Physiology of Pregnancy Flashcards
What at what point does an embryo become a fetus
8 weeks (cardiac activity?)
Defn of grand multip
parity >/= 5
What is Charwicks sign
blue discoloration of cervix (early sign of preg)
What is goodell sign
softening of cervix (early sign of preg)
What is hegar/ladin sign?
softening of uterus
What is naegele’s rule
EDC = LMP + 1yr -3m + 7d
What are indications for US
uncertain gestational age
size/date discrepencies
multiple gestations
uterus at
pubic symphysis = __ wks
umbilicus = ___ wks
xiphoid process = ___ wks
12
20
36
How can heart sounds change in preg?
split S1
S3
systolic murmur (2/2 inc BV)
What is avg materanl HR when baby is at term
108 bpm
how does BP change in preg
dec 2/2 to dec in scr (2/2 effecrts of progesterone/vasodil substances being produced)
acid base state in preg + why?
compensated repiratory alkalosis
Bohr effect, inc RR inc CO2 gradient to inc gas exchange with fetus
Tidal volume inc or dec in preg
increase (dec in FRC) (also dec FRC due to elevated diapragm)
What is the cause of morning sickness?
elevated E/P/hCG
how do kidneys change in pregnancy?
they enlarge, ureters dilate (R>L), hydronephrosis, GFR increased by 50%
what causes ureters to dilate/hydronephrosis
progesterone and compression by enlarging uterus
is preg a hypercoagulable state?
yes! inc E2
why are preg women anemic
dilutional,there is an inc in plasma volume > inc RCV
** but still need inc Fe bc they are making more RBCs
What is the signaling for increased intravascular volume during pregnancy
inc renin –> inc angiotensin –> inc Na retention –> retain fluid to inc intravascular volume
when does hCG peak?
~10 weeks (doubles every 48 until this point)
What is responsible for maintianing fetal nutrition? Effects on mom?
hPL: inc maternal lipolysis and dec glc uptake by mom (anti-insulin effect) which allows for more glc to be available for fetus
–> mom in diabetogenic state with glucosuria and ketonuria
change in posture late in preg
hyperlordosis
Skin changes in preg? cause?
spider angiomata and palmar eryethema (2/2 inc E)
linea nigra and melasma/chlosasma (2/2 inc MSH)
How does PTH change in preg? Why?
increases, to cause inc Ca abs and vit D for growing fetal bones
changes in TSH, T3/4 during preg
transient dec TSH nc hCG is structurally similar to TSH tp the pit gland dec production
Total T3/4 increases because thyroid binding globilin increases, howevere free T3/4 remains normal
vits/minerals/diet changes needed in preg
inc kcal, folate, iron, vit C, omega 3 FA
dec vit A (teratogenic), calcium (still need but it chalates Fe)
what are braxton-hicks contractions?
irreg contractions w/o cervical dilation
how to manage GERD in preg
antacids , PPIs or H2 blockers if severe
What is round ligament pain + Tx?
shooting pelvic pain due to round ligament stretching, Tx is tylenol + warm compress
Tx for varicose veins in preg
elevate legs + compression stockings
management for hyperemesis gravidarum
NPO x 3 days, IVFs + anti-emics, if very severe give doxylamine/unisom (1st gen antihistamine)+ vit B6
management of hemorroids in preg
topical steroids, fiber, stool softeners, sitz baths
how often should preg pt be seen in office during preg
1x in first trimester
q4wk until 28 weeks
q2wks until 36
qwk until delivery
When is Rh status checked? how it it interpreted
before 28 wks, if Rh- give rhogam at week 28 and postpartum (if baby Rh+)
how to manage baby if mom is HBsAg +?
infant HBIG anf HBV vaccine
What is the biobyphysical profile (BPP)? What are the components? How it scored/interpreted?
prenatal US evaluation to assess baby”
The BPP has 5 components: 4 ultrasound things +NST.
The NST evaluates fetal heart rate and response to fetal movement.
The five discrete biophysical variables: Fetal movement Fetal tone Fetal breathing Amniotic fluid volume Fetal Heart Rate
BPP >8: normal
BPP =6: get CST** see next card
BPP <4: deliver
What is CST/OCT
CST/OCT (ctx stress test/oxytocin challenge test): give oxytocin, look for 3 ctx/10 min w/o late decels
**assessed if baby can tolerate labor
