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REPRO > Physiology in pregnancy > Flashcards

Physiology in pregnancy Flashcards

1
Q

what general changes are seen in pregnancy

A 
mechanical systems
metabolism
fatigue (particularly early)
heartburn/reflux
oedema
breast changes
thyroid changes
general state of immunosuppresion
weight gain
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2
Q

how does the appearance of the breasts change in pregnancy

A

increased size
increased pigmentation of the areola/nipple
secondary areola appears
montgomery tubercules appear on the areola

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3
Q

what happens to the vascularity of the breast

A

increased vascularity - breasts become warm and tender

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4
Q

what is expressed from the breasts and when

A

colostrum like fluid from the end of the third month

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5
Q

when do changes to the CVS start occurring

A

significant changes in the early first trimester

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6
Q

what happens to circulating blood volume

A

increased circulating blood volume

- 50-70% higher than non-pregnant

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7
Q

what happens to vascular resistance and when

A

systemic vascular resistance falls - maximal fall at 20-32 weeks

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8
Q

in relation to the CVS what occurs when a pregnancy women is in the supine position

A

25% reduction in cardiac output

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9
Q

what are some other cardiac changes

A 
increased blood flow
increased CO (40%)
increased stroke volume
increased heart rate
increased O2 consumption
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10
Q

what is intrapartum

A

period of time from the onset of labour to the end of the third stage of labour

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11
Q

what are some intrapartum CVS changes

A

autotransfusion of contractions (blood transferred from uterus to maternal circulation

pain - increasing catecholamines

Cardiac Output increases by 10% in labour and by 80% in 1st post delivery hour

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12
Q

when does the CVS return to normal after pregnancy

A

mostly by 3 months

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13
Q

what happens to blood volume postpartum

A

decreased by 10% 3 days postpartum

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14
Q

what happen to BP postpartum

A

initially falls then increased again days 3-7 (back to pre pregnancy levels by 6 weeks)

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15
Q

what happens to systemic vascular resistance postpartum

A

increased over first 2 weeks to 30% above delivery levels

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16
Q

what happens to heart rate postpartum

A

returns to pre preg level over 2 weeks

17
Q

what happens to cardiac output postpartum

A

increase up to 80% 1st hour post delivery then continues to fall over the next 24 weeks

18
Q

what happens to O2 demand in pregnancy

A

increases up to 20%

19
Q

what happens to minute ventilation during pregnancy

A

increaes 40-50%

20
Q

what other respiratory factors increase during pregnancy

A

increased resp rate

increased tidal volume

21
Q

what respiratory factors decrease during pregnancy

A

decreased functional residual capacity

decreased PCO2

22
Q

what respiratory factors remain unchanged during pregnancy

A

PEFR - peak expiratory flow rate

FEV1 - forced expiratory volume in 1 minute

23
Q

what happens to the urinary collecting system during pregnancy

A

dramatic dilatation - more pronounced on the right

24
Q

what happens to renal plasma flow during pregnancy

A

60-80% increase by end of second trimester

25
Q

what other renal system factors increase

A

increased GFR and creatinine clearance (50%)
increased protein excretion
increased rate with increasing gestation

26
Q

what renal system factors decrease

A

decreased urea

decreased creatinine

27
Q

what other renal changes are seen in pregnancy

A

oedema in 80% of women
glycosuria common
microscopic haematuria may be present

28
Q

what haematological increases are seen in pregnancy

A

plasma volume increased (cf to birthweight)
2-3 fold increase in iron requirement
10-20 fold increase in late requirements
WCC increases

29
Q

what haematological decreases are seen in pregnancy

A

decreased hg, script, rcc

decreased platelet count

30
Q

what happens to the coagulable state during pregnancy

A

becomes hyper coagulable

31
Q

recap - lab values that decrease

A 
Hg
Platelets (or stay the same)
Urea
Creatinine
Urate (but increases with gestation)
total protein
albumin
AST/A:T/GGT
32
Q

recap - lab values that increase

A 
WCC
ESR
24hr protein
Alkaline phosphate (***)
D dimer
33
Q

recap - lab values that stay the same

A

bile acids
AST/ALT/GGT (sometimes)
Platelets (sometimes)

REPRO (44 decks)

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