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Obstetrics and Gynecology > Maternal Physiology > Flashcards

Maternal Physiology Flashcards

1
Q

Uterus from 70g becomes

A

1100 g

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2
Q

Uterus from 10ml becomes

A

5 L

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3
Q

Changes in uterine muscle

A

Hypertrophy and hyperplasia (under influence of hormones estrogen and progesterone)

Stretching beyond 20 weeks (1.5 cm or less)

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4
Q

Arrangement of uteirne muscle fiber

A

Outer hood-like layer
Middle layer (figure of 8), forms uterine wall
Internal layer - sphincter-like fibers

Important postpartum minimizing hemorrhage

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5
Q

Uterus shape

A

spherical by 12 weeks

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6
Q

Uterus position in cavity

A

Displaces intestine laterally and superiorly

Ascends from pelvis then rotate to the right (dextrorotation) which is likely caused by rectosigmoid on left side

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7
Q

At term uteroplacental blood flow

A

450-650 ml

Ave 550ml/min

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8
Q

There is increased venous caliber and distensibility of uterine blood vessels due to

A

Remodelling from reduced elastin content and adreneglrgic nerve density

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9
Q

With advancing gestational age, uteroplacental blood flow is regulated by vasodilation by

A

estrogen

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10
Q

Softening and cyanosis of cervix due to increased vascularity and edema
hypertrophy and hyperplasia of cervical glands

A

Goodell’s sign

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11
Q

Red and velvety cervix due to marked proliferation of columnar endocervical glands

Bleeds with minor trauma

A

Eversion

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12
Q

Labor ensues once bloody show occurs in

A

1-2 days

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13
Q

Arborization of crystals

A

Ferning - amniotic fluid leak

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14
Q

Endocervical gland hyperplasia and hypersecretory appearance induced by estrogen

A

Arias-stella reaction

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15
Q

Discoloration violet of vagina due to hyperemia secondary to increased vascularity

A

Chadwick’s sign

Inc in vaginal discharge: thick and white

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16
Q

vaginal pH

A

3.5-6.0

inc in lactic acid production by Lactobacillus acidophilus (Nitrazine test)

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17
Q

Pregnancy mask
Extreme form of pigmentation around the cheek, forehead and around the eyes
May be patchy or diffuse and disappears spontaneously after delivery

OCPs cause similar pigmentation

A

Chloasma gravidarum

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18
Q

Skin changes

A 
Striae gravidarum
Linea nigra
Spider angioma
Palmar erythema
Diastasis recti
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19
Q

Increase in basal metabolic rate

A

10-20%

20-30% in twin gestation

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20
Q

Energy demand/trimester

A

1st - 85
2nd - 285
3rd - 475

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21
Q

Total weight gain

A

27.5 (12.5 kg)

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22
Q

At term, the fetus, placent and AF contains how much fluid

A 
3.5 L
3 L (maternal blood volume)

Min amount of extra water: 6.5 L

Inc plasma osmolality by 10

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23
Q

Protein is regulated by

A

Placenta - protein synthesis, oxidation and transamination of NEAA

Higher nitrogen balance

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24
Q

Carbohydrates in pregnancy

A

Mild fasting hypoglycemia
Postprandial hyperglycemia
Hyperinsulinemia

Hyperplasia and hypertrophy of beta cells

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25
Q

Switch in fuel from glucose to lipids

A

Accelerated starvation

26
Q

GH-like hormone that increases lipolysis

Inc in lipolysis -> inc FA -> inc tissue resistance to insulin

Maternal hyperlipidemia - inc insulin resistance and estrogen stimulation

Inc lipolytic activity and dec lipoprotein lipase activity in adipose tissue

A

Placental lactogen

27
Q

Maternal blood volume inc to

A

45% near term
Expands rapid during 2nd tri

Inc in plasma and erythrocytes causing dilutionak anemia of pregnancy

28
Q

Functions of pregnancy induced hypervolemia

A

Meet metabolic demands
Abundance of nutrients and elements to support placenta and fetus
Protect mother and fetus against deleterious effects of impaired venous return in supine and erect
Safeguard mother against adverse effects of blood loss

29
Q

Amount of iron needed in pregnancy

A

1000mg iron

300mg ferrous sulfate, twice if anemic

30
Q

Blood cell changes

A

Leukocytosis

Thrombocytopenia - below 25th percentile due to inc consumption and hemodilution

Hypercoagulable, Thromboembolism
Inc Fibrinogen (Factor 1) by 50%
Inc F 8
Inc F 7,9,10 and 12

Shortened PT, PTT
Dec FIBRINOLYTIC activity

31
Q

Changes in CV system

A

Inc SV
Inc HR by 10 bpm
Inc CO
Inc O2 consumption

Dec SVR
Dec SBP
Dec DBP
Dec MBP

32
Q

Changes in ECG

A

Inc HR

15 deg LAD

33
Q

Changes in CXR

A

Heart larger
Displaced, left, upward and rotated as a result apex is moved somewhat laterally from its usual position causing a larger silhouette

34
Q

Cardiac sound

A

Exaggerated splitting of 1st heart sound with inc loudness
Loud 3rd sound

Soft and transiet murmurs
90% has systolic murmur during inspiration disappears shortly after delivery

35
Q

Cardiac output

A

Inc due to
dec in MAP
dec in VR
inc in BV and BMR

CO is position dependent
supine - diminished
left lateral cubitus - inc by 20%

36
Q

Dec in 10% CO in supine patients
Significant arterial hypotension

Uterine arterial pressure and blood flow is lower than brachial artery directly affecting fetal heart patterns

Compression of inferior vena cava
Dec venous return
Dec CO output
Lower BP

A

Supine hypotensive syndrome

37
Q

No fall in blood pressure because of reflex vasoconstriction

A

Concealed caval compression

In left lateral cubitus, fetal oxygenation is higher

38
Q

Highest peak of CO

Inc plasma volume and heightened oxygen demand of fetus

A

28-32nd week

39
Q

Periods of inc CO

A

28-32nd week
Labor
Immediately after delivery
First week puerperum (6 weeks after childbirth)

40
Q

Peripheral vascular resistance falls during pregnancy due to

A

Progesterone’s relaxing effect on smooth muscle

Dec in PVR leads to fall in SBP during first 24 weeks

41
Q

Venous blood pressure

A

Unchanges in UE
Inc in LE especially supine sitting or standing returns to normal in lateral decubitus

Occlusion of pelvic veins and IVC hence edema

42
Q

PCWP

CVP

A

No change

43
Q

Changes in respiratory tract

A

Diaphragm rises to 4cm
Subcowtsl angle widens
Transverse diameter of thoracic cage by 2cm
Thoracic cirumference by 6cm

44
Q

Pulmonary function

A

DEC FRC by 20-30% (Dec ERV by 15-20; Dec RV by 20)

Inc IC by 5-10
Inc/unchanged TLC by 5
RR unchanged
Inc TV by 30-50 
Inc RMV (inc respiratory drive from progesterone, low expiratory reserve volume and compensated respi alkalosis)
45
Q

Maternal AV oxygen difference

A

Decreased
amount of O2 delivered to lungs by inc TV exceeds O2 requirement
Total oxygen carrying capacity increased due to inc total hemoglobin mass
Inc CO

46
Q

SOB is a complaint due to

A

Inc TV that lowers PCO2
Over breathing by progesterone acting centrally to lower threshold and inc senstivity of chemoreflex response to CO2
Shift to the left (Bohr)
Offset by inc 2,3 DPG to the right (Haldane)

47
Q

Urinary changes

A

Uterus rises above pelvis resting upon ureters laterally displacing and compressing them at pelvic brim

Dilatation of collecting system because of progesterone and compression of ureter

Physiologic hydroureter: R ureter is compressed more than left because

Dextrorotation of uterus
Sigmoid on left cushioning the ureter
Greater kinking of ureter due to internal iliac within the pelvic brim
Right ovarian complex passes obliquely over the ureter

48
Q

Urinary physiologic changes

A

Inc renal plasma flow RPF
Inc glomerular filtration rate by 50%
expect glucosuria

DEC serum creatinine and BUN

Inc frequency of micturition

49
Q

GI Tract

A

Pregnancy gingivitis - hyperemia and softened bleeding gums

Appendix displaced laterally and upwards

Dec tone and motility of GIT

Pyrosis (heart burn), dec LES

Hemorrhoids

50
Q

Focal, highly vascular swelling of gums

Pyogenic granuloma that occasionally develops but regresses spontaenously after delivery

A

Epulis gravidarum

51
Q

Impaired GB contraction
High residual volume
inhibition of CKK by

A

Progesterone

Inc bile cholesterol saturation -> inc stones for multiparous

52
Q

Pituitary gland inc in size by

A

135%

GH - same as nonpregnant
-at 17 weeks, placenta (synciotrophoblast)primary source differs by 13 AA

53
Q

Major determinant of maternal insulin resistance in mid pregnancy

A

GH by synciotrophoblast

54
Q

Inc by 10 fold (150)

Estrogen stimulation
TRH
Serotonin

A

Prolactin

55
Q

Ensures lactation of delivery by acting to initiate DNA synthesis and mitosis of glandular epithelial cells and presecretory alveolar cells of the breast

Inc estrogen and prolactin receptors

Promotes mammary gland galactopoiesis and production of casein, lipids and lactose

A

Prolactin

56
Q

Prolactin is produced in amniotic fluid (10,000) at 20-26 weeks by

Prevents fetal dehydration by impairing water transfer from fetus to maternal compartment

A

Uterine decidua

57
Q

Thyroid gland changes

A

Euthyroid
Enlarges by hyperplasia and vascularity
Inc production of thyroid hormones 40-100%
Does not cause thyromegaly

58
Q

Early trimester thyroid changes

A

TBG inc and peaks to 20 weeks
FT4 rise slightly and peak with HCG returns to normal
Total serum T4 inc and peaks up to 18 weeks
TRH does not inc but crosses placenta to stimulate pituitary to secrete TSH

TSH and HCG similar alpha components
Elevated HCG affects alpha of TSH manifested as thyroid storm in H moles

59
Q

Musculoskeletal changes

A

Inc mobility of SI, SC, pubic joints
Relaxation of pubic symphysis >1 cm
Regresses and resolves 3-5 months postpartum

60
Q

CNS Changes

A

Memory decline 3rd trimester (attention, concentration, memory)

Sleep - difficulty 12 weeks to first 2 months

Obstetrics and Gynecology (18 decks)

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