Normal/Abnormal Maternal Physiology Flashcards

1
Q

Some conditions where we should reduce or modify physical activity

A

Patients with increased risk of preterm birth
Placenta previa (pelvic rest)
Contact sports and center of gravity considerations
Severe HTN
Fetal growth restriction
Ruptured membranes (pelvic rest)
Supine hypotension in 3rd trimester

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2
Q

Supine Hypotensive Syndrome

A

Compression of gravid uterus on IVC that decreases venous return/CO
10% of women cannot compensate
Maternal symptoms: faint, light-headed, SOB, dizzy
Fetal sx: drop in HR as decreased O2 supply
Encourage lateral lilt, uncross legs, compression stockings, pump calf muscles

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3
Q

3 main hormones in pregnancy

A

Estrogen
Progesterone
Human chorionic gonadotropin

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4
Q

Physiologic anemia of pregnancy

A

Plasma volume increases more than RBC mass increase
Its a dilutional anemia
If < 105g/dL consider pathologic anemia

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5
Q

Cardiovascular physiology adaptations

A

Increased blood volume
Increased CO
Decreased SVR

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6
Q

How does placenta decrease SVR?

A

Cytotrophoblast invasion and remodelling of spiral arteries of uterus to create a low resistance shunt

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7
Q

HTN in pregnancy definition

A

SBP 140 or higher
DBP 90 or higher
Average 2+ measurements, taken at least 15 mins apart, using the same arm

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8
Q

Pre-existing (chronic) HTN

A

HTN that develops pre-pregnancy or < 20 weeks gestation

These patients can also develop chronic HTN with super-imposed preeclampsia

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9
Q

Gestational hypertension

A

HTN that develops for the first time at 20 weeks +

No target organ involvement

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10
Q

Preeclampsia

A

Gestational HTN with target organ involvement
New proteinuria OR
One or more adverse conditions OR
One or more severe complications

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11
Q

Eclampsia

A

Gestational HTN with seizures

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12
Q

Pathophys of gestational HTN and preeclampsia

A

Primary issue is poor placentation which leads to uteroplacental mismatch where the fetoplacental demands exceed the maternal circulatory supply
Mismatch also causes ischemia-reperfusion injury in the intervillous space, apoptosis and release of endothelium-damaging substrates into the intervillous soup
Endothelial activation leads to vasospasm and development or maternal syndrome

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13
Q

Adverse preeclampsia conditions on history

A
N/V
Headache
Visual disturbances
Chest pain or SOB
RUQ pain
Lack of fetal movements or growth
Vaginal bleeding
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14
Q

Adverse preeclampsia conditions on physical

A
DBP > 110
Pulmonary edema
RUQ tenderness
Oligouria
Hyperreflexia and clonus
SFH and fetal movements
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15
Q

Management for gestational HTN and preeclampsia

A

Delivery!
Antihypertensives
Prevent seizures with MgSO4 (eclampsia)
Serial surveillance (mom and fetus)

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