Physiological Changes in Pregnancy

Question 1

Does the anterior pituitary gland produce more ACTH during pregnancy?

Answer 1

Yes

Question 2

What does more ACTH cause a rise in?

Answer 2

Steroid hormones (cortisol and aldosterone)

Question 3

Name a sometimes positive aspect of more steroid hormones in pregnancy.

Answer 3

Improvement in most autoimmune conditions

Question 4

Name a negative aspect of more steroid hormones in pregnancy.

Answer 4

Susceptibility to diabetes and infections.

Question 5

Does the anterior pituitary gland produce more prolactin during pregnancy?

Answer 5

Yes

Question 6

What does an increase in prolactin suppress?

Answer 6

FSH and LH

Question 7

Does the anterior pituitary gland produce more melanocyte stimulating hormone during pregnancy?

Answer 7

Yes

Question 8

What is the effect of increased melanocyte stimulating hormone during pregnancy?

Answer 8

Increased pigmentation of the skin during pregnancy

Question 9

Name two skin changes which can occur due to increased melanocyte stimulating hormone in pregnancy.

Answer 9

1. Linea nigra

2. Melasma

Question 10

Does TSH level increase in pregnancy?

Answer 10

No

Question 11

Does T3 and T4 levels increase in pregnancy?

Answer 11

Yes

Question 12

Describe the degree of hCG increase in pregnancy.

Answer 12

Roughly double every 48 hours until they plateau around 8 – 12 weeks, then gradually start to fall.

Question 13

What suppresses the mother’s immune reaction to foetal antigens?

Answer 13

Progesterone

Question 14

How much does the uterus increase in size during pregnancy?

Answer 14

From 100g to 1.1kg

Question 15

What causes cervical ectropion and cervical discharge during pregnancy?

Answer 15

Oestrogen

Question 16

What causes hypertrophy of the vaginal muscles and increased vaginal discharge during pregnancy?

Answer 16

Oestrogen

Question 17

Whilst the changes in the vagina prepare it for delivery, what is a problem that can occur?

Answer 17

Bacterial and candidal infection more common

Question 18

What breaks down collagen in the cervix before delivery to allow it to dilate and efface during childbirth?

Answer 18

Prostaglandins

Question 19

During pregnancy, does the blood volume increase or decrease?

Answer 19

Increase

Question 20

During pregnancy, does the plasma volume increase or decrease?

Answer 20

Increase

Question 21

During pregnancy, does the cardiac output (stroke volume and heart rate) increase or decrease?

Answer 21

Increase

Question 22

During pregnancy, does the peripheral vascular resistance increase or decrease?

Answer 22

Decrease

Question 23

During pregnancy, does the blood pressure increase or decrease?

Answer 23

Decreased in early and middle pregnancy, returning to normal by term

Question 24

What can occur during pregnancy during to peripheral vasodilation and obstruction of IVC by uterus?

Answer 24

Varicose veins

Question 25

What symptoms does peripheral vasodilation cause?

Answer 25

Flushing and hot sweats

Question 26

What is the effect of pregnancy on tidal volume and respiratory rate?

Answer 26

Increase in later pregnancy to meet increased oxygen demands

Question 27

During pregnancy, does the blood flow to the kidneys increase or decrease?

Answer 27

Increase

Question 28

During pregnancy, does the GFR increase or decrease?

Answer 28

Increase

Question 29

During pregnancy, does the aldosterone level increase or decrease?

Answer 29

Increase leading to increased salt and water reabsorption and retention

Question 30

During pregnancy, does the rate of protein excretion increase or decrease?

Answer 30

Increase - (normal is up to 0.3g in 24 hours)

Question 31

During pregnancy, how do the kidneys change structurally?

Answer 31

Dilation of ureters and collecting system leading to physiological hydronephrosis (more right-sided)

Question 32

During pregnancy, which increases more: plasma volume or red blood cell volume? What does this result in?

Answer 32

Plasma volume increases more than RBC volume - leading to lower concentration of RBCs and haemoglobin leading to anaemia.

Question 33

Since there is increased RBC production in pregnancy, what deficiencies are pregnant women at risk of?

Answer 33

1. Iron 2. Folate 3. B12

Question 34

Do clotting factors increase or decrease during pregnancy?

Answer 34

Increase - making women hyper-coagulable

Question 35

During pregnancy, does the white blood cell count tend to increase or decrease?

Answer 35

Increase

Question 36

During pregnancy, does the platelet count tend to increase or decrease?

Answer 36

Decrease

Question 37

During pregnancy, does the ESR tend to increase or decrease?

Answer 37

Increase

Question 38

During pregnancy, does the D-dimer tend to increase or decrease?

Answer 38

Increase

Question 39

During pregnancy, does the ALP tend to increase or decrease?

Answer 39

Increase - up to 4 times normal, due to secretion by the placenta

Question 40

During pregnancy, does the albumin tend to increase or decrease? Why?

Answer 40

Decrease - due to loss of proteins in kidneys

Question 41

During pregnancy, does the calcium tend to increase or decrease?

Answer 41

Calcium requirements increase, but so does gut absorption of calcium, meaning calcium levels remain stable.

Question 42

What are stretch marks on the expanding pregnant abdomen called?

Answer 42

Striae gravidarum

Question 43

Whilst pruritus can be normal in pregnancy, what can it also indicate?

Answer 43

Obstetric cholestasis

Question 44

What two skin changes are causes by increased circulating oestrogen?

Answer 44

1. Spider naevi | 2. Palmar erythema

Question 45

Is postpartum hair loss normal?

Answer 45

Yes - usually improves within six months