Physiology in Pregnancy Flashcards
What are the general changes in the body associated with pregnancy?
Mechanical
Metabolism
Fatigue – particularly early pregnancy
Heartburn/reflux
Oedema
Breasts
Thyroid
General state of immunosuppression
Weight gain
What happens to metabolism?
Anabolic then quickly becomes catabolic to allow nutrient supply to the foetus
Do you get insulin resisitance?
Yes-almost 2x increase in insulin
What can occur due to the increase in triglyceride breakdown?
Can get starvation Ketoacidosis-within 24-48 hrs can become very acidotic when pregnant & this happens
DKA is very dangerous in preg and can result in what?
IUD
What rate doubles in preg?
BMR
What is gestational diabetes?
Insulin resistance & hyperglycaemia of pregnancy
More likely to develop T2DM (should be checked once a year-mitigate risk with lifestyle factors)
What are the 3 things associated with Preeclampsia?
- High BP
- Oedema
- Proteinuria
What percentage get oedema & is this always physiological?
70-80% get oedema- physiological mostly but can be indicative of pathology such as pre-eclampsia
When do significant changes occur to the CV system?
Early in the first trimester
By how much does circulating BV increase?
50-70% of non pregnant
Does systemic vascular resistance increase or decrease?
DECREASE-maximal at 20-32 weeks
Do each of these increase or decrease?
1. Blood flow
2. CO
3. SV
4. HR
5. 02 consumption
- Increases
- Increases
3, Increases (SVxHR=CO) - Increases
- Increases
ALL INCREASE
What happens to CO in supine position?
25% reduction in CO
What do prostacyclin’s do?
Decrease systemic vascular resistance
In what trimester does BP tend to drop?
BP tends to drop in middle trimester & then rise-those who don’t drop are more inclined to be the ones to have pre-eclampsia
What are the intrapartum CV changes that occur?
-Autotransfusion of contractions
-Pain-increasing catecholamines
-CO increases by 10% in labour & by 80% in 1st post delivery hour (then continues to fall over the next 24 weeks)
When in the post partum period do CV changes return to normal?
3 months (mostly)
BV decreases by how much 3 days post delivery?
10%
How does BP adjust in the postpartum period
BP initially falls then increases again days 3-7(pre preg levels by 6 wks)
What happens to SVR & HR in the postpartum period?
-SVR increase over first 2 wks to 30% above delivery levels
-HR returns to pre preg over 2 weeks
Minute ventilation increases by what?
40-50%
Do these increase or decrease?
1) O2 demand
2) RR
3) TV
4) FRC
5) PCO2
1) INCREASE
2) INCREASE
3) INCREASE
4) DECREASE
5) DECREASE
What happens to PEFR & FEV1?
UNCHANGED