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OB+GYN > Maternal Physiology > Flashcards

Maternal Physiology Flashcards

1
Q

Hematologic changes in pregnancy (Plasma, RBC, Reticulocyte, Hgb)

A

High Plasma
High RBC
High Reticulocyte
Low Hgb (<11g/dL)

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2
Q

Iron requirements for pregnancy and distribution

A

1000mg

  • 300mg for fetus and placenta
  • 200 mg for GI losses
  • 500mg for increase in RBC from pregnancy hypervolemia
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3
Q

Physiology behind pregnancy hypercoagulant state

A
  • Resistance to protein C
  • Drop in protein S
  • Low Antithrombin levels
  • Low platelets
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4
Q

Immunologic stages in pregnancy (Early, mid, parturition)

A

1) Early pregnancy - Pro-inflammatory
2) Mid pregnancy - Anti-inflammatory
3) Parturition - Pro-inflammatory

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5
Q

Amount of T-cell increase (Leukocytosis) in pregnancy

A

T cells 25,000 u/L from 15,000 u/L

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6
Q

Behavior of Cardiac Output (CO) in pregnancy and postpartum

A

CO Peaks in immediate postpartum and achieves baseline by 6-8 weeks

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7
Q

Cardiovascular Changes in pregnancy (HR, Preload, MAP, SVR, TPR, BP)

A

Remember: Hypervolemia! More blood!

Increase in HR
Increase in Preload

Decrease in MAP
Decrease in SVR
Decrease in TPR
Decrease in BP

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8
Q

Heart sounds observed in pregnancy

A

1) Exaggerated splitting in S1
2) Loud S3
3) Systolic murmur (90%)
4) Soft diastolic murlur (20%)
5) Continuous murmur (10%)

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9
Q

ECG findings in Pregnancy

A

1) Slight left axis deviation
2) Q waves in leads II, III, avF
3) Flat/inverted T waves in leads III, V1-V3

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10
Q

Thoracic cage changes in pregnancy (4-2-6)

A

> Diaphragm rises 4cm
Transverse diameter lengthens 2cm
Circumference increases by 6cm

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11
Q

Respiratory changes in pregnancy

Changes in lung capacities

A

1) Increase in Inspiratory capacity (IC) due to increased TV and IRV

2) Decrease in Functinal residual capacity (FRC) due to decreased ERV and RV

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12
Q

Respiratory changes in pregnancy

Lung capacities that remain the same

A

1) Total lung capacity (TLC = IRV + TV + ERV + RV)
2) Forced vital capacity (FVC = IRV + TV + ERV)

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13
Q

Change in Total pulmonary resistance in pregnancy

A

Decrease in TPR (due to progesterone)

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14
Q

Hormones contributing to vasodilation in pregnancy

A

High levels of prostacyclin and Nitric oxide

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15
Q

% Increase in basal metabolic rate by the 3rd trimester

A

20% Increase in basal metabolic rate

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16
Q

Energy requirements in the 3 trimesters of pregnancy

A

1st Trimester = 85kcal/day

2nd Trimester = 285 kcal/day

3rd Trimester = 475 kcal/day

17
Q

Average weight gain during pregnancy

A

12.5kg or 35-35lbs

18
Q

Glycemic changes in pregnancy (fasting and postprandial)

A

1) Mild fasting hypoglycemia
2) Post prandial hyperglycemia

19
Q

Insulin activity in pregnancy

A

Peripheral insulin resistance (dec insulin sensitivity) in order to maintain postprandial supply of glucose for neonate

20
Q

Fat metabolism in the 3 trimesters of pregnancy

A

1st-2nd Trimester = Anabolic (increased fat accumulation)

3rd Trimester = Catabolic (lipolysis) = HyperlipidemiaM

21
Q

Main energy source in late pregnancy

A

Lipids

22
Q

Leptin activity in pregnancy

A

Peak in 2nd trimester and plateau until term. Return to normal after delivery

23
Q

Electrolytes in pregnancy

A

Remember! Hypervolemia = altered osmoregulation

> Decreased serum Na
Decreased serum K
Decreased serum Ca
Decreased serum Mg
unchanged iCa

24
Q

Neonatal complication of excess iodine intake in pregnancy

A

congenital hypothyroidism via Wolff-Chaikoff effect

25
Q

Physiology behind heartburn in pregnancy

A

> Prolonged gastric emptying
Muscle relaxation of LES d/t progesterone
upward displacement of diaphragm

26
Q

Physiology behind intrahepatic cholestasis of pregnancy

A

Progesterone inhibiting contraction of the GB –> Bile stasis

27
Q

GFR Changes in pregnancy

A

Increased GFR (by 25% in 1st Trim and by 50% in 2nd Trim) remains elevated until term

Increased RPF (by 80% in 1st Trim) declines in late pregnancy

28
Q

Reason behind physiologic metabolic acidosis in pregnancy

A

Decreased HCo3 by 4mEq/L)

> Progesterone then stimulates respiratory center > Increased minute ventilation > compensating Respiratory alkalosis

29
Q

Leading cause of septic shock in pregnancy

A

Acute Pyelonephritis (usually during the 2nd trimester)

30
Q

Significant proteinuria in non-pregnant vs pregnant individuals

A

Non-pregnany proteinuria = >150mg/dL

Pregnancy proteinuria = >300mg/dL

31
Q

Human Placental Lactogen (HPL) is produced by which cells

A

Syncytiotrophoblasts from the placenta

32
Q

When do levels of HPL peak in pregnancy

A

24-28 weeks

logic behind timing of 75g OGTT

33
Q

Abdominal Landmark for the fundus of the uterus at 20 weeks

A

Umbilicus

34
Q

Abdominal Landmark for the fundus of the uterus at 36 weeks

A

Xiphoid process

35
Q

Physiology behind hyperpigmentation of areola and linea alba (becomes linea nigra) in pregnancy

A

Estrogen stimulates Anterior pituitary gland to release Melanocyte stimulating hormone

OB+GYN (11 decks)

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