Physiological Changes in Pregnancy Flashcards
Does the anterior pituitary gland produce more ACTH during pregnancy?
Yes
What does more ACTH cause a rise in?
Steroid hormones (cortisol and aldosterone)
Name a sometimes positive aspect of more steroid hormones in pregnancy.
Improvement in most autoimmune conditions
Name a negative aspect of more steroid hormones in pregnancy.
Susceptibility to diabetes and infections.
Does the anterior pituitary gland produce more prolactin during pregnancy?
Yes
What does an increase in prolactin suppress?
FSH and LH
Does the anterior pituitary gland produce more melanocyte stimulating hormone during pregnancy?
Yes
What is the effect of increased melanocyte stimulating hormone during pregnancy?
Increased pigmentation of the skin during pregnancy
Name two skin changes which can occur due to increased melanocyte stimulating hormone in pregnancy.
- Linea nigra
2. Melasma
Does TSH level increase in pregnancy?
No
Does T3 and T4 levels increase in pregnancy?
Yes
Describe the degree of hCG increase in pregnancy.
Roughly double every 48 hours until they plateau around 8 – 12 weeks, then gradually start to fall.
What suppresses the mother’s immune reaction to foetal antigens?
Progesterone
How much does the uterus increase in size during pregnancy?
From 100g to 1.1kg
What causes cervical ectropion and cervical discharge during pregnancy?
Oestrogen
What causes hypertrophy of the vaginal muscles and increased vaginal discharge during pregnancy?
Oestrogen
Whilst the changes in the vagina prepare it for delivery, what is a problem that can occur?
Bacterial and candidal infection more common
What breaks down collagen in the cervix before delivery to allow it to dilate and efface during childbirth?
Prostaglandins
During pregnancy, does the blood volume increase or decrease?
Increase
During pregnancy, does the plasma volume increase or decrease?
Increase
During pregnancy, does the cardiac output (stroke volume and heart rate) increase or decrease?
Increase
During pregnancy, does the peripheral vascular resistance increase or decrease?
Decrease
During pregnancy, does the blood pressure increase or decrease?
Decreased in early and middle pregnancy, returning to normal by term
What can occur during pregnancy during to peripheral vasodilation and obstruction of IVC by uterus?
Varicose veins
What symptoms does peripheral vasodilation cause?
Flushing and hot sweats
What is the effect of pregnancy on tidal volume and respiratory rate?
Increase in later pregnancy to meet increased oxygen demands
During pregnancy, does the blood flow to the kidneys increase or decrease?
Increase
During pregnancy, does the GFR increase or decrease?
Increase
During pregnancy, does the aldosterone level increase or decrease?
Increase leading to increased salt and water reabsorption and retention
During pregnancy, does the rate of protein excretion increase or decrease?
Increase - (normal is up to 0.3g in 24 hours)
During pregnancy, how do the kidneys change structurally?
Dilation of ureters and collecting system leading to physiological hydronephrosis (more right-sided)
During pregnancy, which increases more: plasma volume or red blood cell volume? What does this result in?
Plasma volume increases more than RBC volume - leading to lower concentration of RBCs and haemoglobin leading to anaemia.
Since there is increased RBC production in pregnancy, what deficiencies are pregnant women at risk of?
- Iron
- Folate
- B12
Do clotting factors increase or decrease during pregnancy?
Increase - making women hyper-coagulable
During pregnancy, does the white blood cell count tend to increase or decrease?
Increase
During pregnancy, does the platelet count tend to increase or decrease?
Decrease
During pregnancy, does the ESR tend to increase or decrease?
Increase
During pregnancy, does the D-dimer tend to increase or decrease?
Increase
During pregnancy, does the ALP tend to increase or decrease?
Increase - up to 4 times normal, due to secretion by the placenta
During pregnancy, does the albumin tend to increase or decrease? Why?
Decrease - due to loss of proteins in kidneys
During pregnancy, does the calcium tend to increase or decrease?
Calcium requirements increase, but so does gut absorption of calcium, meaning calcium levels remain stable.
What are stretch marks on the expanding pregnant abdomen called?
Striae gravidarum
Whilst pruritus can be normal in pregnancy, what can it also indicate?
Obstetric cholestasis
What two skin changes are causes by increased circulating oestrogen?
- Spider naevi
2. Palmar erythema
Is postpartum hair loss normal?
Yes - usually improves within six months
