Physiology in Pregnancy

Question 1

What happens to thyroxin demand during pregnancy

Answer 1

It increases

Question 2

What is the commonest cause of hypothyroidism

Answer 2

Grave’s Disease (autoimmune)

Question 3

What does a hypothyroid mother require in pregnancy

Answer 3

Potential adjustment of levothyroxine dose

Question 4

What produces oestrogen during pregnancy

Answer 4

Placenta

Question 5

What produced progesterone during pregnancy

Answer 5

Initially corpus lute

Then the placenta

Question 6

What anti-insulin hormones are produced during pregnancy

Answer 6

Human placental lactose
Prolactin
Cortisol levels

Question 7

Why are anti-insulin hormones produced during pregnancy

Answer 7

To reduce the mothers peripheral uptake of glucose

Ensure there is a continuer supply of glucose to the foetus

Question 8

Risk factors for gestational DM

Answer 8

Age
High BMI
FH Type II DM
Smoking

Question 9

Rx for gestational DM

Answer 9

Diet change
Physical activity

Insulin
Metformin

Question 10

What is the main risk in gestational DM

Answer 10

Macrosomia

Question 11

What does gestational DM increase the risk of in later life

Answer 11

Type II DM

Question 12

Dx criteria for gestational DM

Answer 12

Fasting plasma glc 5.6 mmol/L or above

Two-hour plasma glc 7.8mmol/L or more

Question 13

Pathology of gestational DM

Answer 13

Usually as pregnancy progresses there is increase in insulin resistance

However normally counteracted by insulin production

In women with gestational DM compensatory in insulin production does not occur

Which results in blood sugar levels

Question 14

Describe breast changes in pregnancy

Answer 14

Increase in:
Size
Vascularity
Pigmentation of areola and nipple

colostrum like fluid can be expressed from end of 3rd month

Question 15

How does womens weight change with pregnancy

Answer 15

Increases

Question 16

Why is there a general state of immunosuppression in pregnancy

Answer 16

Because the baby is a forge in body

Need to stop any attacks on the baby

Question 17

Where does oedema in pregnancy particularly occur

Answer 17

Lower limbs

Question 18

What happens to systemic vascular resistance

Answer 18

Falls

Due to progesterone

Question 19

What is the CVs response to decreased systemic vascular resistance

Answer 19

Increase in CO by 30-50%

Question 20

Why should you NOT do CPR on a pregnant woman lying flat

Answer 20

Due to pressure from the foetus and the uterus on the IVC

Question 21

How should you perform CPR in a pregnant woman

Answer 21

Left lateral position

Question 22

When does CVS changes return to normal after delivery

Answer 22

3mnths

Question 23

What happens to O2 demand

Answer 23

It sig. increases

Question 24

What happened to RR

Answer 24

Increase

Question 25

What happens to tidal volume

Answer 25

Increases

Question 26

What happens to functional residual capacity

Answer 26

It decreases | As the lungs get smaller and have less space

Question 27

What is the effect of pregnancy on the stomach

Answer 27

Upward displacement a the uterus grows

Question 28

What is the result of upwardly displaced stomach

Answer 28

Increase in intragastric pressure

Question 29

What does increased intragastric pressure mean pregnant women are more susceptible to

Answer 29

GORD

Question 30

Why can pregnancy cause constipation

Answer 30

Due to the production of progesterones | Which decrease gut motility

Question 31

What happens to urinary collecting system

Answer 31

Dramatic dilatation

Question 32

What happens to renal blood plasma flow

Answer 32

Increases dramatically

Question 33

What happens to GFR and creatinine clearance

Answer 33

It increases | Due to increased renal blood plasma flow

Question 34

Why is glycosuria common in pregnancy

Answer 34

As pregnancy is a state of relative insulin resistance | As the placenta produces anti-insulin factors

Question 35

What happens to creatinine levels in pregnancy

Answer 35

They decrease due to increased clearance at the kidneys from increased renal plasma flow

Question 36

What happens to the ureters and bladder in pregnancy

Answer 36

Dilatin | Due to progesterone

Question 37

What does dilation of the ureters and bladder potential lead to

Answer 37

Urinary stasis

Question 38

What does urinary stasis increase the risk of in pregnancy

Answer 38

Increased risk of UTI | And Pyelonephritis

Question 39

Is microscopic haematuria normal in pregnancy

Answer 39

Yes but investigate if it persists after pregnancy

Question 40

What happens to protein excretion

Answer 40

It increases

Question 41

What happens to plasma volume

Answer 41

it increases

Question 42

What type of anaemia can occur

Answer 42

Dilution anaemia

Question 43

Why does dilution anaemia commonly occur

Answer 43

As plasma volume increases | But RBC count does not increase

Question 44

What happens to folate requirements

Answer 44

There is 10-20 fold increase in requirements

Question 45

Why should women take folic acid supplements

Answer 45

Because there is a dramatic increase in their folate requirements

Question 46

What happens to platelet count

Answer 46

It decreases | But functions as normal

Question 47

What hypercoaguable state changes occur in pregnancy

Answer 47

Increase in fibrinogen Increase in clotting factors Decrease in fibrinolysis

Question 48

Why do hypercoaguable changes occur in pregnancy

Answer 48

To aim to prevent haemorrhage at delivery

Question 49

What does progesterone do to blood vessels

Answer 49

Causes ventilation | And consequently stasis of blood

Question 50

What does stasis of blood in pregnancy increase risk of

Answer 50

Thromboembolic disease: DVT PE

Question 51

Why can warfarin NOT be given during pregnancy

Answer 51

It is teratogenic

Question 52

What is given as anti-coagulant in pregnancy

Answer 52

LMWH

Question 53

what happens to urea during pregnancy

Answer 53

Decreases due to higher renal blood flow and therefore higher excretion/clearance

Question 54

Why do asthmatics not suffer major complications during pregnancy

Answer 54

Because progesterone induced bronchodilator

Question 55

What happens to HR

Answer 55

It increases

Question 56

What mechanical changes occur during pregnancy

Answer 56

Change in the curvature of the spine

Question 57

What else will contribute to weight gain in pregnancy

Answer 57

Oedema