Maternal Physiology Flashcards
Ms. R is a 24-year-old woman who presents to the
office for her routine prenatal visit. She appears
anxious. She denies fever, chills, abdominal pain or
cramping. She says that she has been urinating more
frequently than usual, without pain, and notes fatigue
that she attributes to stress at her work. Her breasts are
more tender. Her last menstrual period was 7 weeks
ago, and she typically has 28-day cycles. She has never
been pregnant. Her medical history is only significant
for a hyperthyroid disorder, which she has had for over
10 years. Her last check up was about 6 months ago.
She takes methimazole. She has had routine
gynecologic follow up, with normal pap smears and she
has never been diagnosed with a sexually transmitted
infection. She reports inconsistent condoms use. Next steps? (5)
urinalysis with urine culture
urine pregnancy test
physical exam
ultrasound
thyroid function
what is a physiological change in the uterus during pregnancy?
smooth muscle undergoes myometrial hypertrophy
what is a physiological change in the cervix during pregnancy, AKA Chadwick’s sign?
increase in vascularity, edema, hypertrophy, and hyperplasia of the endocervical glands
what is formed within the endocervical canal during pregnancy to protect the uterine contents from ascending infection?
mucus plug
when can colostrum begin to be expressed?
2nd trimester
what are 3 dermatologic changes that can occur in pregnancy?
linea alba
melasma gravidarum
striae gravidarum
how does serum creatinine and creatinine clearance change during pregnancy?
serum creatinine decreases
creatinine clearance increases
physiologic hydronephrosis and hydroureters increases the susceptibility of what?
ascending infection
how does thyroid hormone production change in pregnancy?
increases
if a pregnant patient has an elevated T4, what should be started?
thioamide
how does pituitary, prolactin, vasopressin, and oxytocin change in pregnancy?
pituitary enlarges
prolactin increase
vasopressin does not change
oxytocin increases
what causes maternal levels of deoxycorticosterone to rise?
fetal production
what causes the gallbladder contractility to be reduced during pregnancy?
progesterone levels
in regards to the stomach and intestines, what changes in location during pregnancy?
appendix
characterized by mild fasting hypoglycemia, postprandial hyperglycemia, and hyperinsulinemia and peripheral insulin resistance
carbohydrate metabolism
during which trimester is carbohydrate metabolism worse?
3rd trimester
what hematologic changes occur in pregnancy? (3)
erythropoietin increases
blood volume increases
hemoglobin and hematocrit decrease
what hemoglobin level indicates anemia in pregnancy?
< 11
how much iron is required during pregnancy?
6-7 mg/day
what promotes the maternal-fetal immune tolerance?
placental HLA-C
what 4 inflammatory markers are increased in pregnancy?
CRP
ESR
C3 and C4
procalcitonin
what cannot be used to evaluate for a DVT during pregnancy? why?
D-dimer
will be increased either way
how does the heart sound different in pregnancy? (2)
first sound is louder
exaggerated split
how does peripheral vascular resistance change? cardiac output?
peripheral vascular resistance decreases
cardiac output increases
what cardiac finding is more common in multiparous women compared to nulliparous women?
increased aortic stiffness
how does the subcostal angle change?
increased
what remains unchanged in pulmonary function? (4)
respiratory rate
total lung capacity
vital capacity
lung capacity
what decreases in pulmonary function during pregnancy? (2)
functional residual capacity
total pulmonary resistance
what 2 epilepsy drugs have the best safety profile in pregnancy?
keppra
lamotrigine
