ObsGyn 1

Question 1

Why is urinary frequency more common in pregnancy, particularly at night?

Answer 1

• Increased blood volume
• Increased filtration
• Lateral decubitus takes pressure from uterus off IVC: ⬆︎ return, ⬆︎ filtration, ⬆︎ urination

Question 2

Why is UTI worrisome in pregnancy?

Answer 2

• Increased risk of pyelonephritis

- risk factor for preterm labour

Question 3

What are normal GI changes in pregnancy?

Answer 3

• uterus presses against rectum and lower colon → constipation
• Progesterone → relaxes smooth muscle → decreased GI motility
• relaxes LES → increase in heartburn & belching
  There is also some increase in GB disease, and an effect on hepatic function

Question 4

Lung volumes: what changes in pregnancy?

Answer 4

• increase in tidal and minute volume
• decrease total lung capacity, residual volume, inspiratory and expiratory reserve
• vital capacity stays the same

Question 5

Blood gases: what changes?

Answer 5

• Plasma PCO2 decreases
• Plasma PO2 is the same
• Plasma pH increases
  Result is a respiratory alkalosis

Question 6

A pregnant patient complains of shortness of breath. Should you be worried?

Answer 6

R/O other causes, but, SOB on minimal exertion is a common symptom of pregnancy.

Question 7

What changes in the makeup of maternal blood?

Answer 7

• increased blood volume

- plasma increases more than RBC, which can –> dilutional anemia

Question 8

What skin changes are normal in pregnancy? How common are they?

Answer 8

Melasma, linea nigra, spider angiomas

Almost all pregnant women have some degree of skin changes (usually localized; occasionally generalized)

Question 9

What is melasma?

Answer 9

melasma are dark, irregular well demarcated hyperpigmented macules to patches. 3 classic patterns: centrofacial (cheeks, forehead, upper lip, nose, chin), malar, mandibular

Question 10

What is the linea nigra?

Answer 10

Darkening of linea alba in pregnancy. Can extend from pubic symphysis to xiphoid process.

Question 11

What physiological reasons are there for leg swelling in pregnancy?

Answer 11

• Increased water retention
• Decreased interstitial colloid osmotic pressure
• Occlusion of IVC

Question 12

What is Virchow’s triad?

Answer 12

Hypercoagulability, stasis, endothelial damage

Question 13

What changes are there in clotting factors in pregnancy?

Answer 13

All clotting factors but XI and XIII are increased. Fibrinolytic processes are reduced.

Question 14

What can stagnant blood flow cause (commonly seen in pregnancy)?

Answer 14

• varicose veins in the legs and vulva
• hemorrhoids
• dependent edema

Question 15

What happens to HR, BP, and cardiac output in pregnancy?

Answer 15

HR increases by 10bpm
CO increases by 40-50%
BP decreases till mid-pregnancy, then rises till end

Question 16

What is supine hypotension, and what should you do to address it?

Answer 16

Uterus compresses IVC → Hypotension → lightheadedness on sitting up from supine
Normal change in pregnancy
Make sure to consistently measure BP either sitting or in left lateral decubitus to avoid artifact.