Physiological changes during pregnancy

Question 1

What parameters increase in the cardiovascular system during pregnancy?

Answer 1

Cardiac output (CO), heart rate (HR), stroke volume, venous pressure.

Question 2

What parameters decrease in the cardiovascular system during pregnancy?

Answer 2

Peripheral vascular resistance, blood pressure.

Question 3

What are the symptoms and anatomic changes in the cardiovascular system during pregnancy?

Answer 3

Varicose veins, hemorrhoids, increased risk for congestive heart failure in at-risk individuals.

Question 4

What parameters increase in the hematologic system during pregnancy?

Answer 4

Plasma volume (↑ 40%‒50% due to water retention), RBC mass (↑ 15%‒30%), WBC count (up to 29,000/µL can be physiologic), coagulation factors (II, VII, VIII, X, and XII), fibrinogen.

Question 5

What parameters decrease in the hematologic system during pregnancy?

Answer 5

Hemoglobin and hematocrit concentrations, platelets, anticoagulants (protein S), fibrinolysis, blood viscosity, PT and aPTT may be slightly ↓.

Question 6

What are the symptoms and anatomic changes in the hematologic system during pregnancy?

Answer 6

Hypercoagulability → risk of DVT/PE, dilutional anemia → fatigue, shortness of breath, edema.

Question 7

What parameters increase in the respiratory system during pregnancy?

Answer 7

Tidal volume, minute ventilation (↑ 50%), oxygen consumption.

Question 8

What parameters decrease in the respiratory system during pregnancy?

Answer 8

Functional residual capacity (FRC), expiratory residual volume, pulmonary vascular resistance.

Question 9

What are the symptoms and anatomic changes in the respiratory system during pregnancy?

Answer 9

Diaphragm rises by approximately 4 cm due to uterine expansion, physiologic respiratory alkalosis.

Question 10

What parameter increases in the gastrointestinal system during pregnancy?

Answer 10

Intraabdominal pressure.

Question 11

What parameters decrease in the gastrointestinal system during pregnancy?

Answer 11

GI motility (delayed emptying), lower esophageal sphincter tone.

Question 12

What are the symptoms and anatomic changes in the gastrointestinal system during pregnancy?

Answer 12

Stomach and intestines are displaced upward, heartburn, constipation, nausea and vomiting.

Question 13

What parameters increase in the renal system during pregnancy?

Answer 13

Kidney size (due to ↑ blood volume), GFR (↑ approximately 50%), renal plasma flow, creatinine clearance, proteinuria, bicarbonate excretion (compensatory mechanism for respiratory alkalosis).

Question 14

What parameters decrease in the renal system during pregnancy?

Answer 14

Serum creatinine (should be < 0.8 mg/dL in pregnancy), serum BUN, serum sodium, plasma osmolality, glucose reabsorption

Question 15

What are the symptoms and anatomic changes in the renal system during pregnancy?

Answer 15

↑ Urinary frequency, nocturia, urinary incontinence, hydronephrosis in the 3rd trimester (due to ureteral compression), ↑ risk for UTI, glucosuria may be physiologic (seen in 50% of individuals), compensatory metabolic acidosis.

Question 16

What parameters increase in the endocrine and metabolic systems during pregnancy?

Answer 16

Basal metabolic rate, total T3 and T4 (thyroid hormones), glucose intolerance, cortisol, anterior pituitary volume, progesterone and estrogen, prolactin, oxytocin, relaxin, renin, aldosterone, erythropoietin.

Question 17

What parameter decreases in the endocrine and metabolic systems during pregnancy?

Answer 17

TSH.

Question 18

What are the common skin changes during pregnancy?

Answer 18

Stretch marks, hyperpigmentation, spider angiomata, palmar erythema.

Question 19

What are stretch marks, and when do they commonly occur during pregnancy?

Answer 19

Stretch marks (striae gravidarum) are streaks or lines that develop on the skin, commonly occurring on the abdomen, breasts, hips, and thighs as the skin stretches due to weight gain and hormonal changes during pregnancy.

Question 20

What areas are commonly affected by hyperpigmentation during pregnancy?

Answer 20

Face (melasma or the “mask of pregnancy”), nipples, perineum, abdominal line (linea nigra), and umbilicus.

Question 21

What is melasma, and how does it present during pregnancy?

Answer 21

Melasma, also known as the “mask of pregnancy,” is characterized by dark, blotchy patches on the face, particularly on the cheeks, forehead, and upper lip, caused by increased melanin production.

Question 22

What are spider angiomata, and why do they occur during pregnancy?

Answer 22

Spider angiomata are small, red, spider-like blood vessels that appear on the skin, often due to increased estrogen levels during pregnancy.

Question 23

What is palmar erythema, and why does it occur during pregnancy?

Answer 23

Palmar erythema is the reddening of the palms, which occurs due to increased blood flow and hormonal changes during pregnancy.