Physiology in pregnancy

Question 1

What are mechanical changes in pregnancy?

Answer 1

Big bump over abdomen

Curvature of the spine changes to make up for balance

Question 2

How does metabolism change in pregnancy?

Answer 2

Metabolism is greatly increased and ketones are produced earlier in starvation mode - begin being produced at 12 hours

Question 3

What are general symptoms felt throughout pregnancy?

Answer 3

Fatigue - particularly in early pregnancy
Heartburn/reflux
Oedema
Weight gain
General state of immunosuppression

Question 4

What happens to breasts in pregnancy?

Answer 4

They increase in size and there is an increase in glandular tissue
Increased pigmentation of the nipple and areola
Montgomery tubercules appear on the areola

Question 5

What happens to thyroid activity in pregnancy?

Answer 5

There is an increase in thyroid binding globulin and an overall increase in T3 and T4 but free levels remain the same

Question 6

What is colostrum?

Answer 6

Fluid produced briefly after birth from the breasts which is like milk but has higher protein and lower fat, as well as antibodies that can be passed on to the baby

Question 7

What are Montgomery tubercles?

Answer 7

Glands around the areola that can be seen from the skin surface which produce lipoid fluid which keeps the nipple lubricated and protected

Question 8

When would a woman wan to farm colostrum?

Answer 8

If a baby is born very prematurely or if there is cleft palate or another condition that prevents them from feeding from the breast they can be fed from a bottle

Question 9

What happens to cardiac output in pregnancy?

Answer 9

It is increased by 40-50%

Question 10

What happens to heart rate in pregnancy?

Answer 10

It increases

Question 11

Why should a pregnant woman never be resuscitated supine?

Answer 11

Cardiac output is reduced by 25% when supine so they will never be resuscitated

Question 12

Why is cardiac output reduced in pregnancy when supine?

Answer 12

The fetus compresses the IVC leading to reduced venous return

Question 13

What happens to plasma volume in pregnancy?

Answer 13

Increases by 50%

Question 14

Why does heart rate increase so much during labour?

Answer 14

Pain of labour causes an increase in heart rate as well as release of catecholamines which also increases HR as well as blood pressure

Question 15

What is the most common cause of death in pregnancy?

Answer 15

Heart disease

Question 16

Why does cardiac output increase by 80% in the 1st hour after delivery?

Answer 16

Blood from the placentouteral circulation comes back into systemic circulation causing enormously more venous return

Question 17

Why is coronary artery disease becoming more common and why is this important for pregnancy?

Answer 17

Obesity and smoking are more common and this is important because coronary artery disease causes an ischaemic event postpartum

Question 18

When do cardiovascular changes return to normal after pregnancy?

Answer 18

After about 3 months usually

Question 19

When does heart rate return to normal after pregnancy?

Answer 19

Over about 2 weeks

Question 20

What happens to alveolar ventilation in pregnancy?

Answer 20

It increases via increase in tidal volume and respiratory rate

Question 21

What is the increase in oxygen demand during pregnancy?

Answer 21

20%

Question 22

What happens to partial pressure of CO2 during pregnancy?

Answer 22

It decreases

Question 23

What happens to the urinary collecting system in pregnancy?

Answer 23

There is great dilatation

Question 24

What happens to GFR?

Answer 24

Increases by 50% with an increase in creatinine clearance

Question 25

What changes can be seen in urine during pregnancy?

Answer 25

Increased protein excretion
May have microscopic haematuria
Glycosuria
Decrease in urea and creatinine

Question 26

Why is it important to know creatinine and urea are decreased in pregnancy?

Answer 26

Because a pregnant woman with creatinine in a normal non-pregnant range is probably in renal failure

Question 27

What changes haematologically in pregnancy?

Answer 27

Decrease in haemoglobin, haematocrit, red cell count, and platelet count
Increase in white cell count and plasma volume

Question 28

What happens to albumin levels in pregnancy?

Answer 28

They decrease

Question 29

What happens to LFTs in pregnancy?

Answer 29

They decrease

Question 30

What happens to alkaline phosphate in pregnancy?

Answer 30

It greatly increases due to the placenta

Question 31

Why can’t a D dimer measurement be used to determine clotting value in pregnant women?

Answer 31

It is almost always raised by an unpredictable amount

Question 32

What happens to drug metabolism during pregnancy?

Answer 32

It is greatly increased meaning dosages must change

Question 33

What causes gestational diabetes?

Answer 33

Human placental lactogen causes an increase in insulin resistance