maternal physiology during pregnancy

Question 1

immunologic changes

Answer 1

● Polymorphonucleocyte increases
● Adherent and chemotaxis decreases
● Antibody titre for virus decreases
● Infection increases
● C-reactive protein increases 100 folds
● Leucocyte alkaline phosphatase increase

Question 2

metabolic changes

Answer 2

• consist of
  1. weight gain
• ↑ of weight in preg consistent to uterus enlargement w breast n ↑ in b vol, ↓ extravasc n extracircular fluid
• < > total weight gain is 11kg
• during 1st 3mester, < > weight gain is 1kg compared w abt 5kg during each of last 3mester
  2. H2O metabolism
• ↑ in H2O retention in N physiological alteration of preg
• H2O content of fetal, placenta n AF abt 3.5liter
  3. Protein
  4. Mineral metabolism

Question 3

endocrine changes

Answer 3

1. pituitary gl
   - fr pituitary gl may ↑ to compress total chiasma n reduce visual field
2. GH
   - placental lactogen in b of preg mother, the level of pituitary grp of H is ↑ only slightly
3. prolactin
   - in N preg, the level is ↑
   - after delivery, level of plasma prolactin is ↑
4. thyroid gl

Question 4

physiological weight gain

Answer 4

physiological weight gain
- it is the ↑ in weight of a pregnant female by 25% of non-pregnant weight w an <> 12.5kg
- main ↑ occurs in 2nd half of preg abt 0.5kg/wk after wh rate ↓es n after 40wks weight ↓es
- causes r :
● Changes of breast n uterus
● ↑ in circulatory vol n interstitial fluid
● Maternal storage of fat n proteins
● Formation of fetal struct

Question 5

cardiovascular system

Answer 5

• enlarging uterus deviates diaph n displaces heart upward n to the L → apex beat is moved laterally
• ↑ cardiac output → ↑ metabolic demands by the heart → cardiomegaly, hypertrophy n ↑ HR
• auscultation :
  ● Holoystolic murmur ( 95% ), diastolic murmur ( 20% ) dt ↑ cadiac output
  ● ↑ S1 n S2, S3 ↑
  ● Splitting of S1
  ● Continuous murmur ( bruits ) dt ↑ mammary blood flow ( 10% )
• progesterone → sm m relaxation of vessels → ↓ tone of vessels → hypotension
• compression of infr Vn cava by uterus → ↓ return of blood to the heart → venous congestion → edema, varicosity, orthostatic / supine hypotension

Question 6

GI system

Answer 6

• oral cavity : ↑ salivation, hypertrophy of gums n hyperemia
• stomach : Estrogen + progesterone → relaxation of m, ↓ gastric motility, ↑ ga???, ↑ acidity → dyspepsia
• relaxation of esophageal ??? → regurgitation, vomiting ???
• ↓ motility of small intestine dt Progesterone → constipation
• enlarging uterus displaces small n large intest up n laterally
• Progesterone → ↓ tone of sm m of gallbladder → delayed emptying of bile
• liver : Estrogen + Progesterone → ↑ protein synt ( fibrinogen, clotting factors, albumin binding progesterone )
• rectum : venous congestion → hemorrhoids / piles

Question 7

respiratory system

Answer 7

• dt ↑ blood vol n capillary dilation ( progesterone effect ) → congestion of respiratory tract vessels → engorgement of nasopharnyx, larynx, trachea, bronchi → changes of voice, snoring, difficulty in breathing thru nose n dyspnoea
• enlarging uterus → elevation of diaph ( 4cm ) → ??? n widening flaning of ??
• ??? + ↑ mvm of diaph → ↑ tidal vol n total volume capacity
• Progesterone → relaxation of respiratory tract m → ↑ dead air space → ↑ inspiration → → ↑ O2 uptake → high PO2 → good fetal supply
• ↑ respiration → ↓ residual vol → ↑ CO2 output into air → ↓ PCO2 in maternal → easy transfer of CO2 fr fetal blood to maternal blood => compensated respiratory alkalosis
• action of Progesterone on respiratory center in medulla → hyperventilation in preg

Question 8

reproductive system

Answer 8

1. uterus
   - ↑ Estrogen n Progesterone → hyperplasia n hypertrophy of myometrial cells → ↑ uterus weight fr 50g to 1kg where in 2nd half of preg hypertrophy is imp
   - development of special cellular connections ( intracellular gap junctions ) help in spreading of AP btwn cells where in 2nd half of preg present Braxton-Hicks
   - formation of lower segment fr isthmus
2. cervix
   - Estrogen n Progesterone → ↑ blood flow → swelling, softening n ??? blue color
   - ↑ mucous secretion → formation of protective plug ( operculum )
   - Estrogen → generation of cervix epithelium on ectocervix ( ectropian )
3. vagina
   - estrogen → thickening → ↑ blood flow, softening of epithelium
   - ↑ rate of desquamation as ↑ vaginal discharge

Question 9

breast

Answer 9

1. mammary gl
   - estrogen → ↑ no. of glandular ducts → enlargement n tenderness
   - HPL + progesterone → ↑ no.of areola → enlargement n tenderness
   - deposition of fat around glandular tissue → enlargement
   - HPL → areola ceases, lactoglobulin + lactalbumin synt → colostrums secretion in late 3rd 3mester
   - Prolactin, GH, insulin n cortisol → differentiation of glandular cells into secretory n myoepithelial cells

Question 10

investigation

Answer 10

• screening test for gonorrhea n Chlamydia particularly for ptt wh hv history of pelvic infection, multiple sexual partner, history of preterm labor
• sickle cell test recommended for women of African-american or Caribbean descendents
• routine testing for CMV or toxoplasmosis isn’t recommended
• maternal serum testing to test AFP, estriol n hCG offered btwn 16-20wks
• Ultrasonography is an important first step in evaluating an abnormal result, followed by amniocentesis or chorionic villus sampling in certain clinical situations.
• oral glucose tolerance test (performed after a 12-hour fast).
• A hemoglobin or hematocrit determination is recommended at the beginning of the third trimester.
• Some authorities repeat diagnostic testing for Chlamydia trachomatis in the third trimester.