Physiology in Pregnancy

Question 1

Fatigue is a key symptom in pregnancy in which stage of pregnancy?

Answer 1

Early pregnancy

Question 2

Thyroid changes in pregnancy

Answer 2

Kidneys excrete more iodine
Goitre
Hyperthyroidism

Question 3

Why do pregnant women have a general state of immunosuppression?

Answer 3

The baby is a foreign object

Question 4

Weight gains in pregnancy

Answer 4

on average an increase by 10-14kg

first trimester gain 2kg

Question 5

Breast changes in pregnancy

Answer 5

Increased size
increased vascularity - warm and tender
Increased pigmentation of the areola and nipple
Second areola appears
Colostrum like fluid can be expressed from the end of the 3rd month

Question 6

CVS Changes in pregnancy

Answer 6

Increased circulating blood volume (50-70%)
Systemic vascular resistance falls
Increased blood flow
Increased cardiac output (40%)
Increased stroke volume
Increased HR
In supine position => 25% reduction in cardiac output

Question 7

What position do you NEVER do CPR in in a pregnant woman?

Answer 7

Supine (lying flat)

Question 8

Significant CVS changes occur in pregnancy in what trimester?

Answer 8

First trimester

Question 9

Postpartum CVS changes

Answer 9

Return to normal by 3 months (mostly)
BV decreases 10% 3 days post delivery
BP decreases initially then increases again days 3-7
BP pre preg levels by about 6 weeks
SVR increases over 1st 2 weeks to 30% above delivery levels
HR returns to pre preg over 2 weeks
CO increase up to 80% 1 hour post delivery then continues to fall over the next 24 weeks

Question 10

Respiratory changes in pregnancy

Answer 10

Increase in O2 demand (20%)
40-50% increase in minute ventilation 
Increased RR
SOB
Increased TV
Decreased FRC
PEFR and FEV1 unchanged
Decreased PCO2
Increased PO2
lungs get squashed and pushed up 
asthmatics dont change

Question 11

Asthma in pregnancy

Answer 11

Progesterone causes bronchodilation

Steriods produced will make it very unlikely to have an asthma attack

Question 12

Renal changes in pregnancy

Answer 12

Dramatic dilatation of urinary collecting system 
Increased renal plasma flow (60-80%)
GFR increases
Creatinine clearance increases up to 50%
Protein excretion increased 
Microscopic haematuria 
Glycosuria COMMON
80% develop oedema 
Urate increased with increased gestation 
Urea and creatinine decreases

Question 13

Bad value of urea for pregnant women

Answer 13

8

Question 14

Uric acid is increased in

Answer 14

Pre-eclampsia
Twins
Obesity

Question 15

Can a D dimer be used in pregnancy? Why?

Answer 15

NO

Because D dimer is always increased in pregnancy

Question 16

> 600 uric acid is associated with

Answer 16

early neonatal death

Question 17

Haematological changes in pregnancy

Answer 17

Increased PV
Decreased Hg, hcrit, rcc
No change In MCV or MCHC
Decreased platelet count
2-3x increase in requirement for iron 
10-20x increase in folate requirements
WCC increases
Hypercoagulable (very early on)

Question 18

ESR values in pregnancy

Answer 18

Increased

Question 19

CRP values in pregnancy

Answer 19

Stays the same

Question 20

24 hour protein vs total protein in pregnancy

Answer 20

24 hour protein = increased

Total protein = decreased

Question 21

Albumin values in pregnancy

Answer 21

Decreased

Question 22

AST/ALT/AGT values in pregnancy

Answer 22

Decreased or same

Question 23

Alk phos values in pregnancy

Answer 23

VERY increased

Question 24

Bile acid values in pregnancy

Answer 24

Same