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a11. Reproductive (Physiology) > Physiology in Pregnancy > Flashcards

Physiology in Pregnancy Flashcards

1
Q

What are the mechanical (MSK) adaptations that happen during pregnancy?

A
  • Centre of gravity changes: leaning backward to stabilize, the curve of the spine change along the length (relaxin and prolactin)
  • Increased pliability and extensibility of connective tissues (less stable ligaments and joints
    • Especially symphysis pubis and sacroiliac joints
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2
Q

What hormone that is produced during pregnancy causes increased pliability and extensibility of connective tissues?

A
  • Relaxin
  • Estrogen and progesterone
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3
Q

By how much does the normal pubic symphyseal gap increase during pregnancy?

A

Increases from 4.5 mm by another 3 mm

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4
Q

What is symphysis pubis dysfunction?

A

A group of symptoms that cause discomfort in the pelvic region

  • Shooting pain in the lower pelvis area
  • Lower back pain that radiates to the abdomen, groin, thigh and/or leg
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5
Q

When does the loosening of joints begin during pregnancy?

When does this return to normal?

A

~10 weeks

Returns to normal by 4-12 weeks post-partum

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6
Q

What changes to metabolism occur during pregnancy?

A
  • Increase in basal metabolic rate
  • Insulin insensitivity, human placental lactogen acts against maternal insulin
  • Increased storage of lipids in maternal tissues
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7
Q

What is gestational diabetes?

A
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8
Q

What is considered to be a normal weight gain range during a pregnancy?

A

10-14 kg

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9
Q

What are some symptoms that occur during pregnancy?

A
  • Fatigue: increased during 1st trimester, better during 2nd trimester
  • Heartburn/reflux: delayed emptying, hormones cause relaxation of LOS
  • Edema: Na and H2O retention, decreased ability to excrete Na and H2o load, Increased blood volume, decreased venous return due to compression of IVC (sign of pre-eclampsia)
  • Breasts size increase:increased pigmentation of areola, 2ndry areola, Montgomery tubercles,
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10
Q

What is pre-eclapsia?

A
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11
Q

How does pregnancy affect thyroid function?

A
  • Associated with iodine deficiency (iodine transported to fetoplacental unit)
  • Urinary iodine x2 due to increased GFR, decreased renal tubule reabsorption
  • Hypertrophy of thyroid
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12
Q

What is hyperemesis gravidarum associated with?

A

Associated with biochemical hyperthyroidism (increased levels of T4 and suppressed TSH) because the beta subunit of BHCG (a pregnancy hormone) is structurally very similar to TSH

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13
Q

How is Hyperemesis gravidarum treated?

A

Biochemical hyperthyroidism resolves with hyperemesis

  • Beta-blockers (propranolol): symptom control of tachycardia caused by high levels of T4
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14
Q

What is the most common cause of thyrotoxicosis (overactive thyroid) during pregnancy?

A

Graves disease( autoimmune disorder)

Antibodies which cause Graves (TSH receptor antibodies) can cross the placenta causing fetal/neonatal hyperthyroidism

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15
Q

During which week of gestation will the fetal thyroid function start?

A

Week 12

Until then the fetus is dependent on the maternal thyroid function ( need for good thyroid replacement prior to pregnancy)

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16
Q

What autoimmune diseases may improve during pregnancy and why is this?

A

Crohn’s, rheumatoid arthritis

Due to general state of immunosuppression to allow fetal tolerance

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17
Q

What cardiovascular adaptations occur to the mother’s body during pregnancy?

A
  • Circulating blood volume increases by 50-70%
  • Red cell mass increases by 40% (haemodilution occurs → pregnancy anemia)
  • Left ventricular end-diastolic volume increased (seen at 10 weeks on ECHO)
  • Peripheral vasculature resistance falls in systemic circulation (lowest at 20-32 weeks)
  • Blood flow to the kidneys increases by 60-80%
  • Cardiac output increases due to an increase in ventricular stroke volume. Heart rate increases (10-20 beats higher)
  • Oxygen consumption increases by 20-30%
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18
Q

What issues may arise due to an increase in blood volume during pregnancy?

A

Patients with:

  • Dilated cardiomyopathy
  • Mitral stenosis
  • Pulmonary hypertension
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19
Q

How is systemic vascular resistance calculated?

A

(Systemic vascular resistance)SVR = Mean arterial pressure (MAP) – mean venous pressure (MVP)

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20
Q

Why does systemic vascular resistance (SVR) drop during pregnancy?

A

Increased circulating vasodilators and the diversion of blood into the low-pressure uteroplacental unit.

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21
Q

What causes warm, red hands in pregnant women?

A

Increased blood flow

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22
Q

Why are pregnant women more at risk of node bleeds?

A

Increased blood flow to the nasal mucosa increases the risk of nose bleeds. Causes a sensation of stuffiness or congestion.

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23
Q

Define stroke volume

A

the amount of blood pumped out by the ventricle with each beat

24
Q

How is cardiac output calculated?

A

Cardiac output = stroke volume x heart rate

25
Q

What pathologies can cause tachycardia during pregnancy?

A
  • Hypovolaemia
  • Pulmonary embolus
  • Sepsis
26
Q

What are the risk factors that may put a pregnant woman at risk of pregnancy triggering ischemic heart disease or MI?

A

Women with coronary artery disease

  • Older
  • Obese
  • diabetic
  • Smoker
27
Q

Why can you never lay a pregnant patient falt?

A

Vena cava compression due to the pregnant uterus causes loss of 25% of cardiac output → fainting

28
Q

In an event of maternal collapse/cardiac arrest, how is resuscitation performed?

A

The patient must be resuscitated on the left lateral tilt or with the uterus manually displaced. YOU WILL NOT BE ABLE TO RESUSCITATE ANY PERSON WITH A GRAVID UTERUS WHO IS LYING FLAT BECAUSE OF THE REDUCTION IN CARDIAC OUTPUT THIS CAUSES. This is one of the reasons a perimortem CS/emptying of the uterus is part of the pregnancy ALS algorithm.

29
Q

What change occurs to the circulatory system during contractions?

A

Autotransfusion of contractions – with every contraction up to another 500 mls of blood is dumped into the circulation

30
Q

What effect does pain caused by labour, have on the CVS?

A

Increases circulating catecholamines and increases the heart rate, blood pressure and cardiac output (CO =SVxHR)

31
Q

By what percentage does the CO change during labor?

A

CO increases by 10%

32
Q

By what percentage does the CO change after delivery?

A

Increase to 80% above already increased CO of pregnancy due to:

  • Lack of uteroplacental unit
  • Immediate relied of vena caval compression
33
Q

How long do the changes to the CVS that have occurred during pregnancy, take to return to a normal pre-pregnancy state?

A

3 months post delivery

34
Q

How long after delivery will blood volume decrease?

A

3 days, decrease by 10%

35
Q

What happens to the blood pressure postpartum?

A

The blood pressure (BP) initially falls and then increases again by 3-7 days after birth. The BP returns to prepregnancy levels by 6 weeks

36
Q

Respiratory Changes

What respiratory changes occur during pregnancy?

A

Increase in:

  • Tidal volume
  • Minute ventilation
  • Respiratory rate
37
Q

Respiratory changes

By what percentage does the tidal volume increase during pregnancy?

A

40-50% incraese

38
Q

Respiratory changes

What happens due to hyperventilation during pregnancy?

A
  • PCO2 levels lower
  • State of compensatory respiratory alkalosis
39
Q

Respiratory changes

What happens to the thorax during pregnancy?

A
  • Uterus pushes up against diaphragm by ~4 cm
  • Increase in diameter of lowe thorax by 2cm (splaying of lower ribs)
40
Q

Respiratory changes

What happens to functional residual capacity?

A

Reduces ~20-30% (further reduced by supine position)

41
Q

Respiratory changes

What condition may improve during pregnancy?

A
  • Asthma: due to bronchodilator effect of progesterone
42
Q

Hematological changes:

What occurs at week 28?

A
  • Haemoglobin (Hg) of 105 g/L or above is normal (physiological anaemia of pregnancy)
43
Q

Hematological changes:

Plasma volume increases in proportion to what factor?

A

Birthweight

44
Q

Hematological changes:

The requirement for what supplement increases during pregnancy?

A

Iron (Fe) by 2-3 times for fetus and increase in red cell mass

45
Q

Hematological changes:

What is the most common hematological abnormality in pregnancy?

What are some causes of this?

A

Fe deficiency (more common in twin pregnancies)

Causes:

  • Menorrhoea
  • Inadequate diet
  • Previous recent pregnancies
46
Q

Hematological changes:

What is the most common hematological abnormality in pregnancy?

What are some causes of this?

A

Fe deficiency (more common in twin pregnancies)

Causes:

  • Menorrhoea
  • Inadequate diet
  • Previous recent pregnancies
47
Q

Hematological changes:

In 2-5% of deliveries, what contributes to iron deficiencies post-natal?

A

Post-partum hemorrhage

48
Q

Hematological changes:

What is Fe deficiency in pregnancy associated with?

A

Intrauterine growth restriction

49
Q

Hematological changes:

What is the 2nd most common cause of pregnancy anemia?

A

Folate deficiency (10-20 x increase in requirements during pregnancy)

50
Q

Hematological changes:

What other cells increase in the count during pregnancy?

A
  • White cell count (WCC)- 16x109/L is normal pregnancy
  • Neutrophil
51
Q

Hematological changes:

What hematological changes during pregnancy cause a hypercoagulable state?

A
  • Clotting factors VII, IX, and X and fibrinogen increases
  • Protein S and C and anti-thrombin 3 levels decrease.
  • Fibrinolytic activity decreases.
52
Q

Hematological changes:

What physiological changes increase the risk of DVT in pregnancy?

A
  • Venodialitation
  • Reduced venous return → increased venous stasis in lower limbs
53
Q

Hematological changes:

What is one of the main hematological causes of maternal mortality in the UK?

A

Pulmonary embolus: kills ~6-15 people a year

54
Q

Hematological changes:

Pregnancy increases the chances of what by 6 times? W

A

Thromboembolism

55
Q

Renal changes:

What changes occur to the renal system during pregnancy?

A
  • Dilatation of the urinary collecting system (relaxation of the smooth muscle of the ureter by progesterone)
  • Increase in renal plasma flow
  • GFR and creatinine filtration rate increase
  • Increase in excretion of protein
  • Increase in secretion of vitamin D, renin and erythropoietin
56
Q

Renal changes:

What pathology is seen on the right-hand side of the renal system during pregnancy?

A

Hydronephrosis: more pronounced on the right

a11. Reproductive (Physiology) (4 decks)

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