Physiological pregnancy symptoms

Question 1

How does the blood volume change in a pregnant woman

Answer 1

Dilutional anaemia occurs as red cell volume increases, but plasma volume increases more therefore decreasing the haematocrit of the blood

Question 2

What are the cardiovascular changes in pregnancy?

Answer 2

SVR (systemic vascular resistance) is lowered until the 3rd trimester where it begins to rise by term

Blood pressure lowered until 3rd trimester where it begins to return to pre-pregnancy levels

Cardiac output/stroke volume increased throughout pregnancy

Question 3

What are the respiratory changes in pregnancy?

Answer 3

The functional residual capacity is lowered - means there is a reduced capacity to buffer if acidic

Question 4

What is the pH range which is normal during pregnancy?

Answer 4

7.40-7.47

Question 5

What is a normal pCO2 in pregnancy (mmHg)

Answer 5

≤30

Question 6

What is a normal pO2 in pregnancy (mmHg)

Answer 6

100-104

Question 7

What is a normal bicarbonate concentration (mmol/l) in pregnancy

Answer 7

18-22

Question 8

What is a normal pH?

Answer 8

7.35-7.45

Question 9

What is a normal pCO2 (mmHg)

Answer 9

35-40

Question 10

What is a normal pO2 (mmHg)

Answer 10

90-100

Question 11

How would you investigate a potential pulmonary embolism in pregnancy?

Answer 11

CTPA = CT pulmonary angiogram

D-dimer test, healthy = <465ng DDU/ml and <640 ng DDU/ml in second and third trimesters

Question 12

What is a normal D-dimer level in pregnant women?

Answer 12

<465
<640 in second and third trimesters
units = ng DDU/ml

Question 13

How can pulmonary embolism be treated safely during pregnancy

Answer 13

LMWH and thrombolysis are both safe

Question 14

What GI tract changes occur during pregnancy?

Answer 14

Gastric pH increased, intestinal motility reduced

Question 15

At what point in pregnancy is vomiting not normal?

Answer 15

After 15 weeks

Question 16

At what point in pregnancy is constipation not normal?

Answer 16

It is always normal in pregnancy

Question 17

What is the MEOWS chart?

Answer 17

Modified early obstetric working score

Question 18

What dose of folic acids is taken in pregnancy?

Answer 18

400mcg or 5mg for those at higher risk of neural tube defects

Question 19

What factors are associated with a higher risk of neural tube defects? What is done?

Answer 19

Maternal or paternal neural tube defects
Previous pregnancy affected by a neural tube defect
family history of neural tube defects
pre-existing diabetes mellitus
anti-epileptic medication
BMI > 30 kg/m2

Normal dose of folic acid is 400 mcg, however in these high risk patients 5mg is given.