Maternal Physiology

Question 1

During pregnancy, cardiac output increases by ___ [%].

Answer 1

30-50%

Question 2

During pregnancy, maximum cardiac output is reached ___ [age of gestation]

Answer 2

Between 20 and 24 weeks’ gestation and maintained until delivery

Question 3

The increase in cardiac output is first due to an increase in ___ and is then maintained by an increase in ___ as the ___ decreases to near prepregnancy levels by the end of the third trimester

Answer 3

Stroke volume
Heart rate
Stroke volume

Question 4

Systemic vascular resistance decreases during pregnancy, resulting in a fall in arterial blood pressure. This decrease is most likely due to elevated ___ [hormone], leading to smooth muscle relaxation.

Answer 4

Progesterone

Question 5

There is a decrease in systolic blood pressure of ___ [mmHg] and in diastolic blood pressure of ___ [mmHg] that nadirs at week ___ [age of gestation]

Answer 5

5-10 mm Hg
10-15 mm Hg
24

Question 6

There is an increase of 30-40% in tidal volume during pregnancy despite the fact that the total lung capacity is [1: decreased / increased] by 5% due to the elevation of the diaphragm. This increase in tidal volume [2: decreases / increases] the expiratory reserve volume by about 20%.

Answer 6

Decreased total lung capacity

Decreased expiratory reserve volume

Question 7

PaCO2 decreases to approximately 30 mm Hg by ___ weeks’ gestation from 40 mm Hg during prepregnancy.

Answer 7

20 weeks’

Question 8

Nausea and vomiting occur in more than ___ % of pregnancies

Answer 8

70%

Question 9

Nausea and vomiting have been attributed to the elevation in ___, ___, and ___. They may also be due to ___ and can be treated with frequent snacking.

Answer 9

Estrogen
Progesterone
hCG
Hypoglycemia

Question 10

The nausea and vomiting typically resolve by ___ weeks’ gestation

Answer 10

14-16 weeks’

Question 11

A severe form of morning sickness associated with weight loss (>/= 5% of prepregnancy weight) and ketosis

Answer 11

Hyperemesis gravidarum

Question 12

During pregnancy, the stomach has [1: reduced / prolonged] gastric emptying times and the gastroesophageal sphincter has [2: decreased / increased] tone. The large bowel also has [3: decreased / increased] motility.

Answer 12

Prolonged gastric emptying times
Decreased esophageal tone
Decreased motility (leading to increased water absorption and constipation)

Question 13

The glomerular filtration rate increases by ___ % early in pregnancy and is maintained until delivery. As a result of increased GFR, blood urea nitrogen and creatinine decrease by about ___ %.

Answer 13

50%, 25%

Question 14

Although the plasma volume increases by (1) % in pregnancy, the RBC volume increases by only (2) %, which leads to a decrease in the (3), or dilutional anemia.

Answer 14

50%
20-30%
Hematocrit

Question 15

The WBC count increases during pregnancy to a mean of 10.5 million/mL with a range of ___ million.

Answer 15

6-16 million

Question 16

During labor, stress may cause the WBC count to rise to over ___ million/mL.

Answer 16

20 million/mL

Question 17

Changes in clotting and bleeding times in pregnancy

Answer 17

No change

Question 18

A drop in the platelet count below ___ million/mL over a short time is not normal and should be investigated promptly

Answer 18

100 million/mL

Question 19

In pregnancy, there are elevations in the levels of fibrinogen and factors:

Answer 19

VII to X

Question 20

Pregnancy is a hyperestrogenic state. The increased estrogen is produced primarily by the ___.

Answer 20

Placenta (with the ovaries contributing to a lesser degree)

Question 21

The ___ [1] subunit of hCG is identical to the ___ [1] subunits of luteinizing hormone (LH), follicle-stimulating hormone (FSH), and thyroid-stimulating hormone (TSH), whereas the ___ [2] subunits differ.

Answer 21

Alpha subunit

Beta subunit

Question 22

Levels of hCG double approximately every ___ hours during early pregnancy, reaching a peak at approximately ___ weeks. A nadir is reached by approximate ___ weeks.

Answer 22

48 hours
10-12 weeks
16 weeks

Question 23

The placenta produces ___ [1], which acts to maintain the corpus luteum in early pregnancy. The corpus luteum produces ___ [2], which maintains the endometrium. Eventually, the placenta takes over ___ [2] production and the corpus luteum degrades into the corpus albicans. ___ [2] levels increase over the course of pregnancy.

Answer 23

hCG

Progesterone

Question 24

Also known as human chorionic somatomammotropin (hCS)
Induces lipolysis with a concomitant increase in circulating free fatty acids
Also acts as an insulin antagonist, along with various other placental hormones, thereby having a diabetogenic effect

Answer 24

Human placental lactogen

Question 25

Changes in thyroid hormone changes early in pregnancy (T3, T4, TSH)

Answer 25

Slight increase in T3 and T4 and a slight decrease in TSH early in pregnancy
(Overall, however, pregnancy is considered a euthyroid state)

Question 26

Numerous changes occur in the skin, including spider angiomata and palmar erythema secondary to increased ___ levels and hyperpigmentation of the nipples, umbilicus, abdominal midline (the linea nigra), perineum, and face (melasma or chloasma) secondary to increased levels of the ___.

Answer 26

Estrogen

Melanocyte-stimulating hormones and the steroid hormones

Question 27

Pregnancy is also associated with ___, which results from compression of the median nerve.

Answer 27

Carpal tunnel syndrome

Question 28

The caloric requirement is increased by ___ kcal/day during pregnancy and by ___ kcal/day when breastfeeding.

Answer 28

300 kcal/day

500 kcal/day

Question 29

Most patients should gain ___ during pregnancy. Overweight women are advised to gain less, ___; underweight women are advised to gain more, ___.

Answer 29

20-30 lbs
15-25 lbs
28-40 lbs

Question 30

Intraocular pressure [decreases / increases] during pregnancy

Answer 30

Decreases (due to increased vitreous outflow)

Question 31

Maternal adrenal glands secrete more aldosterone as early as:

Answer 31

15 weeks

Question 32

Maternal plasma prolactin increase markedly during normal pregnancy, and concentrations are usually ___ [fold] greater at term–about ___ ng/mL, compared with those of nonpregnant women

Answer 32

Ten-fold

150 ng/mL

Question 33

The pituitary gland increases by ___ [%] in pregnancy

Answer 33

135%

Question 34

Effect of retained bile salts on the skin of pregnant women

Answer 34

Pruritus gravidarum

Question 35

In pregnancy, gallbladder action is impaired because progesterone inhibits:

Answer 35

CCK-mediated smooth muscle contraction

Question 36

Effect of pregnancy on liver size and hepatic blood flow

Answer 36

No effect on liver size

Increased hepatic blood flow

Question 37

Focal, highly vascular swelling of the gums that regresses spontaneously after delivery

Answer 37

Epulis of pregnancy

Question 38

In pregnancy, which ureter is more dilated?

Answer 38

Right ureter

Question 39

During pregnancy, albumin excretion ranges from [mg/day]:

Answer 39

5-30 mg/day

Question 40

Serum creatinine levels are decreased during pregnancy. Values above ___ suggest underlying renal disease and prompt investigation

Answer 40

0.9 mg/dL

Question 41

To compensate for the respiratory alkalosis in pregnancy, serum bicarbonate levels decrease by:

Answer 41

4-5 mmol/L

Question 42

Because of the dilatation of ureters during pregnancy, it is recommended that elective pyelography be deferred until how many weeks’ postpartum?

Answer 42

12 weeks

Question 43

Estimated maternal blood loss in a cesarean section or vaginal delivery of twins

Answer 43

1,000 mL

Question 44

Estimated maternal blood loss in a spontaneous vaginal delivery of a singleton

Answer 44

500-600 mL

Question 45

This hormone is secreted primarily by the stomach in response to hunger. It cooperates with leptin in energy homeostasis modulation. It is also expressed in placenta and likely has a role in fetal growth and cell proliferation.

Answer 45

Ghrelin

Question 46

On blood glucose levels: Pregnancy is characterized by mild fasting ___, postprandial hyperglycemia, and ___

Answer 46

Mild fasting hypoglycemia

Postprandial hyperglycemia

Question 47

This hormone opposes the effects of PTH and vitamin D and protects the maternal skeleton during times of calcium stress

Answer 47

Calcitonin

Question 48

By approximately ___ weeks, the placenta is the principal source of growth hormone secretion

Answer 48

17 weeks

Question 49

Early in the first trimester, levels of thyroxine-binding globulin [decrease / increase].

Answer 49

Increase (reach their zenith at about 20 weeks, and stabilize at approximately double baseline values for the remainder of pregnancy)

Question 50

There is marked [decrease / increase] in aldosterone secretion in pregnancy

Answer 50

Increase

Question 51

The main hormone responsible for hyperglycemia in pregnancy

Answer 51

Human placental lactogen

Question 52

In pregnancy, the respiratory rate is essentially unchanged, but tidal volume and resting minute ventilation ___ [decrease / increase] significantly as pregnancy advances

Answer 52

Increased tidal volumes: 660 mL to 800 mL

Increased resting minute ventilation: 10.7 L to 14.1 L