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Maternal Physiology Adaptations and Problems in Pregnancy Flashcards

1
Q

What are the changes that occur in Glucose Metabolism in Pregnancy?

A
  1. Reduction in maternal blood glucose and amino acid concentrations.
  2. Diminished maternal responsiveness to insulin (insulin resistance) in the second half of pregnancy.
  3. Increase in maternal free fatty acids, ketone and triglyceride levels (alternative metabolic fuel).
  4. Increased insulin release in response to a normal meal.
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2
Q

What is the main function in the first half of pregnancy?

A

Storage-> Anabolism.

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3
Q

What is the main function in the second half of pregnancy?

A

Growth of the fetus-> Catabolism.

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4
Q

What is the function of Human Placental Lactogen (hPL) in glucose metabolism in the pregnancy?

A

Generates maternal resistance to insulin.

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5
Q

What hormone has a similar role to Human Placental Lactogen?

A

Prolactin.

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6
Q

What is the function of Oestrogen in pregnancy?

A
  1. Stimulate and increase in prolactin release.
  2. Breast tissue growth.
  3. Water retention.
  4. Protein synthesis.
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7
Q

What is the function of Progesterone in pregnancy?

A
  1. Increases appetite in the first half of pregnancy.
  2. Diverts glucose into fat synthesis.
  3. Relaxes smooth muscle at the lower oesophageal sphincter.
  4. Slows gastric emptying.
  5. Dilates vessels e.g. in kidneys.
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8
Q

What happens to the maternal glucose usage?

A

Maternal glucose usage declines and gluconeogenesis increases which maximises the availability of glucose to the fetus.

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9
Q

How are the mothers energy needs met in late pregnancy?

A

By metabolising peripheral fatty acids.

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10
Q

How do you define Gestational Diabetes?

A

Glucose intolerance that is first recognised in pregnancy and does not persist after delivery.

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11
Q

How is Gestational Diabetes diagnosed?

A

Oral glucose tolerance test.

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12
Q

Why does Gestational Diabetes occur?

A

Resistance to insulin is not met with a compensatory rise in maternal insulin-> maternal hyperglycaemia.

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13
Q

How can Gestational Diabetes affect the fetus?

A
  1. Increased birth weight (macrosomia),
  2. Congenital birth defects,
  3. Stillbirth,
  4. Shoulder Dystocia due to macrosomia.
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14
Q

How does the Maternal Cardiovascular System change in response to a fetus (in summary)?

A
  1. Vascular-neogenesis.
  2. Increased blood flow to the growing breast, kidneys and GI tract.
  3. Plasma volume increases by 50%.
  4. Cardiac output increases from 4.5L/min to 6L/min.
  5. Increased progesterone-> vasodilation.
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15
Q

How does Vascular-neogenesis occur?

A

This vascular-neogenesis is accommodated by changes in function of the maternal baro and volume receptors.

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16
Q

Why does Vascular-neogensis occur?

A

As pregnancy advances the fatal-placental unit has an increasing need for nutrition. This is met by maternal vascular-neogenesis.

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17
Q

Why is there increased blood flow to the breasts, kidneys and GI tract?

A

There is increased metabolism.

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18
Q

How is an increase in Cardiac Output achieved?

A

Increase in stroke volume mainly but also heart rate also.

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19
Q

Why can flow murmurs and upward displacement of the apex beat occur in pregnancy?

A

Increased plasma volume.

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20
Q

What pathology can happen to the heart during pregnancy?

A
  1. Upward displacement of the apex beat.

2. Flow murmurs.

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21
Q

What problems can progesterone have on the cardiovascular system?

A

Progesterone causes vasodilation which can drop the total peripheral resistance and thus the mean aBP (COxTPR), causing hypotension

22
Q

What effect does increased CO (plasma volume and thus stroke volume) and decreased TPR have on blood pressure in the course of pregnancy?

A

Initially lowers blood pressure in the first and second trimester, then the BP returns to normal in the third trimester.

23
Q

What happens to the ECG in normal physiological pregnancy?

A
  1. Atrial and ventricular ectopics.
  2. There is a left shift in the QRS axis due to mild hypertrophy.
  3. There is a small Q wave and an inverted T wave in lead III.
  4. ST segment depression and T wave inversion in the inferior and lateral leads.
24
Q

What is pre-eclampsia?

A

A condition relating to placental insufficiency which manifests itself and a clinical syndrome in pregnancy of hypertension and proteinuria.

25
Q

What can pre-eclampsia lead to?

A
  1. Intrauterine growth restriction.
  2. Preterm labour.
  3. Infant respiratory distress syndrome.
  4. Eclampsia: seizures and other multi-organ complications.
26
Q

What does the maternal haematology change in pregnancy?

A

Pro-thrombotic stage due to increased clotting factor and fibrinogen and reduced fibrinolysis.
Increased blood volume: red cell mass increases but not to the same extent.

27
Q

What is the clinical significance of these haematological changes?

A

Can lead to thromboembolic disease in pregnancy which cannot be treated with warfarin.

28
Q

Why can’t thromboembolic disease be treated with warfarin?

A

Warfarin is teratogenic and can cross the placenta.

29
Q

How can a pregnancy women get physiological anaemia?

A

Increased blood volume means the red blood cells increase in mass, however this is not to the same extent so can lead to anaemia.
Anaemia can occur in pregnancy due to iron and folate deficiency due to increased demand.

30
Q

How does the Respiratory Function change during pregnancy?

A
  1. Pulmonary function isn’t impaired but with an underlying disease, these can be made worst (due to increased oxygen demand in gestation).
  2. Respiratory rate is little changes.
  3. Tidal volume and oxygen uptake increase.
31
Q

Why is Dyspnoea a common presentation in pregnancy?

A

There is an increased oxygen demand and thus the mother may feel more of a need to take in a deep breath.
This is because an increased tidal volume lowers pCO2 which causes respiratory alkalosis.

32
Q

How are the increased respiratory effort induced?

A

Progesterone acting directly on the respiratory centre and sensitising the chemoreceptors to the CO2 changes.

33
Q

How does the Renal Function change during pregnancy?

A
  1. There is an increased renal blood flow, causing an increase in glomerular filtrate to 160% of the normal.
  2. This increases renin, aldosterone and angiotensin II to compensate for the expected sodium loss.
  3. Creatinine clearance increases.
  4. Serum urea and creatinine decreases.
  5. Increased size of kidney and ureter.
  6. Progesterone relaxes smooth muscle to allow hyper-motility of the ureters.
34
Q

What happens to calcium during pregnancy?

A

Intestinal calcium absorption doubles during pregnancy driven by calcitriol.

35
Q

Why do the changes in calcium absorption happen during pregnancy?

A

So women can meet the calcium demands of pregnancy, for the fetus and to allow optimal bone development.

36
Q

Does the placenta contribute to calcium absorption and if yes how?

A

The placenta contributes to maternal synthesis of calcitriol.

37
Q

What does Prolactin do in pregnancy and postpartum?

A
  1. Stimulates breast development.

2. Promotes and maintains lactation postpartum.

38
Q

How does TSH change in pregnancy?

A

TSH is lower in T1 due to high hCG.

There is more T4 because hCG can act on thyroid receptors to make more thyroid hormone.

39
Q

What is the role of oxytocin in pregnancy?

A
  1. Major role in labour.

2. Let down process of breast feeding.

40
Q

How does the Gastrointestinal Tract Change in Pregnancy?

A
  1. Progesterone causes smooth muscle relaxation throughout the GIT which causes slow gastric emptying.
  2. Gallbladder emptying is reduced.
41
Q

What are the consequences in terms of symptoms of GI changes in pregnancy?

A

Slow gastric emptying can cause nausea, constipation and heart burn.

42
Q

How does maternal immunity change in pregnancy?

A

There is a change from Th1 to Th2 immunity.
Reduces cell-mediated immunity and T helper cytokine production.
Increases humoral immunity and Th2 cytokine production.
hCG reduces maternal levels of IgG, IgA and IgM.

43
Q

Why is there a change in maternal immunity in pregnancy?

A

To prevent rejection of the fetus.

44
Q

What is the clinical relevance of a change of immunity in pregnancy?

A

Effectively an immunosuppression in pregnancy so can make some conditions better and some conditions worst.

45
Q

What is the normal pH of plasma in pregnancy vs in non-pregnancy?

A

7.40-7.45 in pregnancy and 7.35-7.45 in unpregnant people.

46
Q

How does Respiratory Physiology change in pregnancy?

A

Early: Increases subcostal angle and circumference of chest.
Later: elevation of the diaphragm by the uterus by 4cm.

47
Q

How does the Musculoskeletal system change in pregnancy?

A

Progesterone and relaxin causes loosening which can be painful in the ribs and tail bone, and in the symphysis pubis and sacroiliac joint creating the waddling gait.

48
Q

What causes pre-eclampsia?

A

The placenta not invading into the endometrium properly and thus doesn’t have a normal blood flow, causing maternal hypertension.

49
Q

What are the signs of pre-eclampsia?

A
  1. Headache,
  2. Viral disturbance,
  3. RUQ pain.
  4. Seizures-> eclampsia.
  5. Hyperflexia.
  6. Oedema.
50
Q

How do you treat pre-eclampsia?

A
  1. Antihypertensives.
  2. Magnesium sulphate to stop fits.
  3. If eclampsia get the baby out! No matter what.

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