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Week 16: Pregnancy > Maternal Physiology > Flashcards

Maternal Physiology Flashcards

1
Q

When does progesterone production switch from corpus luteum to placenta?

A

10 weeks

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2
Q

What makes

  1. hCG
  2. Estrogen
  3. Relaxin
A
  1. Syncytiotrophoblasts
  2. Placenta
  3. Corpus luteum and placenta
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3
Q

4 main CV signs you might see during pregnancy

A

Decreased BP
Physiologic anemia
Enlarged heart, displaced left and upward on CXR
Systolic ejection murmur

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4
Q

What happens to
1. Blood volume
2. CO
3 SVR

A
  1. Increases
  2. Increases
  3. Decreases
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5
Q

Most changes occur in what trimester?

A

Begin in early trimester, peak in SECOND trimester and plateau until delivery

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6
Q

What happens to
1. plasma volume
2. RBC mass
Why?

A
  1. Increases

2. Increases (increased erythropoietin levels, need iron)

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7
Q

Which increases more, plasma volume or RBC mass? What is the result of this?

A

Plasma volume increase > RBC mass increase

Results in physiologic anemia of pregnancy (<105g/L)

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8
Q

CO increases due to…

A 
Increased stroke volume (esp early pregnancy)
Increased HR (esp 3rd trimester)
Normally this is well tolerated, but pregnancy is a functional stress test so many be hard on a diseased heart
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9
Q

What happens to SVR? Why?

A 
Decreases
Placenta functions as a high flow, low resistance shunt
Also vasodilation (decreased response to AII, and increased estrogen)
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10
Q

How does BP change over the course of a pregnancy?

A

Decrease begins in early pregnancy, reaches lowest at 24 weeks, then returns to pre-pregnancy levels by term

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11
Q

Supine hypotensive syndrome

A

Common! But also occurs with sitting or standing
Caused by compression of IVC by the uterus
Results in a decreased venous return and preload, decreasing the CO
Most women can compensate with increasing the PVR, but some cannot

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12
Q

Symptoms of supine hypotension in

  1. Mother
  2. Fetus
A
  1. Faint, light-headed, SOB, dizzy

2. Drop in HR as decreased O2 supply (fetal distress)

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13
Q

How do you treat supine hypotension?

A

When lying down, lie on left side
Uncross legs
Compression stockings
Keep calf muscles pumping when standing for prolonged periods of time

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14
Q

Why do pregnant women get a systolic ejection murmur?

A

Flow murmur due to increased CO across valves

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15
Q

When does the uterus stop being a pelvic organ?

A

At 12 weeks

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16
Q

2 main goals of the respiratory changes in pregnancy

A

Enhance oxygen delivery (oxygen consumption increases in pregnancy)
Eliminate excess CO2 from fetus

17
Q

Resp maternal symptoms

A

Nasal stuffiness
Nosebleeds (epistaxis)
Dyspnea

18
Q

How does the diaphragm change in pregnancy?

A

Elevated diaphragm

Widening of the subcostal angle

19
Q

What hormone causes the SOB? How does it work?

A

Progesterone!!
Increases central chemoreceptor sensitivity to CO2
Results in increased minute ventilation via increased tidal volume

20
Q

3 anatomic changes in the urinary tract

A

Dilated ureters
Dilated renal pelvis
Increased kidney size

21
Q

What 2 things cause the anatomical changes in the urinary tract

A

Progesterone smooth muscle relaxation

Mechanical compression by uterus at pelvic brim

22
Q

What side of the urinary system is more effected? Why?

A

Right side more than left

Because the uterus is slightly rotated to the right by the sigmoid colon

23
Q

What happens to

  1. Renal plasma flow
  2. GFR
  3. Serum creatinine and urea
A
  1. Increases
  2. Increases
  3. Decreases
24
Q

5 Common symptoms in GI

A 
Nausea and vomiting (morning sickness)
GERD
Constipation
Hemorrhoids
Gall stones
25
Q

2 main causes of GI signs and symptoms

A

Progesterone smooth muscle relaxation (LES relaxes, decreased GI motility and gall bladder contractility)
Mechanical displacement of GI tract due to enlarging uterus (elevation of stomach (GERD), displacement of colon)

26
Q

Why do you not want to use general anaesthetic in pregnant women?

A

Increased risk of aspiration

Because of GI changes

27
Q

2 main hormones responsible for the nausea and vomiting

A 
Progesterone (delayed motility, reflux)
Beta hCG (higher levels = worse, as levels plateau at 10-12 weeks it improves)
28
Q

Hyperemesis gravidarum

A

Prolonged, severe nausea and vomiting

May require IV fluid and hospital admission

29
Q

Hemorrhoids due to…

A

Constipation (decreased motility, increased water reabsorption)
Increased venous pressures due to obstruction of venous return by enlarging uterus

30
Q

Postpartum blues vs depression

A

Blues: very common, usually resolves by day 10, give support and reassurance
Depression: requires medical attention

Week 16: Pregnancy (9 decks)

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