Physiology in Pregnancy Flashcards
describe the breast changes in pregnancy
The breasts increase in size and vascularity resulting in them becoming warm, tense and tender.
There is increased pigmentation of the areola and nipple.
A secondary areola appears.
Montgomery tubercles appear on the areola.
Colostrum like fluid can be expressed from the end of the 3rd month.
why does systemic vascular resistance fall during pregnancy?
decreased afterload
what is the main indirect cause of maternal death?
CV disease
how much does blood volume increase during pregnancy
50-70%
what is increased in CV in pregnancy
blood flow HR CO SV O2 consumption red cell mass
in the supine position there is a reduction in CO of a pregnant women, how much and why?
25%
decreased venous return
by how much does red cell mass increase in pregnancy?
40%
what causes the physiological anaemia in pregnacny?
dilution
what doe the changes during pregnancy in the CVS result in?
warm hands and feet
pregnancy glow
why are pregnant women more prone to nose bleeds?
nasal mucosa has increase blood flow
how much blood does each contraction use?
500ml
what does pain during labour cause? in regards to the CVS
increased catecholamine release which increases BP and heart strain
how does CO change during labour?
increased bt 10%
80% in 1st hr post delivery
why do you give epidurals to women with cardiac issues?
takes away pain
therefore decreases strain on heart and BP
describe the post partum CV changes
By 3 months most of the changes have returned to normal. Blood volume decreases by 10% in the first 3 days post-delivery. BP initially falls then increases again days 3-7, pre-pregnant levels by 6 weeks. SVR increases over the first 2 weeks to 30% above delivery levels. HR returns to pre-pregnant state over 2 weeks. CO increases by up to 80% in the 1st hour post-delivery then continues to fall over the next 24 weeks.
describe the respiratory changes in pregnancy
There a significant (20%) increase in oxygen demand. 40-50% increase in minute ventilation. Respiratory rate and tidal volume increases whilst there is decreased functional residual capacity. PERF and FEV1 are unchanged. PCO2 is decreased. Pregnancy is essentially a state of compensated respiratory alkalosis. Asthma doesn’t really change during pregnancy because progesterone causes bronchodilatation. Most women get psychological SOB that gets better by moving around.
describe the renal changes in pregnancy
Dramatic dilatation of the urinary collecting system which is more pronounced on the right. Increased renal plasma flow by 60-80% at end of second trimester. GFR increases and creatinine clearance increases by up to 50%. Protein excretion is increased. Microscopic haematuria may be present. 80% of women develop oedema. Glycosuria is common. Urate increases with gestation. Urea is decreased, creatinine decreased.
describe the haematological changes in pregnancy
Plasma volume increases cf birthweight. Decreased haemoglobin, haematocrit, rcc. No change in MCV and MCHC. Decreased platelet count as a dilutional factor – gestational thrombocytopenia. 2-3-fold increase in requirement for iron. 10-20-fold increase in folate requirements. WCC increases. Hypercoagulable state.
lab values in pregnancy: Hb
decreased
lab values in pregnancy: WCC
increased
lab values in pregnancy: platelets
decreased/no change
lab values in pregnancy: CRP
no change
lab values in pregnancy: ESR
increased - not done in pregnancy
lab values in pregnancy: Urea
decreaased
lab values in pregnancy: creatinin
decreased
lab values in pregnancy: urate
decreased but increases with gestation
lab values in pregnancy: 24hr protein
increased
lab values in pregnancy: total protein
decreased
lab values in pregnancy: albumin
decreased
lab values in pregnancy: AST/ALT/GGT
decrease/no change
lab values in pregnancy: alk phos
ver increased as placenta can produce
lab values in pregnancy: bile acids
no changw
lab values in pregnancy: D-dimer
increased - not used in pregnancy so don’t know what upper limiti is
