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Exam - M - Reproduction System (Megan and Rachel) > Physiology in pregnancy > Flashcards

Physiology in pregnancy Flashcards

1
Q

Why are pregnant people more prone to back pain?

A

Their centre of gravity has changed, so they need to lean back more. This changes the curves of the spine.

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2
Q

Which hormones affect the connective tissue? Which tissue is most affected?

A

Relaxin (produced during pregnancy)
Oestrogen and progesterone.

Symphysis pubis and sacroiliac joints

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3
Q

How does relaxin, progesterone and oestrogen change the pubic symphysis?

A

The gap increases from 4-5mm by another 3mm.

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4
Q

When does the pubic symphysis joint loosen?

A

10 weeks, should return to normal 4-12 weeks post party.

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5
Q

What is the increased load on the hips?

A

By term the load has increased by 2.8

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6
Q

What is pubic symphysis dysfunction?

A

This is pain in the pelvic region, caused by stiffness or unequal movement on the joints. It is painful but not harmful to baby.

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7
Q

What does human placental lactose do?

A

Produced by the placenta:

  • decreases maternal insulin sensitivity
  • decreases maternal glucose utilisation

To ensure there is enough energy for the baby.

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8
Q

What is the normal weight gain for pregnancy?

A

10-14kg.

Lipid storage is increased.

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9
Q

Why are lipids essential to the foetus?

A

For organogenesis.

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10
Q

When is fatigue most likely to affect a women during pregnancy?

A

1st trimester (due to change in hormones)

3rd trimester (due to heavier and harder workload)

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11
Q

Which hormone relaxes the lower oesophageal sphincter?

A

Progesterone. gastric emptying is also delayed.

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12
Q

Why is general anaesthetic a higher risk in pregnancy?

A

Due to the relaxation of the lower oesophageal sphincter - the risk of aspiration is increased.

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13
Q

Which vessel dues the uterus tend to compress?

A

The inferior vena cava, leads to oedema or fainting if woman lies on her back.

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14
Q

What condition is oedema a sign of?

A

Pre-eclampsia. Its also very often normal.

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15
Q

How many women experience oedema during pregnancy?

A

80%

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16
Q

What is pre-eclampsia?

A

When you have high blood pressure and traces of protein in your urine.

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17
Q

What changes occur to the areola in pregnancy?

A

it gets bigger and more pigmented.

Montgomery tubercles appear (they are always on the areola but not normally visible)

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18
Q

What is the physiology behind oedema in pregnancy?

A

increased sodium and water retention.

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19
Q

How many Montgomery tubercles are found on the areola?

A

0-40

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20
Q

What do the Montgomery tubercles do?

A

They produce some breast milk but mainly produce an oil which prevents bacterial infections.

They contain milk glands and sebaceous glands.

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21
Q

What happens to the thyroid gland during pregnancy?

A

thyroid binding globulin, T3 and T4 all increase. This evens out so the levels of free T3 and T4 remain the same.

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22
Q

Why might the thyroid gland hypertrophy?

A

to try and absorb enough iodine.

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23
Q

How common is overactive thyroid in pregnancy?

A

1 in 500
mostly caused by graves disease. the antibodies that cause graves can cross the placenta and cause foetal and/or neonatal hyperthyroidism.

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24
Q

How long does the foetus rely on the mothers thyroid function?

A

until 12 weeks gestation.

Hypothyroidism occurs in 1% of pregnancies.

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25
Q

Why do some auto immune conditions improve during pregnancy?

A

Because the body becomes more immunosuppressed. This allows for the foetus not to be rejected.

26
Q

What is the leading cause of indirect maternal death?

A

Cardiac Disease.

27
Q

How much does circulating blood volume increase?

A

50-70%

28
Q

How much does the haemoglobin increase?

A

40%

29
Q

Why is anaemia common in pregnancy?

A

Blood volumes increase more than haemoglobin does - causing dilution of haemoglobin.

30
Q

Where is there increased blood flow during pregnancy?

A

Kidney (60-80% ^)
hands and feet
nasal mucosa (^risk of nose bleeds)

31
Q

When is the systemic vascular resistance at its lowest?

A

20-32 weeks.

32
Q

How much does cardiac output increase?

A

30-50%

33
Q

How much does the HR increase?

A

By term, the HR is usually 10-20 beats higher.

34
Q

How much does oxygen consumption increase?

A

20-30% - the myocardium needs more oxygen.

35
Q

What should you never do to a pregnant patient?

A

Lie them flat.

They will lose 25% of cardiac output - faint.

36
Q

How must a pregnant person be resuscitated?

A

On a left lateral tilt

or with the uterus manually displaced

37
Q

What is a perimortem Cesarian section?

A

Emptying of the uterus immediately during cardiac arrest to try and save the mother and foetus.

38
Q

What is auto transfusion of contractions?

A

This is when the uterus contracts and transfers blood from the uterus into the maternal circulation.

39
Q

How much blood can be transferred to the maternal circulation during uterine contractions?

A

Up to 500mls.

40
Q

What effect does the pain of pregnancy have on the heart rate and cardiac output?

A

They both increase because pain causes an increase in circulating catecholamines.

41
Q

How much does cardiac output increase during pregnancy?

A

10%

42
Q

How much does cardiac output increase immediately after pregnancy?

A

up to a further 60-80%, due to the release of pressure on the inferior vena cava and the lack of blood needing to supply the uteroplacental unit.

43
Q

How long does cardiac output take to return to normal after labour?

A

About 1hr.

44
Q

How much do blood volumes decrease 3 days post delivery?

A

10%

45
Q

What happens to the blood pressure after delivery?

A

It initially falls
then increases again 3-7 days after birth
then returns to PRE-pregnancy levels by 6 weeks

46
Q

Why does systemic vascular resistance drop during pregnancy?

A
  • Due to blood travelling away to the uteroplacental unit

- theres an increase in circulating vasodilators

47
Q

How long after pregnancy does heart rate take to return to pre-pregnancy levels?

A

2 weeks

48
Q

How long after pregnancy does systemic vascular resistance take to return to pre-pregnancy levels?

A

2 weeks

49
Q

What happens to carbon dioxide levels in pregnancy?

A

The mothers tidal volume and minute ventilation increases so carbon dioxide decreases.

They are in compensated respiratory alkalosis.

50
Q

What affect does progesterone have on asthma?

A

It acts as a bronchodilator, some peoples asthma improves during pregnancy.

51
Q

What is considered normal haemoglobin levels at 28 weeks?

A

105g/L

52
Q

What is the physiological anaemia of pregnancy?

A

Plasma volume increases to a larger extent than haemoglobin, giving a dilution effect.

53
Q

What is the most common haematological abnormality of pregnancy?

A

Iron deficiency anaemia - theres a 2-3 fold increase in iron requirements, mostly used by the baby.

54
Q

What can iron deficiency during pregnancy cause?

A

Intrauterine growth restriction - when the baby is not as big as it should be.

55
Q

What is the second most common haematological abnormality during pregnancy?

A

Vitamin B12 (folate) deficiency.

serum B12 decreases but liver levels stay the same.

56
Q

Which clotting factors increase during pregnancy?

A

Clotting factors Vii, IX, X, fibrinogen.

57
Q

Which anti-clotting factors decrease during pregnancy?

A

Protein S and C, anti-thrombin 3.

Fibrinolytic activity also decreases (clot busting).

58
Q

How much does pregnancy increase thromboembolism risk?

A

6x.
DVT common - venous dilation and pressure on IVC.
Pulmonary embolism common.

59
Q

What happens to the kidneys in pregnancy physiology?

A

Hydronephrosis (swelling), usually worse on the right.

60
Q

What happens to urea and creatinine levels in pregnancy?

A

Filtration increases by 50% so their levels decrease.

61
Q

What do the kidneys secrete more of in pregnancy?

A 
creatinine
urea
protein
vitamin D
renin
erythropoietin
62
Q

What do the kidneys secrete less of in pregnancy?

A

Sodium

Water

Exam - M - Reproduction System (Megan and Rachel) (45 decks)

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