Physiology in Pregnancy

Question 1

Normal or abnormal? Pregnant woman with cardiomegaly, split S1, loud S3 and a SEM. You do an ECG and find left axis deviation, ectopic beats, flat T waves and Q waves in lead III.

Answer 1

Normal. These are all physiologic changes that can occur in pregnancy.

Question 2

Normal or abnormal? A pregnant woman presents with edema. It is confined to her L leg.

Answer 2

Abnormal. Unilateral leg swelling is a red flag. Dependent edema is physiological. It occurs due to decreased osmotic pressure and increased hydrostatic pressure. Other red flags include: rapid onset of non-dependent edema, underlying symptomatic cardiac disease.

Question 3

Normal or abnormal? A pregnant woman presents complaining of being unable to maintain her usual 5km pace. She states that she feels SOB. Vitals are all stable.

Answer 3

Normal. It is normal during pregnancy to experience SOB and a decrease in exercise tolerance. There is an increase in minute ventilation, tidal volume, oxygen consumption, FRC and RV. It is also normal for a pregnant woman to have a respiratory alkalosis.

Question 4

Normal or abnormal? A pregnant presents with complaints of increased frequency of urination. Investigations reveal increased glucose, protein and calcium excretion in the urine. The protein is less than 300 mg/day.

Answer 4

Normal. These are normal changes in pregnancy that occur secondary to hyper filtration.