Normal/Abnormal Maternal Physiology Flashcards
Some conditions where we should reduce or modify physical activity
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
Supine Hypotensive Syndrome
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
3 main hormones in pregnancy
Estrogen
Progesterone
Human chorionic gonadotropin
Physiologic anemia of pregnancy
Plasma volume increases more than RBC mass increase
Its a dilutional anemia
If < 105g/dL consider pathologic anemia
Cardiovascular physiology adaptations
Increased blood volume
Increased CO
Decreased SVR
How does placenta decrease SVR?
Cytotrophoblast invasion and remodelling of spiral arteries of uterus to create a low resistance shunt
HTN in pregnancy definition
SBP 140 or higher
DBP 90 or higher
Average 2+ measurements, taken at least 15 mins apart, using the same arm
Pre-existing (chronic) HTN
HTN that develops pre-pregnancy or < 20 weeks gestation
These patients can also develop chronic HTN with super-imposed preeclampsia
Gestational hypertension
HTN that develops for the first time at 20 weeks +
No target organ involvement
Preeclampsia
Gestational HTN with target organ involvement
New proteinuria OR
One or more adverse conditions OR
One or more severe complications
Eclampsia
Gestational HTN with seizures
Pathophys of gestational HTN and preeclampsia
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
Adverse preeclampsia conditions on history
N/V Headache Visual disturbances Chest pain or SOB RUQ pain Lack of fetal movements or growth Vaginal bleeding
Adverse preeclampsia conditions on physical
DBP > 110 Pulmonary edema RUQ tenderness Oligouria Hyperreflexia and clonus SFH and fetal movements
Management for gestational HTN and preeclampsia
Delivery!
Antihypertensives
Prevent seizures with MgSO4 (eclampsia)
Serial surveillance (mom and fetus)