Maternal Physiology Flashcards
Uterine enlargement is primarily stimulated by ___ and also by ___
ESTROGEN
Progesterone
Uterine enlargement causes the ___ and ___ of muscle cells
Stretching
Hypertrophy
Other accumulation in part of the uterine enlargement
Accumulation of fibrous tissue
Increased in elastic tissue
The production of new myocytes are ___
LIMITED
The weight of a nonpregnant uteus and its capacity
70 grams
10ml or less
The weight of a prenant uterus and its capacity
1100 gram at term
5-20 liters
The position of a pregnant uterus
Dextrorotated
Layer of the uterus which is composed of dense muscle fibers perforated in all direction by blood vessels
Middle layer
The layer of uterus which consist of sphincter like fiber around the fallopian tube and internal os of the cervix
Inner layer
Irregular, painless contractions which is unpredictable, sporadic, nonrhythmic and intensity varies
Braxton hicks
Braxton hicks approximates __ mmhg
15-25 mmHg
The uteroplacental blood flow near tearm
450-650ml/min
Vasodilation in the maternal placental blood flow is mediated by?
Estrogen
Progesterone
Nitric oxide
Increased in fetal-placental blood flow happens on the ___ weeks were uterine artery doubles
20
Changes in the cervix during pregnancy
Increased vascularity and edema
Hypertrophy and hyperplasia of cervical gland
Copius amount of a tenacious mucus that obstruct the cervical canal soon after conception
Mucus plug
Only a __ corpus luteum of pregnancy can be found in the ovaries of a pregnanct women
SINGLE
Corpus luteum functions maximally during the first ___ weeks of pregnancy
6-7 weeks
The ovarian pedicle increases in about __ cm at term
2.5 cm
This is secreted by the corpus luteum, placenta, decidua and also be expressed by the heart, brain, kidney
Relaxin
Functions of relaxin:
☑️ Remodelling of the reproductive tract tissue during pregnancy
☑️ Initiation of AUGMENT renal hemodynamics and DECREASE osmolality
Solid ovarian tumor composed of large acidophile luteinized cells
Pregnancy luteoma
Solid, complex appearing UNILATERAL mass, with cystic features that correspond to areas of hemorrhage
Pregnancy luteoma
Pregnancy luteoma can cause ___ virilization only
Maternal
This is a self limited, due to exaggerated physiological follicle stimulation (hyperreactio luteinalis)
Theca lutein cyst
This is usually BILATERAL and associated with gestational trophoblast disease
Theca lutein cyst
Theca lutein cyst is also associated in large palacentas such as those found in patients with _ and in patients with _
DM, D-isoimmunization, Multiple fetuses
Chronic renal disease, Hyperthyroidism
What are the three change in the fallopian tubes?
☑️ Undergoes little hypertrophy during pregnancy
☑️ Epithelium of tubal mucosa flattened
☑️ Decidualization may be seen
Vaginal and perineal changes on labor and delivery:
✔️ Increased in the thickness of the mucosa
✔️ Loosening of the connect tissue
✔️ Hypertrophy of the smooth muscle cells
What is the vaginal pH?
3.5 - 6.0
Two changes in the skin:
Striae gravidarum
Diastasis recti
Hyperpigmentation cause __ and __ this is due to __
Linea negra
Chloasma or Melasma gravidarum
Increase MSH
Vascular changes are due to ___ examples are __ and __
Hyperestrogenemia
Vascular spiders, angioma, nevus os telangiectasia
Palmar erythema
Breast will have HYPERTROPHIC sebaceous gland formation called __
Galnds of montgomery
Weight gain in pregnant women is attributed to:
Uterus and its content
Breast
Blood volume
Extravascular extracellular fluid
What is the approximate weight gain during pregnancy:
12.5 kg or 27.5 lbs
Maternal reserve is attributed to ___ and ___
Increased in water and deposition of new proteins and fats
Total water retention during pregnancy ___, divided into two parts with their corresponding volumes
6.5 liter
Fetus, placenta, amniotic fluid (3.5 liters)
Increased in plasma volume, uterine, and breast size (3.0 liters)
Pitting edema in pregnancy is due to?
Partial vena cava occlusion
Decreased in interstitial colloid osmotic pressure
Protein metabolism:
Grams contained in the fetus and placenta
Grams added to the uterus, breast, maternal blood
500 grams
500 grams
CHO metabolism in normal pregnancy:
Mild fasting hypoglycemia
Post prandial hyperglycemia
Hyperinsulinemia
Insulin resistance is ___ in pregnancy to about ____
INCREASED
45-70%
Insulin resistance is mediated by:
Estrogen
Progesterone
Human Placental Lactogen
This is the most consistent change in lipid metabolism durinjg pregnancy
Maternal hyperlipidemia
Maternal hyperlipidemia is due to:
✔️ Decreased circulating levels and activity of lipoprotein lipase
✔️ Estradiol and Progesterone hepatic effects
Leptin and Ghrelin serum levels are ___ and these are mainly secreted by ___
INCREASED
Adipocytes
How many mEq of sodium is retained? How many in potassium?
1000 mEq
300 mEq
Increased or decreased or Unchanged: Ionized calcium Total calcium Magnesium Phosphate GFR of Na and K Reabsorption of electrolytes Excretion of electrolytes
Unchanged Decreased Decreased Unchanged Increased Increased Unchanged
Fetus accumulates __ grams of calcium at term which is met by:
30 grams
☑️ Doubling maternal calcium intestinal absorption
☑️ Dietary intake of sufficient calcium
Hypervolemia accounts for:
☑️ To meet metabolic demands of the enlarging uterus
☑️ To provide abundant nutrients and elements to support the growing fetus and placenta
☑️ To protect mother and fetis against deleterious effects of impaired venous return in the supine and erect position
☑️ To safeguard the mother against the adverse effect of blood loss associated in parturition
___ in both RBC and Plasma begins within the ____ and expans rapidly in the ___
Increased
1st trimester
2nd trimester
Total iron requirement during pregnancy: _____ mg
To the fetus and placenta: ___ mg
Lost portion: ___ mg
To 450 ml of circulating erythrocytes: ___ mg
1000 mg
300 mg
200 mg
500 mg
Blood volume increased at near term by ___%
40-45%
Rate of increase in iron requirement
6-7 mg/day
Increased or decreased or unchanged: Iron requirement Blood volume Hgb Hct
Increased
Increased
Decreased
Decreased
Increased or decreased or unchanged: All clotting factors except XI and XIII Platelets Anti-thrombin levels Clotting time Fibrinogen Thromboxane A2 Activated C protein resistance Protein S Protein Z Clotting factors XI and XIII
Increased Decreased Unchanged Unchanged Increased Increased Decreased Decreased Increased Increased
Increased or decreased or unchanged:
T helper 2 cells suppresion
CD4 T lymphocytes
Monocytes
All are decreased
Increased or decreased or unchanged: T helper 1 cells suppression T cytotoxic 1 cells Interleukins 4,6,13 IgA and IgG Leukocyte counts CD8 T lymphocytes CRP, ESR, C3, C4, leukocyte alkaline phosphatase
All are INCREASED
Increased or decreased or unchanged: Systemic vascular response ECG CO HR Plasma volume Pulmonary vascular resistance A2 and P2 Preload MAP Pulmonary capillary wedge pressure
Decreased Unchanged Increased Increased Increased Decreased Unchanged Unchanged Increased Decreased
Increased or decreased or unchanged: S1 splitting BP on sitting CVP Antecubital venous pressure S3 sound Basal metabolic rate
Increased Decreased Unchanged Unchaged Increased Increased
10% if women have this due to supine compression of great vessels that may affect directly the fetal heart rate patterns
Supine hypotension syndrome
Increased or decreased or unchanged:
Renin
Aniotensin
Plasma volume
ALL are INCREASED
Renin is produce by:
Maternal kidney and Placenta
Angiotensinogen is produced by:
Maternal and Fetal liver
There is an ___ refractoriness in angiotensin II refractoriness in normal pregnancy and lost immediately after delivery of the placenta
Increased
Increased or decreased or unchanged:
ANP
BNP
ALL are UNCHANGED
Diaphragm rises about ___ during pregnancy
Subcostal angle widens appreciably as the transverse diameter of the thoracic cage increase about ___
Thoracic circumference increases about ___
4cm
2cm
6cm
Increased or decreased or unchanged: Tidal volume FRC Maximum breathing capacity Minutes Ventilatory colume Residual volume Timed vital capacity Minute oxygen uptake Peak expiratory flow Total pulmonary resistance Lung compliance Airway conductance Critical losing volume Total oxygen carrying capacity
Increased Decreased No change Increase Decrease Unchange Increased Decreased Decreased Unchange Increased Increased Increased
Urinalysis:
Glucosuria
Proteinuria
Hematuria
Normal
Abnormal
Contamination
Increased or decreased or unchanged:
Gastric emptying time
Increased
Common during pregnancy and is mostblikely caused by reflux of acidic secretions into the lower esophagus
Pyrosis
Increased or decreased or unchanged:
Lower esophageal tone
Decreased
Increased or decreased or unchanged:
Intraesophageal pressure
Intragastric pressure
Lower
Higher
Increased or decreased or unchanged:
Esophageal peristalsis have: speed and amplitude
Decreased
Decreased
Increased or decreased or unchanged: Serum aspartate transaminase Alanine transaminase Glutamyl transaminase Leucine aminopeptidase Bilirubin Gall bladder contractility Alkanine phosphatase Serum albumin
Decreased Decreased Decreased Increased Decreased Decreased Increased Decreased
The unchanged level in endocrine in pregnancy:
Growth hormones
TRH
The decreased level in endocrine pregnancy:
Dehyroepiandrosterone sulfate
IOP in pregnancy is ___
Vitreous outflow is ___
Corneal sensitivity ___
Decreased
Increased
Decreased
Brownish red opacity on the posterior surface of the cornea
Krukenberg spindles