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Reproductive System > Physiology in Pregnancy > Flashcards

Physiology in Pregnancy Flashcards

1
Q

What are the general physiological changes in pregnancy?

A 
Mechanical 
Metabolism 
Fatigue 
Heartburn/reflux 
Oedema 
Breast changes 
Thyroid changes 
General state of immunosuppression 
Weight gain
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2
Q

Why do mechanical changes occur?

A

Skeletal changes occur to accommodate the change in centre of gravity, there is a change in spinal curvature and relaxin causes the relaxation of all joints

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3
Q

What is the average weight gain in pregnancy?

A

14kg

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4
Q

Why does heartburn/reflux occur in pregnancy?

A

Sphincter at the top of the stomach relaxes due to relaxin
Stomach is generally more acidic
Increased pressure from growing uterus/foetus

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5
Q

What percentage of women get oedema in pregnancy? Why?

A

80% will have it by 3rd trimester due to osmotic changes, plasma changes, slowed venous return

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6
Q

What are the thyroid changes in pregnancy?

A

Can enlarge due to relative iodine deficiency

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7
Q

What are the breast changes in pregnancy?

A

Increased size and vascularity
Increased pigmentation of areola and nipple
Secondary areola appears
Montgomery tubercles appear on the areola
Colustrum-like fluid can be expressed from the end of the 3rd month of pregnancy
Can feel lumpy

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8
Q

What does the increased size and vascularity of the breasts cause?

A

Causes them to become warm, tense and tender

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9
Q

What is the main indirect cause of maternal mortality?

A

Cardiac disease

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10
Q

What is the change in circulating blood volume in pregnancy?

A

Increased by 50-70% compared to non-pregnant women

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11
Q

What is the change in systemic vascular resistance? Why?

A

Systemic vascular resistance falls
Circulating prostaglandins cause relaxation of vessels, high volume of blood flowing through a relatively low pressure foetal/placental unit

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12
Q

What are the changes in blood flow, cardiac output and heart rate in pregnancy?

A

Blood flow increased
CO increased by 40%
HR increased 20-30bpm above normal

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13
Q

What is the change in cardiac output in the supine position in pregnancy?

A

25% reduction

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14
Q

Why should a pregnant woman be resuscitated in the left lateral position?

A

Relieve the pressure on the IVC from the uterus

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15
Q

What is the change in oxygen consumption in pregnancy? Why?

A

Increased

Demand from foetus, utero-placental unit, enlarged breasts and uterus

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16
Q

Why might there be intrapartum cardiac pain?

A

Increasing catecholamines increase BP and HR

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17
Q

What is the increase of cardiac output in labour and in the first hour post-delivery?

A

10% increase in labour

80% increase post-delivery

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18
Q

What mode of delivery carries better outcomes for most women with cardiac disease?

A

Epidural and vaginal delivery

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19
Q

When does the cardiovascular system usually return to normal after pregnancy?

A

By 3 months post-delivery

20
Q

What is the change in blood volume 3 days post-delivery?

A

10%

21
Q

What is the change in BP in the postpartum period?

A

BP initially falls, then increases again by days 3-7

Pre-pregnancy levels are reached by 6 weeks

22
Q

What is the change in systemic vascular resistance in the postpartum period?

A

Increases over the first 2 weeks to 30% above delivery levels

23
Q

When does HR return to normal after pregnancy?

A

Over 2 weeks post-delivery

24
Q

What is the change in CO post-delivery?

A

80% increase in first hour post-delivery, then continues to fall in the next 24 weeks

25
Q

What is the increase in oxygen demand in pregnancy?

A

20%

26
Q

What is the increase in minute ventilation in pregnancy?

A

40-50%

27
Q

What is the effect of pregnancy on respiratory rate, tidal volume and functional residual capacity?

A

RR increased
TV increased
FRC decreased

28
Q

What is the effect of pregnancy on PEFR and FEV1, and PCO2?

A

PEFR and FEV1 unchanged

PCO2 reduced

29
Q

What changes occur in the urinary collecting system in pregnancy?

A

Dramatic dilatation, more pronounced on the right

30
Q

What is the change in renal plasma flow in pregnancy?

A

Increased, by 60-80% by the end of the second trimester

31
Q

What is the change in GFR and creatinine clearance in pregnancy?

A

GFR increases

Creatinine clearance increases by up to 50%

32
Q

What should be done if microscopic haematuria is detected in a pregnant woman?

A

Microscopic haematuria may be present and is ok as long as it is not associated with proteinuria or infection, but should be followed up after birth to ensure that urine returns to normal

33
Q

What is the change in protein excretion, urate, urea and creatinine in pregnancy?

A

Protein excretion increased
Increasing urate with increasing gestation
Decreased urea and decreased creatinine

34
Q

What are the changes in plasma volume in pregnancy?

A

Plasma volume increases with birthweight and as red cell mass increases

35
Q

What are the changes in haemoglobin, MCV and MCHC in pregnancy?

A

Hb decreased

No changer MCV or MCHC unless iron deficiency anaemia

36
Q

What is the increase in requirements for iron in pregnancy?

A

2-3 fold increase

37
Q

What is the increase in requirements for folate in pregnancy?

A

10-20 fold increase

38
Q

What is the effect of pregnancy on coagulation?

A

Pregnancy is a hyper-coagulable state
Clotting factors 8, 9 and 10 increase
Fibrinogen increases

39
Q

What can be given to women to decrease the risk of PE?

A

Low molecular weight heparin

40
Q

What is the effect of pregnancy on white cell count and platelets?

A

WCC increased

Platelets decreased

41
Q

Why do platelets appear to be decreased in pregnancy?

A

Due to increase in plasma volume - not an actual decrease in platelets, relative decrease

42
Q

What is the effect of pregnancy on CRP and ESR?

A

CRP unchanged unless infection present

ESR increased

43
Q

What is the effect of pregnancy on 24-hour protein and total protein?

A

24-hour protein increased

Total protein decreased

44
Q

What is the effect of pregnancy on albumin, AST, ALT and GGT?

A

Albumin decreased

AST, ALT and GGT slightly decreased or no change

45
Q

What is the effect of pregnancy on alkaline phosphatase?

A

Greatly increased because placenta produces alkaline phosphatase

46
Q

What is the effect of pregnancy on bile acids?

A

No change - if raised can be used to diagnose cholestasis of pregnancy

47
Q

What is the effect of pregnancy on D-dimer?

A

Increased

Reproductive System (33 decks)

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