
23
Q
Cardiovascular system
Circulation and blood pressure
Diastolic pressure _____ more than systolic
A
Decrease
24
Q
Cardiovascular system
Circulation and blood pressure
Supine femoral venous pressure rises from 8mmhg in
A
Early pregnancy to 24mmhg at term
25
Cardiovascular system
Circulation and blood pressure
Venous BF in the legs is retarded during pregnancy except in
Lateral recumbent position
26
Cardiovascular system
Circulation and blood pressure
10% supine compression of the great vessels by the uterus causes significant arterial hypotension, referred to as
Supine hypotensive syndrome
27
Cardiovascular system
Renin angiotensin 2, and plasma volume
Involved in Bp control via sodium and water balance
Renin angiotensin aldosterone axis
28
Cardiovascular system
Renin angiotensin 2, and plasma volume
All components of this system
Increase din normal pregnancy
29
Cardiovascular system
Renin angiotensin 2, and plasma volume
Renin produced by
Maternal kidney
| Placenta
30
Cardiovascular system
Renin angiotensin 2, and plasma volume
Increase renin substrate (angiotensinogen) is produced by
Both maternal and fetal liver
31
Cardiovascular system
Renin angiotensin 2, and plasma volume
Increased estrogen production during pregnancy
Important in first T BP maintenance
32
Cardiovascular system
Renin angiotensin 2, and plasma volume
Pregnant women lose their acquired vascular refractories to angiotensin 2 within 15-30minutes after the
Placenta is delivered
33
Cardiovascular system
Renin angiotensin 2, and plasma volume
Exogenous progesterone does not restore angiotensin 2 refractories to women with gestational hypertension, this can be done with infusion of its major metabolites
5alpha dihyroxyprogesterone
34
Cardiovascular system
Cardiac Natriuretic Peptide
Secreted by cardiomyocytesin response to chamber wall stretching
Atrial natriuretic peptide
| B-type natriuretic peptide
35
Cardiovascular system
Cardiac Natriuretic Peptide
Increased in severe preeclampsia caused by cardiac strain from increased after load
BNP
36
Cardiovascular system
Cardiac Natriuretic Peptide
Induced physiological adaptations participate in ECF volume expansion and in the increased plasma aldosterone
ANP
37
Cardiovascular system
Cardiac Natriuretic Peptide
Secreted by non cardiac tissue pred
C-type natriuretic peptide
38
Cardiovascular system
Cardiac Natriuretic Peptide
Major regulator of fetal bone growth
C type natriuretic peptide
39
Cardiovascular system
Increase in production is thought to have a central role in control of vascular tone, BP and sodium balance.
Prostaglandins
40
Cardiovascular system
Increased during late pregnancy and is presumed to be natriuretic
Renal medullary prostaglandin E2 synthesis
41
Cardiovascular system
Principal prostaglandin of endothelium.
Increased in late pregnancy and regulates Bp and platelet function
Prostacyclin PG12
42
Cardiovascular system
Considered important in preeclampsia pathogenesis
PG12 and
| Thromboxane
43
Cardiovascular system
Potent vasoconstrictor produced in endothelial and vascular smooth muscle cells and regulate local vasomotor tone
Endothelin 1
44
Cardiovascular system
Endothelins production is stimulated by
Angiotensin 2
Arginine vasopressin
Thrombin
45
Cardiovascular system
Endothelin1 stimulate secretion of
ANP
Aldosterone
Cathecolamines
46
Cardiovascular system
Counter balance the endothelins 1 vasoconstrictor effects and reduce peripheral vascular resistance
Vasodilating factors
47
Cardiovascular system
Potent vasodilator
Implications for modifying vascular resistance during pregnancy
One of the most important mediators of placenta vascular tone an development
Nitric oxide
48
Cardiovascular system
Abnormal NO syntesis has been linked to
Preeclampsia development
49
Respiratory system
```
Diaphragm rises 4 cm
Subcostal angle widens
Transverse diameter lengthens
Thoracic circumference increase
Excursion of diaphragm is greater
```
50
Sa cardio and no change ay
ANP
51
Respiratory system
No change
RR
Lung compliance
Max. Breathing capacity
Forced or timed vital capacity
52
Respiratory system
Decrease
FRC
Residual volume
Total pulmonary resistance
53
Respiratory system
Increase
```
Tidal volume
Resting minute ventilation
Peak expiratory flow rate
Airway conductance
Oxygen requirement
Critical closing time
```
54
Respiratory system
Imposed by pregnancy make respiratory disease more serious
Increased oxygen
| Increased critical requirements
55
Respiratory system
Decreases by approximately 20-30% or 400-700ml
Functional residual capacity
56
Respiratory system
Decrease 15-20% or 200-300 ml
Expiratory reserve volume
57
Respiratory system
Decrease 20-125% or 200-400ml
Residual volume
58
Respiratory system
Max volume that can be inhaled from FRC increases
Inspiratory capacity
59
Respiratory system
Combination of FRC and inspiratory capacity is unchanged or decreases by less than 5% at term
Total lung capacity
60
Respiratory system
Essentially unchanged
Respiratory rate
61
Respiratory system
Increase significantly as pregnancy advances
Tidal volume and resting minute ventilation
62
Respiratory system
| Increase progressively as gestation advances
Peak expiratory flow rates
63
Respiratory system
Unaffected by pregnancy
Lung compliance
64
Respiratory system
Increased
Airway conductance
65
Respiratory system
| Reduced possibly as result of progesterone
Total pulmonary resistance
66
Respiratory system
Not altered
Maximu breathing capacity
| Forced or timed vital capacity
67
Respiratory system
Lung volume at which airways in the dependent parts of the lung begin to close during expiration is higher in pregnancy
Closing volume
68
Respiratory system
In oxygen delivery, lahat increase except?
Maternal AV O2 different kasi decrease sya
69
Respiratory system
Acid base equilibrium
Lahat decrease except
Desire to breathe
Blood pH
Kasi increase to, hahahaha
70
Respiratory system
| Reduction of PCO2 is likely induced in large part of
Progesterone and to a lesser degree by estrogen
71
Respiratory system
Blood pH increased minimally but shifts
Oxygen dissociation curve to the left
72
Respiratory system
Decreasing the oxygen releasing capacity of maternal blood
Bohr effect
73
Respiratory system
Slightly pH increase also stimulates an increase also stimulates an
Increase in 2,3 di phosphoglycerate in maternal erythrocytes
74
Urinary system
Increase
Size
GFR (early)
Renal plasma flow (early)
75
Urinary system
Decrease
GFR
| Renal plasma flow. (Late)
76
Urinary system
| Factors of hyper filtration
Hypervolemia
| Renal plasma flow increase
77
Urinary system
Reversal of gestational Hypervolemia and hemodilution also evident on the ____________ and eventuates by the __________
1st postpartum day
| 2nd postpartum week
78
Urinary system
Increases endothelin and NO production in the renal circulation
Relaxin
79
Urinary system
| May increase vascular gelatinase activity during pregnancy
Relaxin
80
Urinary system
Urinary flow and sodium excretion average less than 1/2 in
Supine position compared to lateral recumbent position
81
Urinary system
Renal function test
Decrease
Serum creatinine
82
Urinary system
Renal function test
Increase
Creatinine clearance
| Bile cholesterol saturation
83
Urinary system
Decrease during pregnancy
Serum creatinine level
84
Urinary system
During pregnancy may not be abnormal
Glucosuria
85
Urinary system
May result from contamination during collection and if not often suggest to urinary tract disease
Hematuria
86
Urinary system
Common after difficult labor and delivery because of trauma to the bladder or urethra
Hematuria
87
Urinary systems
Excretion rate of atleast 300 mg/day
Proteinuria
88
Urinary system
Ureters
Which is remarkably dilated lies obliquely over the right ureter and may contribute significantly to
Right ureteral dilatation
89
Urinary system
Ureters
Unequal dilatation may result from cushioning provided the left ureter by the sigmoid colon and perhaps from greater right ureteral compression exerted by the
Dextrorotated uterus
90
Urinary system
Ureters
Accompany distention and the ureter is frequently thrown into curves of varying size, the smaller may be sharply angulated
Ureteral elongation
91
Urinary system
Urinary bladder
Increase lahat except
```
Bladder capacity (decrease)
Mucosa (no change)
```
92
Gastrointestinal system
Decrease lahat except
```
Intragastric pressure (increase)
Gastric emptying time ( no change)
```
93
Gastrointestinal system
Subsides postpartum
Pregnancy gingivitis
94
Gastrointestinal system
Focal, highly vascular swelling of the gums
Epulis gravidarum
95
Gastrointestinal system
Occasionally develops but regresses
Pyrogenic granuloma
96
Gastrointestinal system
Common during pregnancy and most likely caused by reflux of acidic secretions into the lower esophagus
Pyrosis (heartburn)
97
Gastrointestinal system
Common, caused by constipation and elevated pressure in veins below the level of the enlarged uterus
Hemorrhoids
98
Liver
Increase
```
Hepatic blood flow
Portal vein diameter
Alkaline phophatase
Total albumin
Serum globulin
Leucine amino peptidase
```
99
Liver
Decrease
AST
ALT
GGT
Bilirubin
100
Liver
No change
Liver size
101
Gall bladder increase
Residual volume
| Bile cholesterol saturation
102
Gallbladder decrease
Contractility
103
Endocrine system
Growth hormone
Secreted predominantly from the maternal pituitary gland and concentrations in serum and amniotic fluid
1st. T
104
Endocrine system
Growth hormone
Secreted from the placenta become detectable
At 8 weeks
105
Endocrine system
Growth hormone
Placenta is the principle source of Ghon
At 17 weeks
106
Endocrine system
Growth hormone
In amniotic fluid peaks at
14-15 weeks
Decline after 36 weeks
107
Endocrine system
Growth hormone
Differs from pituitary GH by 13 amino acid residues, secreted synchitiotropoblast
Placental GH
108
Endocrine system
Prolactin
Increase during normal pregnancy and concentration are usually 10x greater at
Term
109
Endocrine system
Prolactin
Decrease
After delivery kahit nag breast feed
110
Endocrine system
Oxytocin and ADh
ADH do not change during pregnancy
| Vasopressin def, associated with DI
111
Endocrine system
Secreted by the hypothalamus and stimulates thyrotrope cells of the anterior pituitary to release thyroid stimulating hormone
Thyroptropin-releasing hormone
112
Endocrine system
Most common preventable cause of impaired neurological development after famine
Iodine deficiency
113
Endocrine system
Decrease in plasma calcium or acute decrease in magnesium stimulate
PTH release
114
Endocrine system
Increase calcium and magnesium levels
Suppress PTH release
115
Endocrine system
Considered to oppose those of PTH and vitamin D
Calcitonin
116
Endocrine system
Increase calcitonin plasma level
Gastrin hormones
| Food ingestion
117
Endocrine system
Increase calcium and magnesium
Secretion of calcitonin
118
Endocrine system
Increase fetal blood
Deoxycorticosterone
119
Endocrine system
Androgen
Both androsterone and testosterone is elevated
120
Endocrine system
Principal mineralocorticoid
Aldosterone
121
Sleep
12 weeks difficulty going to sleep
122
Eyes
IOP decrease attributed to increased vitreous outflow
| Decreased corneal sensitivity
123
Cardiovascular system
Lahat increase except
Systemic vascular resistance
| Arterial BP
