Normal pregnancy and physiologic changes Flashcards
When measuring gravidity, does a multiple gestation count as 1 or 2?
One - counting the number of times pregnant
When measuring gravidity would a hydatidiform molar pregnacy count?
Yes
What is Goodell’s sign? When does it occur?
- Softening of the cervix
- 4-6 wks
What is Chadwick’s sign?
- Blueish discolouration of the cervix and vagina
- Due to engorgement of pelvic vasculature
What is Hegar’s sign? When does it occur?
- Softening of the cervical isthmus
- 6-8 weeks
What breast changes occur in normal pregnancy?
- Engorgement
- Areolar darkening
- Prominent vascular patterns
What is the B hCG rule of 10’s?
- 10 IU at missed period
- Week 10 is the peak at 100,000 IU
- 10,000 IU at term
What produces B hCG? What is the function of B hCG?
- Produced by placental trophoblastic cells
- Function: maintains the corpus luteum during pregnancy
When is hCG detectable in the serum? The urine?
1) Serum: 9 days post conception
2) Urine: 28 days after first day of LMP
What is the expected doubling time for hCG? When does it peak?
- Doubles every 1-2 days
- Peaks at 8-10 weeks (100,000IU) and then plateaus until delivery
- Term level expected to be around 10,000 IU
A patient comes in and has an hCG level less than expected for gestational age what is on your differential?
- Ectopic
- Abortion
- Inaccurate dating
A patient comes in and has an hCG level higher than expected for gestational age what is on your differential?
- multiple gestation
- molar pregnancy
- trisomy 21
- inaccurate dates
During which weeks is the 1st trimester?
0-14
When is the second trimester?
week 14-28
When is the 3rd trimester?
week 28-42
What range is considered to be a normal term pregnancy?
37 weeks - 42 weeks
What are some normal physiologic skin changes that occur during pregnancy? (4)
1) ^ pigmentation of perineum, areola, and under eyes on bridge of nose (chloasma)
2) Linea nigra (midline abdo pigmentation)
3) Spider angiomas, palmar erythema (due to ^ estrogen, like in liver disease)
4) Striae gravidarum (stretch marks)
What are normal physiologic changes that occur to the cardiovascular system during pregnancy? (3)
1) Increased blood volume, CO, and HR
2) Decreased BP (due to v in PVR and v in venous return from enlarging uterus)
3) Increase in venous pressure (from uterus) ^ risk of varicose veins, hemorrhoids and leg edema
What would you expect to see on the CBC of a pregnant women due to normal physiologic changes? (4)
1) Decrease in hemoglobin and hematocrit (dilution)
- > 33% hct (vs 37-47 non preg)
- > 110g/L (vs >120 in non-preg)
2) Increased WBC count (but with impaired fx)
- This is why autoimmune conditions improve in preg
3) Mild thrombocytopenia (no symptom)
- plt > 80k (typically 100-150k)
- normal for adults is > 150k
4) Hypercoagulable state
- Increased risk of DVT, PE
- v risk of bleeding at delivery
What are some physiologic changes that occur to the respiratory system during pregnancy? (4)
1) ^ nasal congestion, epistaxis
2) ^ O2 requirement due to metabolic demand
3) Barrel chested (due to elevated diaphragm)
4) ^ minute ventilation, leads to v CO2 and mild respiratory alkalosis (this ^ diffusion of CO2 across placenta from baby to mom)
What are the physiologic GI changes that occur during pregnancy? Which hormone causes most of these changes? (3)
1) GERD
- increased intra-abdo pressure
- progesterone decreases tone of sphincter and delays gastric emptying
2) Increased gallstones
- progesterone leading to biliary stasis
3) Constipation and hemorrhoids
- progesterone causing v GI motility
Which physiologic GU changes occur in pregnancy? (5)
1) ^ urinary frequency due to ^ urine output
2) ^ incidence of UTI due to urinary stasis
3) Glycosuria can be physiologic in 3rd trimester (must test for GDM)
4) Dilation of ureters and renal pelvis (R>L)
- due to progesterone and uterine enlargement
5) decreased creatinine, uric acid, BUN
- ^ in GFR due to the increase in cardiac output
Which two neurologic findings are more common during pregnancy?
1) carpal tunnel
- pressure on median nerve through carpal tunnel
- small space to start, becomes compressed with edema in pregnancy
2) Bell’s palsay
- CN VII palsay
- unknown etiology in pregnancy
During pregnancy what results would you expect for:
1) Total thyroxine
2) Thyroxine binding globulin
3) Free thyroxine
4) TSH
1) total thyroxine: Elevated
2) TBG: increased
3) Free T4: normal
4) TSH: normal
* elevated total thyroxine and TBG counteract each other, so free (active) T4 and TSH are both unchanged
What adrenal changes occur during pregnancy physiologically? (1)
- increased cortisol (total and free)
How does calcium metabolism change in pregnancy? (3)
1) Decreased total maternal Ca2+
- due to decreased albumin
2) Free ionized Ca2+ (active) remains the same
- due to PTH increase
- causes ^ bone resorption and ^ gut absorption
3) Increased bone turnover without loss of bone density
- due to estrogen inhibition
