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Physio OB Midterm > Maternal Physio 2 > Flashcards

Maternal Physio 2 Flashcards

1
Q

Cardiovascular system

Changes apparent during the

A

First 8 weeks

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2
Q

Cardiovascular system

CO increased as early as

A

5th week

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3
Q

Cardiovascular system

Brachial systolic BP, diastolic BP and central systolic BP are significantly lower

A

6-7 weeks from the LMP

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4
Q

Cardiovascular system

Plasma blood volume expansion begins, and preload is increased

A

10-20 weeks

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5
Q

Cardiovascular system

Heart

A

Elevated diaphragm
Left upward displacement
Larger cardiac silhouette
Increase cardiac silhouette

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6
Q

Cardiovascular system

Cardiac sounds

A

1st heart sound - exaggerate splitting
2nd heart sound - no changes
3rd heart sound- loud

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7
Q

Cardiovascular system

Physiologic hypertrophy

A

Cardiac plasticity

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8
Q

Cardiovascular system

90% of pregnant women, they also heard

A

Systolic murmur that was intensified during inspiration

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9
Q

Cardiovascular system

Ventricular function during pregnancy is normal, as estimated by the

A

Braunwald ventricular function graph

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10
Q

Cardiovascular system

Cardiac function and
Myocardial function

A

Eudynamic

Normal

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11
Q

Cardiovascular system

Remodeling in

Nonpregnat and
Pregnant

A

Longitudinal remodeling

Spherical remodeling

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12
Q

Cardiovascular system
Cardiac output

Decrease

A

Mean arterial pressure

Vascular resistance

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13
Q

Cardiovascular system
Cardiac output

Increase

A

Blood volume

Basal metabolic rate

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14
Q

Cardiovascular system
Cardiac output

At rest
Lateral recumbent position
Increase

A

Early pregnancy

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15
Q

Cardiovascular system
Cardiac output

Supine woman
Large uterus compresses venous return

A

Late pregnancy

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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

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17
Q

Cardiovascular system
Cardiac output

Implies reduced cardiovascular reserve in multiple gestations

A

Increased HR

Inotropic contractility

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18
Q

Cardiovascular system
Cardiac output

Increase moderately

A

1st stage of labor

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19
Q

Cardiovascular system
Cardiac output

With vigorous expulsive efforts

A

2nd stage of labor

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20
Q

Cardiovascular system

Hemodynamic function in late pregnancy

A

Normal pregnancy is not a continuos “high output” state

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21
Q

Cardiovascular system
Circulation and blood pressure

Changes in posture affect

A

Arterial BP

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22
Q

Cardiovascular system
Circulation and blood pressure

When sitting is lower than lateral recumbent supine position

A

Brachial artery

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23
Q

Cardiovascular system
Circulation and blood pressure

Diastolic pressure _____ more than systolic

A

Decrease

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24
Q

Cardiovascular system
Circulation and blood pressure

Supine femoral venous pressure rises from 8mmhg in

A

Early pregnancy to 24mmhg at term

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25
Q

Cardiovascular system
Circulation and blood pressure

Venous BF in the legs is retarded during pregnancy except in

A

Lateral recumbent position

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26
Q

Cardiovascular system
Circulation and blood pressure

10% supine compression of the great vessels by the uterus causes significant arterial hypotension, referred to as

A

Supine hypotensive syndrome

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27
Q

Cardiovascular system
Renin angiotensin 2, and plasma volume

Involved in Bp control via sodium and water balance

A

Renin angiotensin aldosterone axis

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28
Q

Cardiovascular system
Renin angiotensin 2, and plasma volume

All components of this system

A

Increase din normal pregnancy

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29
Q

Cardiovascular system
Renin angiotensin 2, and plasma volume

Renin produced by

A

Maternal kidney

Placenta

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30
Q

Cardiovascular system
Renin angiotensin 2, and plasma volume

Increase renin substrate (angiotensinogen) is produced by

A

Both maternal and fetal liver

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31
Q

Cardiovascular system
Renin angiotensin 2, and plasma volume

Increased estrogen production during pregnancy

A

Important in first T BP maintenance

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32
Q

Cardiovascular system
Renin angiotensin 2, and plasma volume

Pregnant women lose their acquired vascular refractories to angiotensin 2 within 15-30minutes after the

A

Placenta is delivered

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33
Q

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

A

5alpha dihyroxyprogesterone

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34
Q

Cardiovascular system
Cardiac Natriuretic Peptide

Secreted by cardiomyocytesin response to chamber wall stretching

A

Atrial natriuretic peptide

B-type natriuretic peptide

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35
Q

Cardiovascular system
Cardiac Natriuretic Peptide

Increased in severe preeclampsia caused by cardiac strain from increased after load

A

BNP

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36
Q

Cardiovascular system
Cardiac Natriuretic Peptide

Induced physiological adaptations participate in ECF volume expansion and in the increased plasma aldosterone

A

ANP

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37
Q

Cardiovascular system
Cardiac Natriuretic Peptide

Secreted by non cardiac tissue pred

A

C-type natriuretic peptide

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38
Q

Cardiovascular system
Cardiac Natriuretic Peptide

Major regulator of fetal bone growth

A

C type natriuretic peptide

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39
Q

Cardiovascular system

Increase in production is thought to have a central role in control of vascular tone, BP and sodium balance.

A

Prostaglandins

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40
Q

Cardiovascular system

Increased during late pregnancy and is presumed to be natriuretic

A

Renal medullary prostaglandin E2 synthesis

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41
Q

Cardiovascular system

Principal prostaglandin of endothelium.
Increased in late pregnancy and regulates Bp and platelet function

A

Prostacyclin PG12

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42
Q

Cardiovascular system

Considered important in preeclampsia pathogenesis

A

PG12 and

Thromboxane

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43
Q

Cardiovascular system

Potent vasoconstrictor produced in endothelial and vascular smooth muscle cells and regulate local vasomotor tone

A

Endothelin 1

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44
Q

Cardiovascular system

Endothelins production is stimulated by

A

Angiotensin 2
Arginine vasopressin
Thrombin

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45
Q

Cardiovascular system

Endothelin1 stimulate secretion of

A

ANP
Aldosterone
Cathecolamines

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46
Q

Cardiovascular system

Counter balance the endothelins 1 vasoconstrictor effects and reduce peripheral vascular resistance

A

Vasodilating factors

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47
Q

Cardiovascular system

Potent vasodilator
Implications for modifying vascular resistance during pregnancy
One of the most important mediators of placenta vascular tone an development

A

Nitric oxide

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48
Q

Cardiovascular system

Abnormal NO syntesis has been linked to

A

Preeclampsia development

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49
Q

Respiratory system

A 
Diaphragm rises 4 cm
Subcostal angle widens
Transverse diameter lengthens 
Thoracic circumference increase
Excursion of diaphragm is greater
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50
Q

Sa cardio and no change ay

51
Q

Respiratory system

No change

A

RR
Lung compliance
Max. Breathing capacity
Forced or timed vital capacity

52
Q

Respiratory system

Decrease

A

FRC
Residual volume
Total pulmonary resistance

53
Q

Respiratory system

Increase

A 
Tidal volume
Resting minute ventilation
Peak expiratory flow rate
Airway conductance
Oxygen requirement
Critical closing time
54
Q

Respiratory system

Imposed by pregnancy make respiratory disease more serious

A

Increased oxygen

Increased critical requirements

55
Q

Respiratory system

Decreases by approximately 20-30% or 400-700ml

A

Functional residual capacity

56
Q

Respiratory system

Decrease 15-20% or 200-300 ml

A

Expiratory reserve volume

57
Q

Respiratory system

Decrease 20-125% or 200-400ml

A

Residual volume

58
Q

Respiratory system

Max volume that can be inhaled from FRC increases

A

Inspiratory capacity

59
Q

Respiratory system

Combination of FRC and inspiratory capacity is unchanged or decreases by less than 5% at term

A

Total lung capacity

60
Q

Respiratory system

Essentially unchanged

A

Respiratory rate

61
Q

Respiratory system

Increase significantly as pregnancy advances

A

Tidal volume and resting minute ventilation

62
Q

Respiratory system

Increase progressively as gestation advances

A

Peak expiratory flow rates

63
Q

Respiratory system

Unaffected by pregnancy

A

Lung compliance

64
Q

Respiratory system

Increased

A

Airway conductance

65
Q

Respiratory system

Reduced possibly as result of progesterone

A

Total pulmonary resistance

66
Q

Respiratory system

Not altered

A

Maximu breathing capacity

Forced or timed vital capacity

67
Q

Respiratory system

Lung volume at which airways in the dependent parts of the lung begin to close during expiration is higher in pregnancy

A

Closing volume

68
Q

Respiratory system

In oxygen delivery, lahat increase except?

A

Maternal AV O2 different kasi decrease sya

69
Q

Respiratory system

Acid base equilibrium

Lahat decrease except

A

Desire to breathe
Blood pH

Kasi increase to, hahahaha

70
Q

Respiratory system

Reduction of PCO2 is likely induced in large part of

A

Progesterone and to a lesser degree by estrogen

71
Q

Respiratory system

Blood pH increased minimally but shifts

A

Oxygen dissociation curve to the left

72
Q

Respiratory system

Decreasing the oxygen releasing capacity of maternal blood

A

Bohr effect

73
Q

Respiratory system

Slightly pH increase also stimulates an increase also stimulates an

A

Increase in 2,3 di phosphoglycerate in maternal erythrocytes

74
Q

Urinary system

Increase

A

Size
GFR (early)
Renal plasma flow (early)

75
Q

Urinary system

Decrease

A

GFR

Renal plasma flow. (Late)

76
Q

Urinary system

Factors of hyper filtration

A

Hypervolemia

Renal plasma flow increase

77
Q

Urinary system

Reversal of gestational Hypervolemia and hemodilution also evident on the ____________ and eventuates by the __________

A

1st postpartum day

2nd postpartum week

78
Q

Urinary system

Increases endothelin and NO production in the renal circulation

79
Q

Urinary system

May increase vascular gelatinase activity during pregnancy

80
Q

Urinary system

Urinary flow and sodium excretion average less than 1/2 in

A

Supine position compared to lateral recumbent position

81
Q

Urinary system

Renal function test

Decrease

A

Serum creatinine

82
Q

Urinary system

Renal function test

Increase

A

Creatinine clearance

Bile cholesterol saturation

83
Q

Urinary system

Decrease during pregnancy

A

Serum creatinine level

84
Q

Urinary system

During pregnancy may not be abnormal

A

Glucosuria

85
Q

Urinary system

May result from contamination during collection and if not often suggest to urinary tract disease

86
Q

Urinary system

Common after difficult labor and delivery because of trauma to the bladder or urethra

87
Q

Urinary systems

Excretion rate of atleast 300 mg/day

A

Proteinuria

88
Q

Urinary system
Ureters

Which is remarkably dilated lies obliquely over the right ureter and may contribute significantly to

A

Right ureteral dilatation

89
Q

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

A

Dextrorotated uterus

90
Q

Urinary system
Ureters

Accompany distention and the ureter is frequently thrown into curves of varying size, the smaller may be sharply angulated

A

Ureteral elongation

91
Q

Urinary system
Urinary bladder

Increase lahat except

A 
Bladder capacity (decrease)
Mucosa (no change)
92
Q

Gastrointestinal system

Decrease lahat except

A 
Intragastric pressure (increase)
Gastric emptying time ( no change)
93
Q

Gastrointestinal system

Subsides postpartum

A

Pregnancy gingivitis

94
Q

Gastrointestinal system

Focal, highly vascular swelling of the gums

A

Epulis gravidarum

95
Q

Gastrointestinal system

Occasionally develops but regresses

A

Pyrogenic granuloma

96
Q

Gastrointestinal system

Common during pregnancy and most likely caused by reflux of acidic secretions into the lower esophagus

A

Pyrosis (heartburn)

97
Q

Gastrointestinal system

Common, caused by constipation and elevated pressure in veins below the level of the enlarged uterus

A

Hemorrhoids

98
Q

Liver

Increase

A 
Hepatic blood flow
Portal vein diameter
Alkaline phophatase
Total albumin
Serum globulin
Leucine amino peptidase
99
Q

Liver

Decrease

A

AST
ALT
GGT
Bilirubin

100
Q

Liver

No change

A

Liver size

101
Q

Gall bladder increase

A

Residual volume

Bile cholesterol saturation

102
Q

Gallbladder decrease

A

Contractility

103
Q

Endocrine system
Growth hormone

Secreted predominantly from the maternal pituitary gland and concentrations in serum and amniotic fluid

104
Q

Endocrine system
Growth hormone

Secreted from the placenta become detectable

A

At 8 weeks

105
Q

Endocrine system
Growth hormone

Placenta is the principle source of Ghon

A

At 17 weeks

106
Q

Endocrine system
Growth hormone

In amniotic fluid peaks at

A

14-15 weeks

Decline after 36 weeks

107
Q

Endocrine system
Growth hormone

Differs from pituitary GH by 13 amino acid residues, secreted synchitiotropoblast

A

Placental GH

108
Q

Endocrine system
Prolactin

Increase during normal pregnancy and concentration are usually 10x greater at

109
Q

Endocrine system
Prolactin

Decrease

A

After delivery kahit nag breast feed

110
Q

Endocrine system

Oxytocin and ADh

A

ADH do not change during pregnancy

Vasopressin def, associated with DI

111
Q

Endocrine system

Secreted by the hypothalamus and stimulates thyrotrope cells of the anterior pituitary to release thyroid stimulating hormone

A

Thyroptropin-releasing hormone

112
Q

Endocrine system

Most common preventable cause of impaired neurological development after famine

A

Iodine deficiency

113
Q

Endocrine system

Decrease in plasma calcium or acute decrease in magnesium stimulate

A

PTH release

114
Q

Endocrine system

Increase calcium and magnesium levels

A

Suppress PTH release

115
Q

Endocrine system

Considered to oppose those of PTH and vitamin D

A

Calcitonin

116
Q

Endocrine system

Increase calcitonin plasma level

A

Gastrin hormones

Food ingestion

117
Q

Endocrine system

Increase calcium and magnesium

A

Secretion of calcitonin

118
Q

Endocrine system

Increase fetal blood

A

Deoxycorticosterone

119
Q

Endocrine system

Androgen

A

Both androsterone and testosterone is elevated

120
Q

Endocrine system

Principal mineralocorticoid

A

Aldosterone

121
Q

Sleep

A

12 weeks difficulty going to sleep

122
Q

Eyes

A

IOP decrease attributed to increased vitreous outflow

Decreased corneal sensitivity

123
Q

Cardiovascular system

Lahat increase except

A

Systemic vascular resistance

Arterial BP

Physio OB Midterm (6 decks)

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