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Reproductive System > Maternal Physiology + Pregnancy > Flashcards

Maternal Physiology + Pregnancy Flashcards

1
Q

Why does the body need to adapt?

A

Volume support
Nutrition
Waste clearance
Pregnancy maintenance
Childbirth

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2
Q

What drives adaptational changes?

A

Hormones
Human placental lactogen
Oestrogen
Progesterone
hCG

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3
Q

What is gestational diabetes?

A

A glucose intolerance that is first recognised in pregnancy + does not persist after delivery

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4
Q

How does gestational diabetes occur?

A

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

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5
Q

Adaptations in the respiratory system in pregnancy

A

tidal volume increases > increases ventilation

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6
Q

What is the clinical consequence of adaptations to respiratory system in pregnancy?

A

Dyspnoea
(Women may complain of feeling SOB)

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7
Q

Adaptations of the cardiovascular system in pregnancy

A
  • reduced systemic vascular resistance to increased cardiac output by 40%
  • increased procoagulants
  • decreased anticoagulants ^v (increases clotting)
  • reduced fibrinolysis
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8
Q

How does pregnancy cause an increase in cardiac output?

A
  • oestrogen + progesterone cause a drop in BP
  • stimulates RAAS
  • AngII causes release of aldosterone
  • aldosterone stimulates reabsorption at kidneys
  • increases plasma volume > increased stroke volume + heart rate > increased cardiac output
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9
Q

What are the clinical consequences of adaptations to CVS in pregnancy?

A
  • peripheral oedema (due to increased RAAS)
  • dilutional anaemia (due to increase in plasma volume)
  • hyper coagulable state > increased risk of DVT + PE
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10
Q

What is the most common cause of anaemia in pregnancy?

A

Iron deficiency

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11
Q

What is dilutional anaemia in pregnancy?

A

Plasma volume increases > dilutes RBCs > anaemia

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12
Q

Complications of anaemia in pregnancy

A
  • increased morbidity for mum + baby
  • preterm delivery
  • infant iron deficiency anaemia
  • maternal fatigue
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13
Q

Adaptations of the renal system in pregnancy

A

GFR needs to increase to increased clearance
- systemic vasodilation > increased renal blood flow
- decreased PCT absorption
- smooth muscle relaxation > increased size of kidneys + ureters

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14
Q

What is normally seen in U&Es in pregnancy?

A

Decreased serum urea + creatinine

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15
Q

What effect does the changes in the renal system in pregnancy have?

A
  • increased GFR
  • decreased serum urea + creatinine
  • glucosuria
  • increased risk of UTI
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16
Q

Adaptations in the GI system in pregnancy

A

slow transit time to increase absorption
- progesterone causes smooth muscle relaxation in GI tract > slow gastric emptying
- nausea, constipation + heart burn

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17
Q

Adaptation of the thyroid in pregnancy

A
  • oestrogen increased liver production of thyroid binding globulin
  • causes increase in TSH + thyroxine production
  • free levels are unchanged
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18
Q

How are the change in the endocrine system in pregnancy achieved?

A

Thyroid regulation
Parathyroid activation
Insulin resistance

19
Q

Changes to calcium metabolism in pregnancy
Why is this needed?

A
  • increased calcitriol
  • increased calcium reabsorption in gut
  • increased phosphate excretion in kidneys
    .
  • allows for greater calcium availability for fetus > optimal bone growth
20
Q

What changes to glucose metabolism occurs in pregnancy?

A
  • reduction in maternal blood glucose + aa conc.
  • insulin resistance in 2nd half of pregnancy
  • increase in maternal free fatty acids, ketone + triglyceride levels (alternative metabolic fuel)
  • increased insulin release in response to normal meal
21
Q

Risk factors of gestational diabetes

A
  • BMI >30kg/m2
  • previous macrosomic baby
  • previous gestational diabetes
  • family history
  • ethnicity with high prevalence of diabetes (Asian)
22
Q

Impact of gestational diabetes on fetus

A
  • Increased birth weight
  • Congenital defects especially cardiac, renal, unreal tube defects
  • Stillbirth
23
Q

Investigations of gestational diabetes

A

Oral glucose tolerance test

24
Q

Consequences of gestational diabetes to mother

A
  • increased risk of pre-eclampsia, polyhydramnios + premature labour
  • shoulder dystocia during labour
  • increased risk of developing type 2 DM
25
Q

Adaptions in the MSK in pregnancy

A
  • change in centre of gravity
  • stretching of abdominal muscles
  • increased mobility of sacroiliac joint + pubic symphysis
  • anterior tilt of pelvis
26
Q

Complications in neonates of gestational diabetes

A

Hypoglycaemia
Respiratory distress
Jaundice

27
Q

Changes in posture in pregnancy due to MSK changes

A
  • forward flexion on neck
  • increased lordosis + kyphosis
  • impedes postures
28
Q

Adaptations in the skin in pregnancy

A

Linea nigra
Vascular spiders
Palmar erythema
Chloasma

29
Q

What is pre-eclampsia?

A

Pregnancy induced hypertension with proteinuria +/- maternal organ dysfunction after 20 weeks

30
Q

Risk factors of pre-eclampsia

A
  • > 40 years
  • nulliparity
  • pregnancy interval of >10 years
  • family history + previous history
  • BMI >30kg/m2
  • pre-existing vascular or renal disease e.g. hypertension
  • multiple pregnancy
31
Q

How does pre-eclampsia occur?

A
  • placental insufficiency
  • impaired invasion of trophoblast > shallow invasion of spiral arteries
  • causes hypoperfusion + ischaemia
32
Q

Presentation of pre-eclampsia

A
  • headache
  • visional distubrnace
  • epigastric pain
  • oedema of hands, feet + hands
  • vomiting
  • dyspnoea
33
Q

What is nulliparity?

A

First pregnancy

34
Q

Complications of pre-eclampsia in mother

A
  • seizure (eclampsia)
  • cerebral haemorrhage
  • renal failure
  • pulmonary oedema
  • HELLP syndrome
  • disseminated intravascular coagulation
35
Q

What is HELLP syndrome?

A
  • Haemolysis
  • Elevated Liver enzymes
  • Low Platelets
36
Q

Complications of pre eclampsia in fetus

A
  • growth restrictions
  • oligohydramnios
  • placental infarct
  • renal distress
  • premature deliver
  • still birth
37
Q

What is eclampsia?

A

Seizures

38
Q

Changes in immunity:
- what does baby need?
- what does mum need?
- how is this achieved?

A
  • baby needs to thrive but as a ‘parasite’
  • mum needs to be a good ‘host’
  • immune regulation
39
Q

What adaptations occur within the immune system during pregnancy?

A

Mother in immunosuppressed state

40
Q

What does the baby need in regard to the respiratory system?

A

Oxygen delivery
Carbon dioxide removal

41
Q

What does mum need in regard to respiratory system during pregnancy?

A
  • continued O2 delivery to her
  • increased O2 supply to meet metabolic demand
  • increased CO2 clearance
42
Q

How are the respiration requirements of pregnancy achieved?

A

Increased ventilation

43
Q

What does mum need in regard to CVS during pregnancy?

A
  • fill utero-placental-fetal circulation
  • oxygenated growing uterus
  • protect from impaired venous return
  • prepare for possible blood loss during delivery
44
Q

How are the CVS requirements of pregnancy achieved?

A

Volume expansion
Clotting mechanisms

Reproductive System (20 decks)

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