Physiological pregnancy symptoms& pre-conceptual care

Question 1

What is alpha-foetoprotein?

Answer 1

• A foetal hormone involved in pregnancy
• Produced in the liver of a developing fetus
• Elevated levels could indicate other cancers

Question 2

What neurological physiological changes occur due to pregnancy?

Answer 2

• Increase in CSF
• Engorgement of epidural veins
• Decreased MAC
• Decreased LA volumes required

Question 3

What cardiac physiological changes occur due to pregnancy?

Answer 3

• Increased CO
• Increased SV
• Increased HR
• Left ventricular hypertrophy
• Regurgitant murmurs
• Decreased systemic vascular resistance

Question 4

What GI physiological changes occur due to pregnancy?

Answer 4

• Lower oesophageal sphincter tone
• Reflux
• Increased risk of aspiration
• decreased conc. of liver enzymes
• Increased ALP

Question 5

What renal physiological changes occur due to pregnancy?

Answer 5

• Increased renal blood flow
• Increased GFR
• Decreased plasma urine and creatinine
• Increased urinary protein and glucose
• Increased risk of UTI

Question 6

What endocrine physiological changes occur due to pregnancy?

Answer 6

• Increased progesterone& oestrogen
• Placenta secretes relaxin, human placental lactogen and human chorionic gonadotrophin
• Thyroid hyperplasia
• Transient hyperthyroidism
• Insulin resistance
• Increased cortisol secretion by adrenal glands

Question 7

What musculoskeletal physiological changes occur due to pregnancy?

Answer 7

• Increased ligamentous laxity
• Increased risk of dislocation
• Increased lumbar lordosis

Question 8

What respiratory physiological changes occur due to pregnancy?

Answer 8

• Increased mechanical ventilation (increased total volume & RR)
• Decreased PaCo2
• Increased Pao2
• Decreased function residual capacity

Question 9

Is there a change in bicarbonate(mmol/l) during pregnancy?

Answer 9

-Slight decrease

Question 10

Is there a change in base excess during pregnancy

Answer 10

-No change

Question 11

How can we treat a PE in pregnancy

Answer 11

• Low molecular weight heparin

- Thrombolysis

Question 12

What GI tract changes occur in pregnancy?

Answer 12

• Gastric pH increasing & intestinal motility reduced

- This may lead to delayed absorption

Question 13

What renal changes occur in pregnancy?

Answer 13

• Kidney size increases by 1cm
• Increase in kidney volume by up to 30%
• Dilatation of the renal,calyces, pelvis & ureters
• GFR increase by 40-65%
• Serum creatinine conc. fall 35-55 micromol/L

Question 14

What is a MEOWS chart& what is it used for?

Answer 14

Modified early obstetric warning system

-Used to track early physiological parameters and aid early recognition of acutely unwell women

Question 15

What are the folic acid requirements for pregnant women

Answer 15

• 400mcg of folic acid before conception ( at least 3 months before)
• 5mg Folic acid for those at higher risk of neural tube defects

Question 16

What makes a woman at higher risk of having a baby with neural tube defects?

Answer 16

• Maternal or Paternal neural tube defect
• Previous pregnancy affected by a neural tube defect
• Family history of neural tube defects
• Pre-existing diabetes mellitus
• Anti-epileptic diabetes mellitus
• BMI>30kg/ m^2

Question 17

What is different in pregnancy ABCDEF approach?

Answer 17

• After 20 weeks we need to be aware of compression of the abdominal aorta & inferior vena cava by the gravid uterus when a pregnant woman lies in the supine position
• So we’d have to give an emergency c-section if the mother is injured/dead/fainted
• You can’t lie a pregnant woman flat when she faints; need to lie her to the side or sit her up so she’s more comfortable

Question 18

What are the effects of folic acid deficiency?

Answer 18

• Mutations of 5,10-methylenetetrahydrofolate reductase enzyme ( this enzyme is essential for catalyzing the transfer of a methyl group to homocysteine to form methionine)
• Differential methylation of insulin-like growth factor 2 (IGF-2) gene
• hyperhomocysteinaemia
• direct effect on neural epithelium in the embryo