OB: PRECONCEPTION PHYSIOLOGY OF PREGNANCY Flashcards
What happens to systemic vascular resistance in mom during preganancy?
systemic vascular resistance decreases due to addition of parallel blood vessels from the placenta. Trophoblastic cells from the placenta increase vasodialation of vascular smooth mm. It nadirs around 26 weeks
What happens to preload during pregnancy?
As SVR decreases, preload increases! Preload= volume, sodium, aldosterone
What happens to stroke volume and CO dueing pregnancy?
As preload increases, stroke volume and CO INCREASE! this results in higher filtration rate in the kidneys
Why do we get a dilutional anemia in pregnancy?
RBCs increase but not in proportion to volume increase resulting in dilutional anemia.
Lower hemoglobin on labs but improved oxygen carrying capacity
Summarize what happens to SVR, preload, HR, BP, and HgB during pregnancy
In summary, the SVR decreases, the preload increases greatly, and the heart rate increases slightly. The blood pressure and hemoglobin level drift downward, nadir at week 26, and trend toward normal by term.
What position will alleviate the pressure on the inferior vena cava and allow venous return to the heart?
In the event of maternal hypotension, turn her on all fours (if she can support herself ) or left lateral decubitus (if she cannot support herself ).
What findings findings of cirrhosis are also normal in pregnancy?
Estrogen drives many processes in pregnancy, and we’ve selected the highest-yield estrogen-driven changes. Cirrhotic patients have palmar erythema (red palms) and spider angiomata(blanchable, spider-like telangiectasia) because the liver cannot clear the estrogen.
Why is bed rest never an appropriate treatment in pregnancy?
Estrogen also drives a procoaguable state!
Mom has the red blood cell mass and preload to survive hemorrhage. A procoaguable state helps prevent mom from hemorrhaging so much. Clotting factors increase (2, 7, 9, 10, and von Willebrand) and anti-clotting factors decrease (protein C, protein S, and antithrombin). Because of venous stasis from venous compression and relative hypercoagulability, deep-vein thrombosis is not an uncommon pregnancy complication. Early mobility, in all inpatient settings but especially in Labor and Delivery, should be encouraged
In a pregnant patient, why can’t D-Dimer be used to test for DVT?
Fibrinogen should be elevated. Consider DIC if fibrinogen is normal during or after delivery. In a similar sense, the increase in fibrin degradation products, called split products, can be measured using a D-dimer level. Thus, the D-dimer level should be elevated and cannot be used to exclude a DVT.
All in all, elevated d-dimer is NORMAL in pregnancy!
What happens to GFR in pregnancy?
Increases, due to overall increase in CO and reduced SVR
What happens to Cr in pregnancy?
Decreases
Darkening can also occur on the face, this is called…
Melasma
Why is proteinuria and glucosuria normal in pregnancy?
Increased GFR!
Why do pregnant patients get gerd?
Smooth muscle changed decrease LES tone resulting in GERD
How do we treat GERD in pregnancy?
Any proton pump inhibitor or H2 blocker (OTC)Constipation: Stool softener + motility agent (OTC)Nausea: Ondansetron
