Physiology

Question 1

Hemodynamic changes in pregnancy

Answer 1

1. Increased total body water
2. Decreased peripheral vascular resistance
3. BP drops in second trimester
4. Leg edema, particularly with pre-eclampsia

Question 2

Cardiovascular changes in pregnancy

Answer 2

1. Increased cardiac output
2. Exaggerated splitting, SEM common
3. ECG shows left axis deviation, sinus tachy, mild inferior ST changes

Question 3

Respiratory changes in pregnancy

Answer 3

Hyperventilatory state

Question 4

Hematologic changes in pregnancy

Answer 4

Increased RBCs but physiologic anemia
Impaired leukocyte function
Increased iron requirements
Hypercoagulable state

Question 5

Renal/GU changes in pregnancy

Answer 5

GFR increases (decreased Cr by half!, Urea)
Glucosuria can be physiologic but should test for DM
Increased risk of UTI due to urinary stasis

Question 6

GI changes in pregnancy

Answer 6

GERD very common

constipation, hemarrhoids, bloating

Question 7

Liver changes in pregnancy

Answer 7

Increased ALP, decreased albumin (increases bone turnover via feedback with calcium)

Question 8

Endocrine changes in pregnancy

Answer 8

50-70% reduction in insuline sensitivity

Thyroid: TSH decreases early, increased thyroxine, total T3/4

Question 9

Fetal shunts

Answer 9

1. Ductus venosus: bypasses liver, becomes ligametum venosum
2. Foramen ovale: directs oxygenated blood to brain. Closes after birth
3. Ductus arteriosus: pulmonary artery to aorta (bypasses lungs). Becomes ligamentum arteriosus