Maternal Physio, Preconception Counseling Flashcards
during pregnancy, hemangioma can appear on genitals due to effect of…
estrogen
pH of vagina during pregnancy
3.5-6 (acidic, may become moreso)
changes to vascular tree during pregnancy
- uterine a. diameter doubles
- uterine BF inc
- vasodilatation (estradiol, progesterone)
- v. dilate, less competent
- lymph channels open
breast changes during pregnancy
leakage at 12 wk
sebaceous gland hypertrophy at 5-15 wk
linea nigra
black pigmented area in midline
strie graviderum
stretch marks
skin changes during pregnancy
- inc sweating, sebum
- hair loss
blood during preg
- rbc mass inc
- disproportionate inc in plasma and rbc vol –> HEMODILUTION
- hypercoaguable state
- inc hepatic synthesis of proteins
- reduced total plasma proteins (albumin)
chest changes during preg
- displaced diaphragm
- heart displaced up, left
- apex moves laterally
- straightening of L border of heart
- inc prominence of pulmonary conus
respiratory changes during preg
- chest shape/circumference inc
- inc in O2 consumption
- mucosa of nasopharynx –> hyperemic and edematous
- HYPERVENTILATION –> inc tidal vol
- respiratory ALKALOSIS
- arterial O2 is unchanged
progesterone effects on respiration
stimulant of respiration and respiratory drive
cardiovascular changes during preg
- heart size inc
- murmurs
- ECG positional changes
- extrasystoles
- output rises
- HR rises
- progesterone dec SVR
- inc angio II –> water and sodium retention
cardiac exam in pregnancy - which type of murmurs are common?
systolic
cardiac exam in pregnancy - which type of murmurs are potentially pathologic?
diastolic
ECG changes
left axis deviation
- sagging ST segments, inversion or flattening of T wave
- mammary souffle
- arrythmias
best position to lay in while pregnant
lateral decubitus, avoids venocaval compression
COP during preg
progesterone –> dec SVR –> low bp –> inc COP
urinary changes during preg
- inc renal BF
- inc excretion and reduced blood urea, creatinine
- mild glycosuria (inc GFR)
- inc water retention –> dec plasma osmolality
- HYDRONEPHROSIS
GI tract changes during preg
- progesterone –> relax LES –> reflux
- reduced GI motility (inc absorption, inc constipation)
- delayed emptying
- gallbladder may dilate
- CHL gallstomes
- spongy, friable gums
ptyalism
xs saliva
acidic saliva contents
pseudocyesis
-false pregnancy, unknown cause
follicle development - 2 phases
- gonadotropin independent phase
2. gonadotropin dependent phase
meiosis of oocytes is arrested at
prophase I
When is meiotic division of oocytes completed?
just prior to ovulation
sperm binding protein on oocytes
ZP3
endometrium stromal cells (fb-like)
get transformed by steroid hormones like progesterone into decidua
implantation window
about 4d, 6-10d after LH peak
decidua basalis
uterus at site of impact (interacts with trophoblast)
immune protection of early implantation
- maternal immune cells removed
- maternal/decidual/conceptus cells release CRH which blinds to receptors on surface of trophoblast –> expression of Fas –> immune cell death
placenta accreta
Abnormal adherence of the placenta to the uterine wall (attaches to myometrium)
placenta increta
Abnormal adherence of the placenta THROUGH the myometrium.
placenta percreta
Abnormal adherence in which the placenta invades through the myometrium to the uterine serosa and even to adjacent organs (bladder, rectum)
low-pregnancy weight consequences
gastroschisis
type I pregestational diabetes
- AI, destroys beta
- onset earlier in life
- need insulin therapy
type II pregrestational diabetes
- MORE COMMON
- onset later
- peripheral insulin resistance
- relative insulin deficiency
- obesity
human placental lactogen
- anti-insulin, lipolytic effects
- peripheral insulin sensitivity during 3rd trimester falls by 50%
- higher basal hepatic glucose output
specific genetic testing
- Canavan (neuro, infancy, white matter, aspartoacylase)
- Tay-Sachs
- cystic fibrosis
Comm meds to avoid during preg
- acne
- asthma
- DM (stop oral, start insulin)
- HTN ( NO ACEi or ARB)
- hypERthyroidism (use propylthiouracil dur 1st trimester)
Fick equation
kA(P2-P1)/D
k=diffusion constant
A=area for gas exchange
P=diff in partial pressure
D=diffusion distance
