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HOS Final > Packet 12 Physiology of Normal Pregnancy > Flashcards

Packet 12 Physiology of Normal Pregnancy Flashcards

1
Q

T-F—cardiovascular function is increased in pregnancy?

A

True

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2
Q

T-F—pregnancy induces respiratory acidosis?

A

False- alkalosis

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3
Q

The increased cardiovascular function found during pregnancy leads to what changes in the kidney tubular function?

A 
proteinuria
glycosuria
amnio-aciduria
increased fluid volume
net potassium retention
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4
Q

Is pregnancy a hypo or hyper coagulable state?

A

hypercoaguable

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5
Q

What plays a very important role in controlling postpartum hemostasis?

A

uterine decidua

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6
Q

Are pregnant women at an increased risk to venous thromboembolism?

A

Yes

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7
Q

Can you see skin changes during pregnancy?

A

yes from hormonal and physical reasons

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8
Q

Which direction is the heart displaced during pregnancy?

A

up and to the left

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9
Q

What do we see on a heart x ray in a pregnant woman?

A

cardiomegaly

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10
Q

Generalized softening of all things collagen in the pregnant woman leads to what?

A

hypertrophy of smooth muscle components

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11
Q

Ventricular wall muscle and end diastolic volume increases without what? what does this lead to?

A
  1. increase in end systolic volume or end diastolic pressure

2. increase in compliance and slight reduction in ejection fraction

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12
Q

What percentage increase in plasma volume is seen in pregnancy?

A

45%

[1.2-1.5 L by 32 weeks to a maximum of 4.7-5.2L]

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13
Q

Why does plasma volume increase during pregnancy?

A

NO release—>vasodilation—>renin angiotensin aldosterone

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14
Q

Why do pregnant women have an increase in risk for enemia?

A

Increased volume of plasma outpaces the 25% in RBC amount

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15
Q

How high does pregnant CO increase to? why?

A

7-12 liters/ min

increased SV and HR

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16
Q

What happens when a pregnant woman lies down to CO?

A

caval compression and decreases CO by 25%

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17
Q

Do we see an increases in blood flow to the brain or liver during pregnancy?

A

No

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18
Q

Do we see an increase to uterine blood flow during pregnancy?

A

yes 10 fold

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19
Q

Besides the uterine, where do we see increased blood flow? how much?

A

renal, breast and skin

50%

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20
Q

Does systolic pressure remain stable throughout pregnancy?

A

yes

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21
Q

Does diastolic pressure decrease or increase in pregnancy?

A

decrease by about 10 mmHg by 28 weeks

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22
Q

What happens to BP of pregnant woman lying down?

A

both sys and dia. BP decrease

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23
Q

when do we see a slight increase in pulse pressure in the early trimester?

A

early third trimester

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24
Q

What may be the trigger for an increase in HR, SV and CO?

A

early decrease in SVR

[seen as early as 5 weeks, lowest at 14-24]

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25
Q

What are the antepartum hemodynamics like? [up, down, same]

A

up= CO, SV, HR

down= SVR, serum colloid pressure

same= PCWP, CVP or MAP

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26
Q

During the first stage of labor, what increase do we see in CO and in SV?

A

12-31% in CO

22% in SV

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27
Q

During the second stage of labor what increase do we see in CO?

A

49% in CO

28
Q

A contraction pushes how much blood from the uterus to systemic blood?

A

500ml—-> increase to systolic and diastolic pressures

29
Q

Why does CO increase about 60-80% 10-15 minutes postpartum? [3 reasons]

A
  1. release of venal caval obstruction of uterus.
  2. auto transfusion of utero-placental blood 500ml
  3. reapid mobilization of extravascular fluid
30
Q

When does CO return to pre-labor values after delivery?

A

1 hour

31
Q

The left atrial dimensions increased after postpartum and leads to what? when do dimensions decrease?

A

ANP—-> diuresis and naturesis

[LA dimensions decrease 10 days and LV after 4-6 months]

32
Q

What increases to stimulate the respiratory centers of the brain?

A

progesterone

33
Q

upward displacement of the diaphragm leads to what pulmonary changes?

A

decrease functional residual capacity, expiratory reserve volume

34
Q

A 40% increase in tidal volume leads to what in pregnancy?

A

hyperventilation and hypocapnia

35
Q

Does respiratory rate change during pregnancy?

A

No— but increase in tidal volume—> 40% increase in minute ventilation

36
Q

Hyperventilation leads to what?

A

hypocapnia which leads to mild respiratory alkalosis

37
Q

What does mild respiratory alkalosis do?

A

-shifts O2 dissociation curve left to reduce Hgb offloading of oxygen to the fetus

[i believe this is bad, but compensated by 2,3 BPG with a right shift promoting oxygen release to the fetus]

38
Q

What happens to renal size and weight during pregnancy?

A

both increase—

39
Q

Why is the right renal collecting system possibly more dilated than the left?

A

dextrorotation [clockwise, but from what vantage point???] of the uterus and the protection of the sigmoid colon

40
Q

What happens to urinary stasis during pregnancy?

A

Increases

41
Q

How long may hydronephrosis [water inside kidney] and hydroureter [distension with urine] persist for after birth?

A

3-4months

42
Q

decreased ureteral length and intraurethral closure pressure leads to what?

A

physiologic stress incontinence

43
Q

T-F—glomerular filtration rate increases in pregnancy as early as 6 weeks?

A

True—

44
Q

Why does GFR increase?

A

increase CO

vasodilation of vessels pre and post glomerulus

45
Q

Increase in GFR leads to decreased what that can be measured?

A

decreased serum creatinine and urea concentrations

46
Q

Why does increased sodium filtration and excretion occur during pregnancy?

A

up progesterone–> inhibits aldosterone
up prostaglandins—>vasodilator
up ANP

47
Q

What does progesterone do to potassium excretion?

A

it inhibits excretion

48
Q

T-F—calcium excretion and resorption is balanced during pregnancy?

A

True

[calcitriol increases intestinal resorption, but there is increased calcium clearance]

49
Q

T-F—there is increased in glucose reabsorption due to changes in collecting tubule and loop of hence?

A

False decreased reabsorption so more excretion

50
Q

T-F—there is increase in uric acid reabsorption?

A

False—excretion due to decreased reabsorption and increased GFR

51
Q

Is there an increase in amino acid excretion during pregnancy?

A

yes—mechanism is largely unknown

52
Q

What increase in total body water do we see during pregnancy?

A

2 L intravascular

6-7 L extravascular

53
Q

Progesterone increases what coagulation factors?

A

Tissue factor and plasminogen activator inhibitor [at the decimal level]

54
Q

What plays the primary role in mediating puerperal hemostasis?

A

Decidual Tissue Factor

55
Q

What happens to fibrinogen during pregnancy?

A

doubles [with normal value between 200-400]

56
Q

What happens to Factors 7, 8, 9, 10 and vWF during pregnancy?

A

increases 20-1000%

57
Q

What coagulation factors remain unchanged during pregnancy?

A

prothrombin and factor 5

58
Q

What coagulation factor declines modestly in pregnancy? How much are Protein S levels at?

A

Factor 11

60-70%

59
Q

T-F—during pregnancy there is a decrease in resistance to Protein C?

A

Increased resistance

60
Q

What are the 5 results of all the coagulation and venous changes during pregnancy?

A
  1. increased clotting
  2. decreased anticoagulant activity
  3. decreased fibrinolysis
  4. increased venous stasis
  5. increased risk of venous thromboembolism
61
Q

What is striae gravid arum?

A

stretch marks

[occurs late…due to physical stretching and separation of underlying collagen]

62
Q

What is linea nigra? due to what?

A

black line occurring late in pregnancy due to melanocyte stimulating hormone from placenta [melanocytes in a line]

63
Q

What is cholasma?

A

mask of pregnancy—also due to increase melanocyte stimulating hormone

64
Q

What is chadwicks sign?

A

bluish discoloration of vagina, cervix, and labia

[venous congestion
estrogen effect]

65
Q

What does estrogen do in the pregnant woman? 5 things

A
  1. up procoagulant factors
  2. Up liver synthesis of fibrinogen and binding proteins
  3. ligamen laxity
  4. breast duct growth
  5. withdrawal postpartum leads to lactation
66
Q

What does progesterone do in the pregnant woman? 6 things

A
  1. maintain early preg.
  2. conserve K
  3. smooth muscle relax everywhere!!
  4. hypervent–>alkalosis
  5. hypertrophy of breast alveoli
  6. withdrawal postpartum promotes lactation
67
Q

Does withdrawal of estrogen or progesterone lead to lactation?

A

Both!

HOS Final (12 decks)

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