Physiological pregnancy symptoms& pre-conceptual care Flashcards
What is alpha-foetoprotein?
- A foetal hormone involved in pregnancy
- Produced in the liver of a developing fetus
- Elevated levels could indicate other cancers
What neurological physiological changes occur due to pregnancy?
- Increase in CSF
- Engorgement of epidural veins
- Decreased MAC
- Decreased LA volumes required
What cardiac physiological changes occur due to pregnancy?
- Increased CO
- Increased SV
- Increased HR
- Left ventricular hypertrophy
- Regurgitant murmurs
- Decreased systemic vascular resistance
What GI physiological changes occur due to pregnancy?
- Lower oesophageal sphincter tone
- Reflux
- Increased risk of aspiration
- decreased conc. of liver enzymes
- Increased ALP
What renal physiological changes occur due to pregnancy?
- Increased renal blood flow
- Increased GFR
- Decreased plasma urine and creatinine
- Increased urinary protein and glucose
- Increased risk of UTI
What endocrine physiological changes occur due to pregnancy?
- 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
What musculoskeletal physiological changes occur due to pregnancy?
- Increased ligamentous laxity
- Increased risk of dislocation
- Increased lumbar lordosis
What respiratory physiological changes occur due to pregnancy?
- Increased mechanical ventilation (increased total volume & RR)
- Decreased PaCo2
- Increased Pao2
- Decreased function residual capacity
Is there a change in bicarbonate(mmol/l) during pregnancy?
-Slight decrease
Is there a change in base excess during pregnancy
-No change
How can we treat a PE in pregnancy
- Low molecular weight heparin
- Thrombolysis
What GI tract changes occur in pregnancy?
- Gastric pH increasing & intestinal motility reduced
- This may lead to delayed absorption
What renal changes occur in pregnancy?
- 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
What is a MEOWS chart& what is it used for?
Modified early obstetric warning system
-Used to track early physiological parameters and aid early recognition of acutely unwell women
What are the folic acid requirements for pregnant women
- 400mcg of folic acid before conception ( at least 3 months before)
- 5mg Folic acid for those at higher risk of neural tube defects
What makes a woman at higher risk of having a baby with neural tube defects?
- 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
What is different in pregnancy ABCDEF approach?
- 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
What are the effects of folic acid deficiency?
- 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
