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Women's Health > Maternal Physiology (Pregnancy) > Flashcards

Maternal Physiology (Pregnancy) Flashcards

1
Q

What is the purpose of maternal cardiovascular changes occurring with pregnancy?

A

Improve foetal oxygenation and nutrition

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2
Q

What are the CV anatomic changes of pregnancy?

A

-heart displaced upward and to left
-heart assumes more horizontal position (apex moved laterally)
-ventricular muscles mass increase (due to inc in circulating blood volume)
Occur due to diaphragmatic elevation by enlarging uterus

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3
Q

What is the primary functional change of CV system with pregnancy?

A

Increase in CO

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4
Q

How much does CO increase with pregnancy?

A

30-50%.

50% of increase in first 8 weeks

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5
Q

what is the mechanism of increased CO during pregnancy?

A
  • First half: due to inc SV

- Second half: inc HR (SV returns normal)

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6
Q

What causes the alterations in stroke volume?

A

Alterations in circulating blood volume and systemic vascular resistance

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7
Q

When is the peak increase in blood volume during pregnancy?

A

Peak of 45% increase at 32 weeks

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8
Q

Why does systemic vascular resistance decrease?

A
    1. Progesterone relaxing SM
    1. Inc production of vasodilators (PGs, NO, ANP)
    1. Arteriovenous shunting to uteroplacental circulation
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9
Q

What may cause a decrease in CO during pregnancy?

A

Venous return to heart being impeded by venal caval obstruction by enlarging gravid uterus

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10
Q

What is the path of venous return from lower extremities in the setting of complete vena caval obstruction in term pregnancy?

A

Dilated paravertebral collateral circulation

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11
Q

How does maternal HR change in pregnancy?

A

Increases as pregnancy progress.

Increases 10-18bpm over non pregnant value by term

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12
Q

What happens to dBP with pregnancy?

A

Decreases begin in 7th week; maximal decrease of 10mmHg by 24-32 weeks

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13
Q

What is inferior vena cava syndrome?

A 
10% women have symptoms of:
-dizziness
-light headedness
-syncope 
when lying supine. May be due to insufficient shunting by paravertebral circulation when gravid uterus occludes IVC
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14
Q

What are the normal CV PEx findings during pregnancy?

A
  • Increased S2 split with inspiration
  • Distended neck veins
  • Low grade systolic ejection murmur (? due to increased flow across aortic and pul valves)
  • Many have S3 gallop
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15
Q

What is the primary mediator of the respiratory changes occurring with pregnancy?

A

Progesterone

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16
Q

How does oxygen consumption change with pregnancy?

A

20% increase (50mL/min)

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17
Q

How is the increased oxygen consumption utilised within the pregnant body?

A

Ff the increase:

  • 50% used by uterus and contents
  • 30% heart and kidneys
  • 18% respiratory muscles
  • remainder to mammary tissues
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18
Q

What is the primary respiratory parameter changed with pregnancy?

A

30-40% increase in minute ventilation

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19
Q

What are the results of the increased minute ventilation?

A

Changes in acid-base

  • progesterone sensitises central chemoreceptors to CO2 -> increased respiration and decreased arterial PCO2
  • respiratory alkalosis compensated by renal excretion of bicarbonate
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20
Q

What causes the dyspnoea of pregnancy?

A

Physiologic response to low arterial PCO2

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21
Q

URT changes pregnancy

A
  • allergy like symptoms or chronic colds

- mucosal hyperemia producing nasal stuffiness and increased nasal secretions

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22
Q

What do ABGs in pregnancy usually show?

A

Compensated respiratory alkalosis

23
Q

What are the haematologic changes of pregnancy?

A
  • increase in plasma volume
  • increase in red cell volume
  • increase in coagulation factors
24
Q

When does maternal plasma volume peak?

A

30-34 weeks then stabilises

25
Q

What is the mean plasma volume increase?

A
  • 50% singleton

- Greater if multiple

26
Q

What is the maternal blood volume increase with pregnancy?

A

35% by term

27
Q

What is the total additional iron requirement during pregnancy?

A

Additional 1000mg

  • 500mg to increase red cell mass
  • 300mg to foetus
  • 200mg to compensate for iron loss
28
Q

What is the recommended daily iron need in a pregnant woman who is not anemic?

A

60mg

29
Q

How do WBCs change during pregnancy?

A
  • Mild increase throughout
  • More pronounced increase in labour: primarily increased granulocytes linked with stress induced demargination (cf disease associated inflammatory response)
30
Q

How do clotting factor concentrations change with pregnancy?

A

-FI (fibrinogen) 50% increase
-VII, VIII, IX, X 50% increase
-Promthrombin (II), V, VII unchanged
Inhibitors of coagulation (protein C and S) both decrease

31
Q

What are the functional changes of erythrocytes during pregnancy?

A

Enabled enhanced oxygen uptake in lungs inc delivery to foetus and CO2 exchange

  • significant increase in total oxygen carrying capacity
  • Bohr effect (due to comp resp alkalosis) shifts O2 dissociation curve to left
  • M lung O2 affinity increases
  • Placental CO2 (F:M) gradient inc -> facilitates transfer to mother
32
Q

Why is there a physiologic anaemia of pregnancy?

A

Disproportionate increase in plasma volume cf red cell volume (dec in Hb and haematocrit)

33
Q

What is the primary anatomic change of the renal system in pregnancy?

A

Enlargement and dilation of kidneys and urinary collecting system largely due to increased renal plasma flow

34
Q

How does GFR change with pregnancy?

A

Increases to 50% over non pregnant state; at term may be up to 75%

35
Q

Why is urinary glucose excretion common (i.e. nearly all) in pregnant patients?

A

Increased GFR results in increased load of solutes presented to renal system.

36
Q

Symptoms of changes to renal physiology with pregnancy?

A
  • Urinary frequency due to bladder compression
  • Stress urinary incontinence
  • urinary stasis predisposes to pyelonephritis in pts with asymptomatic bacteriuria
37
Q

What are the GIT anatomic changes of pregnancy?

A
  • Displacement of stomach and intestines due to enlarging uterus
  • Increase in portal blood flow
38
Q

What are the functional change of the GIT during pregnancy?

A 
Generalised SM relaxation due to progesterone produces:
-lower oesophageal sphincter tone
-decreased GIT motility
-impaired GB contractility
Leading to:
-Significantly increases transit time
-GORD
-Increased prevalence gallstones, cholestasis
39
Q

What effect does pregnancy have on hepatic biosynthesis?

A

Oestrogen increases biosynthesis of:

  • fibrinogen
  • ceruloplasmin
  • binding proteins for:
  • corticosteroids
  • sex steroids
  • thyroid horones
  • vitamin D
40
Q

GIT symptoms of pregnancy?

A
  • NVP (4-8w - 14-16w)
  • Increased energy requirements
  • Cravings
  • GORD
  • Constipation
  • Generalised pruritus?
41
Q

What causes NVP?

A

Unknown; related to increased

  • progesterone
  • hCG
  • relaxation of SM of stomach
42
Q

PEx GIT findings of pregnancy?

A
  • Gingivial disease

- Haemorrhoids

43
Q

What is epulis gravidarum?

A

Violaceous, pedunculated lesions occurring at gum line; pyogenic granulomas related to oedematous, soft gums of pregnancy.

44
Q

Why does ALP increase?

A

Doubled mainly due to increased placental production

45
Q

How does HCG affect thyroid?

A

Has thyrotropin like effect producing transient T4 increase in first trimester. Normalisation with decline of HCG after first trimester.

46
Q

How does oestrogen affect thyroid balance?

A

Induces hepatic synthesis of TBG - increased T4 and T3 levels.
Free T3 and T4 (active) unchanged.

47
Q

How does oestrogen affect cortisol?

A

Increases hepatic synthesis of cortisol binding globulin: inc levels of serum cortisol.

  • serum cortisol increases progressively from first trimester until term.
  • ACTH rises until term
48
Q

What is the metabolic effect of pregnancy?

A

Diabetogenic effect: reduced tissue response to insulin, hyperinsulinemia, hyperglycemia.
Net effect: maternal response to glucose load is blunted producing post prandial hyperglycaemia.

49
Q

Why does insulin resistance occur with pregnancy?

A

Mainly due to effect of human placental lactogen

50
Q

What is the primary fuel of the foetus and placenta?

A

Glucose.

Hence maternal hypoglycaemia may occur during periods of fasting

51
Q

Lipid changes of pregnancy?

A

Increased circulating concentrations of lipids, lipoproteins, apolipoproteins.
Fuel in cases of maternal hypoglycemia; characterised as accelerated starvation.

52
Q

What causes ligament laxity in pregnancy?

A

Relaxin and progesterone

53
Q

Calcium metabolism of pregnancy?

A
  • Increased skeletal Ca mobilisation (total maternal calcium decreases)
  • significant inc in PTH (maintains serum Ca: inc intestinal absorption, decreases renal loss)
  • No loss of bone density (?protective effects of calcitonin)
54
Q

Skin changes with pregnancy?

A
  • Spider angiomata
  • Palmar erythema
  • Striae gravidarum
  • Hyperpigmentation (?oestrogen, MSH)
  • Chloasma / melasma
  • Eccrine sweating and sebum production

Women's Health (39 decks)

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