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Reproduction > Physiology in Pregnancy > Flashcards

Physiology in Pregnancy Flashcards

1
Q

What mechanical changes occur to the mother’s body during pregnancy?

A

Relaxin (a hormone produced by the placenta) relaxes joints incl the pubic symphysis –> the pelvis more roomy in prep for birth/growth of baby

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2
Q

What changes occur to the pregnant mother’s metabolism?

A

Become easily fatigued

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3
Q

Why are pregnant woman more likely to get heart burn/reflux?

A

Hormones relax LOS

Physical presence of baby putting pressure on stomach/oesophagus

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4
Q

Under GA, what are pregnant woman more at risk of?

A

Aspiration

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5
Q

What is the presence of oedema associated with in pregnancy?

A

Pre-eclampsia

Also uterus presses on pelvic veins –> back up of blood –> lower leg/ankle oedema/varicose veins

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6
Q

Does thyroxine decrease or increase in pregnancy?

A

Increases to meet higher metabolic demand

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7
Q

Why might you get goitre in pregnancy?

A

Increased iodine loss due to iodine being sent to the foetus –> iodine deficiency which the thyroid can compensate for –> goitre

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8
Q

Why is there a general state of immunosuppression in pregnancy?

A

Baby is like a parasite, must go into this state so mother doesn’t reject foetus

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9
Q

What is normal wt gain in pregnancy?

A

2kg in 1st & 5kg in 2/3rd trimester is normal

More if twins, oedema etc

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10
Q

How do the breasts change in pregnancy?

A

Inc. in size and vascularity - become warm, tense & tender

Oestrogen/progesterone –> ant. pituitary to release prolactin –> milk production

Pigmentation of areola/nipple

Secondary areola appears

Montgomery tubercles appear on areola

Colostrum like fluid can be expressed by end of 3rd month

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11
Q

Why do the nipples darken in pregnancy?

A

Ant. pituitary releases more melanocyte stimulating hormone –> this darkens the nipples and can also darken the linea alba –> linea gravidarum/nigra

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12
Q

What are montgommery tubercles?

A

Small bumps that produce oil to lubricate the areola and nipple during pregnancy/lactation

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13
Q

What is colostrum?

A

Thick, sticky fluid that is perfect neonate food

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14
Q

When do the significant changes to the CV system occur in pregnancy?

A

1st trimester

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15
Q

What changes occur to the circulating volume & red cell count?

A

Circulating BV increases by 50-70%

RCC only increases a little

Therefore physiological anaemia results

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16
Q

What other changes occur to the CV system during pregnancy?

A 
Systemic vascular resistance falls (20-32wks) --> drop in TVPR --> pink, warm skin, prone to nosebleeds 
Increased BF
Increased CO & therefore SV 
Increased HR (10-20bmp)
Increased O2 consumption 
Lower BP at start/middle of pregnancy 
BP rises after 32 weeks
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17
Q

Why is BP lower at start/middle of pregnancy?

A

Progesterone causes the BVs to dilate

18
Q

Why must you never examine a pregnant lady supinely?

A

25% reduction in CO due to compression of IVC by foetus

19
Q

Why must you never try to resus a pregnant woman supinely?

A

Most likely to be unsuccessful - use left lateral/manually displace the foetus

20
Q

What are the intrapartum CV changes?

A

Autotransfusion of contraction - 1 contraction pushes 500ml blood to heart
Pain due to inc. catecholamines increases HR and BP
CO increases by 10% in labour & 80% in 1st post delivery hour

21
Q

What do you need to be careful of in woman giving birth who have CAD?

A

Extra strain on the heart increases risk of IHD

Give epidural to reduce pain and catecholamines –> therefore reducing peripheral vasodilation

22
Q

When does the CV system return to normal after pregnancy?

A

3 months

23
Q

What respiratory changes occur during pregnancy?

A 
Inc. in oxygen demand - lungs squashed but must work harder
50% increase in minute ventilation 
Increase in RR, TV & reduced FRC 
PEFR & FEV1 unchanged
Decrease in PCO2
24
Q

Why are asthmatics usually better during pregnancy?

A

Progesterone is a bronchodilator

25
Q

What % of woman experience SoB during pregnancy?

A

33%

26
Q

How do the structure of the kidneys change during pregnancy?

A

Compensate for extra workload by increasing in size –> dramatic dilatation of calyces & renal pelvis –> physiological hydronephrosis (& hydroureter)

More pronounced on R side (as uterus tilts to R)

27
Q

How does GFR change in pregnancy?

A

Renal plasma flow increases by 60-80% so GFR and creatinine clearance increase by 50%

28
Q

What % of pregnant woman develop oedema?

A

80%

There is extra protein excretion

29
Q

What dipstick finding is common in pregnancy and not indicative of disease?

A

Glycosuria

30
Q

In relation to renal function:

______ increases with gestation, _______ & ________decrease

A

Urate increases

Urea and creatinine decrease

31
Q

Why are pregnant woman more prone to UTIs?

A

More bladder stasis (progesterone leads to hypomotility of the ureters & ureters shorter)

32
Q

Why is their increased urinary frequency in pregnancy?

A

Increased GFR & pressure on bladder

33
Q

Why is their relative insulin resistance in pregnancy?

A

Placenta produces human placental lactogen which counters the effect of maternal insulin to make sure there is plenty glucose for the foetus

34
Q

How can you work out an expected uric acid level in a pregnant woman?

A

Relates to no of weeks gestation

e.g. 20 weeks, expect 200

35
Q

What is high uric acid a marker of?

A

Pre-eclampsia
But not diagnostic
Also higher in twins/obesity

36
Q

What are the haematological changes that occur during pregnancy?

A 
Plasma vol increases
Decrease in Hb, hcrit, RCC, platelet count
No change in MCV, MHCH
WCC increase
2-3x increase for iron 
Hypercoagulable state (for child birth) 
10-20x increase in folate req.
37
Q

How do CRP and ESR change during pregnancy?

A

CRP tends to stay the same - helpful marker of inflammation

ESR goes up - DONT USE IN PREGNANCY

38
Q

How does albumin change during pregnancy?

A

Goes down - contributes to oedema

39
Q

How does AST/ALT/GGT/Alk phos change in pregnancy?

A

Alk phos increases (placenta produces it)

AST/ALT/GGT may go down or stay the same

40
Q

How does D-dimer change in pregnancy?

A

Goes up

Can’t use it to help diagnose DVTs/PEs

Reproduction (28 decks)

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