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RGU 2 > Physiology of Pregnancy > Flashcards

Physiology of Pregnancy Flashcards

1
Q

What is the size of the uterus in a non-pregnant woman?

A
  • weighs 70 g with a cavity of 10 mL
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2
Q

How large will the uterus grow during pregnancy?

A
  • 1,100 g holding 5 L to 20 L total.

* increased 500-1000x

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3
Q

What causes the distention of the uterus?

A
  • both estrogen and the products of conception
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4
Q

Is uterine enlargement symmetrical?

A

NO
*mostly marked in the fundus (aka tell your pt the top grows faster than the bottom, moving the placenta up and out of the way)

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5
Q

By what week is the uterus outside of the pelvis?

A

week 12

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6
Q

Does an increase in blood flow occur progressively throughout the gestational period?

A

YES (450-650 mL/min in late pregnancy).

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7
Q

By the end of what trimester does the endometrium receive 50% of blood flow?

A

end of 1st trimester

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8
Q

What is Chadwick’s sign?

A
  • pronounced softening and cyanosis of the cervix caused by increased vascularity, edema, hypertrophy and hyperplasia of the cervical glands.
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9
Q

By term, how much will the cervix reduce it’s mechanical strength?

A
  • 12 fold reduction
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10
Q

Does nulliparity increase your risk for ovarian cancer?

A

YES, because you ovulate more when you aren’t pregnant, causing more trauma to the ovaries as they ovulate, leading to more micro nicks in the DNA.

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11
Q

What happens to the ovaries during pregnancy?

A
  • maturation of the follicles is suspended and ovulation ceases.
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12
Q

What happens to the fallopian tubes during pregnancy?

A
  • the musculature hypertrophies
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13
Q

What happens to the vagina during pregnancy?

A
  • it undergoes hyperemia and takes on a characteristic violet color (secretions are 3.6-6.0 pH).
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14
Q

What is a common midline pigmentation of the abdomen that occurs during pregnancy?

A
  • LINEA NIGRA
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15
Q

What are some other skin changes that occur during pregnancy?

A
  • irregular brown patches on face and neck (CHLOASMA or MELASMA GRAVIDARUM)
  • angiomas and PALMAR ERYTHEMA (more in white women).
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16
Q

What breast changes occur during pregnancy?

A
  • breast tenderness and tingling.
  • the nipples become larger (more pigmented and erectile).
  • after the first few months colostrum (milk) can be expressed with gentle massage.
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17
Q

Does breast size correlate with milk production?

A

NO

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18
Q

What contributes to most weight gain during pregnancy?

A
  • the uterus and its contents, the breasts, and an increase in fluid (intracellular and 3rd spaced).
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19
Q

How many more calories do you need to supplement your diet during pregnancy?

A

about 300 more

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20
Q

Is increased water retention normal during pregnancy?

A

YES (6.5 L extra)= fall in plasma osmolality (aka fall in albumin during pregnancy due to decreased interstitial colloid osmotic pressure)! THIS IS NORMAL :)

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21
Q

Is normal pregnancy characterized by FASTING hypoglycemia or hyperglycemia?

A

HYPOglycemia

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22
Q

Is normal pregnancy characterized by POST PRANDIAL hypoglycemia or hyperglycemia?

A

HYPERglycemia and HYPERinsulinemia

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23
Q

What rapidly appears in prolonged fasting in a pregnant woman?

A

ketonemia

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24
Q

Does GLUCOSE cross the placenta?

A

YES

*this is why gestational diabetes causes big babies

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25
Q

Does INSULIN cross the placenta?

A

NO

*this is why gestational diabetes causes big babies

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26
Q

Why then are women with PRE-GESTATIONAL diabetes prone to having smaller babies, rather than larger babies?

A
  • vascular disease associated with DM leads to lack of fetal blood flow, causing smaller babies
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27
Q

What happens to concentrations of lipids, lipoproteins, and apolipoproteins in plasma during pregnancy?

A
  • increase
  • LDL peaks at 36 weeks
  • HDL peaks at 25 weeks then decreases at week 32.
  • when pts go to get health insurance, make sure you tell them that it is normal for these to be elevated during pregnancy.
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28
Q

What happens to iron, calcium, and magnesium plasma levels during pregnancy?

A
  • decline (important to supplement so baby doesn’t get anemia).
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29
Q

By how much does maternal blood volume increase above non-pregnant levels?

A
  • 40-45% from both plasma and erythrocytes
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30
Q

Does erythroid hyperplasia and elevated reticulocyte count occur during pregnancy?

A

YES slightly

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31
Q

** What happens to hemoglobin and hematocrit during pregnancy?

A

decrease slightly, HOWEVER hemoglobin less than 11 g/dL is abnormal!
*this would be a macrocytic anemia.

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32
Q

Is elevated WBC count (leukocyte count) normal during pregnancy?

A

YES (ranges from 5,000-12,000, with more neutrophils; neutrophilia).
*note chemotaxis and adherence of these are depressed in the 2nd trimester and onward.

33
Q

What happens to leukocyte alanine phosphatase, CRP, ESR, C3 and C4 during pregnancy?

A
  • all elevated
34
Q

What happens to the coagulation cascade during pregnancy?

A
  • it is in an active state (all factors are elevated except 11 and 13).
  • this is why risk of DVT or PE is increased.
35
Q

What happens to platelet counts in pregnancy?

A
  • decrease in 12%
36
Q

When do the most important cardiovascular changes occur during pregnancy?

A
  • in the first 8 weeks
37
Q

What cardiovascular changes occur during these first 8 weeks?

A
  • pulse rate increases by about 10 BPM (so HR up to 120 is normal).
  • as the diaphragm elevates, the heart becomes displaced left and upward.
  • therefore an increase size of the heart is noted on radiographs.
38
Q

So what electrical axis shift will you see on EKG during pregnancy?

A
  • left left (remember this is NORMAL)
39
Q

Is it normal from pregnant women to have some degree of benign pericardial effusion?

A

YES

40
Q

Does end diastolic dimension increase?

A

YES

41
Q

Does the INOTROPIC state of the myocardium change during pregnancy?

A

NO

42
Q

Will you hear murmurs during pregancy?

A

YES

43
Q

** How do you tell if it’s a systolic murmur?

A
  • put your hand on the woman’s wrist. If the murmur coincides with the wrist pulse, it is a SYSTOLIC murmur (90% of pts but disappears after delivery). If you hear the murmur on the off beat, then it is a DIASTOLIC murmur!
44
Q

What happens to arterial BP and vascular resistance during pregnancy?

A
  • DECREASES until mid-term, and then begins to rise (diastolic pressures more affected than systolic)
45
Q

What happens to CO during pregnancy?

A
  • INCREASES
46
Q

Does posture of a pregnant woman affect BP?

A

YES

47
Q

What is considered HTN in a pregnant woman?

A

greater than 140/90

48
Q

What happens to the diaphragm during pregnancy?

A
  • rises about 4 cm
  • transverse diameter increases by 2 cm
  • thoracic circumference increases by 6 cm, but does NOT stop a reduction in residual volume.
  • diaphragmatic excursion is actually GREATER.
49
Q

*** Does respiratory rate change during pregnancy?

A
  • slightly INCREASES due to increased PROGESTERONE.
50
Q

What happens to tidal volume, minute volume, and minute oxygen uptake during pregnancy?

A
  • all INCREASE
51
Q

What happens to functional residual capacity (FRC) and residual volume?

A
  • DECREASED
52
Q

** Since minute ventilation increases, what blood gas changes will you see?

A
  • respiratory alkalosis

* compensated via plasma bicarb reduction

53
Q

What happens to the O2 dissociation curve?

A
  • NO CHANGE, because as pH increases (shifting O2 curve to the left and increasing maternal affinity for O2), maternal erythrocytes produce 2,3 DPG (shifting the curve back to the right), thus balancing it.
54
Q

What happens to kidney size during pregnancy and why is this important?

A
  • increases, causing renal plasma flow and GFR to increase 50%. This will lower serum creatinine
55
Q

Is glucosuria normal or abnormal in pregnancy?

A

NORMAL, secondary to impaired tubular resorption of glucose.
*however, do NOT ignore the possibility of gestational DM.

56
Q

Is proteinuria normal or abnormal in pregnancy?

A
  • ABNORMAL (may be slight amounts).
57
Q

Is hematuria normal or abnormal in pregnancy?

A

ABNORMAL

58
Q

Is hydronephrosis and hydroureter common in pregnancy?

A

YES (moderate only).

*uretic distention is greater on the right.

59
Q

What does the extra progesterone during pregnancy do to the ureters?

A
  • lengthens and can twist or bend causing more distention.

* this is the reason why pts get more UTIs after pregnancy.

60
Q

Is pregnancy associated with increased urinary incontinence?

A

YES due to baby compressing the bladder.

61
Q

What happens to gastric emptying and transit time during pregnancy?

A
  • they are DECREASED due to progesterone and decreased levels of motilin.
  • Mirilax and fiber bulking agents work well.
62
Q

Is pyrosis (GERD) common in pregnancy?

A

YES due to the alteration in stomach position and loss of lower esophageal sphincter tone.
*use Ranitidine (ZANTAC; H2 blocker). Safe in pregnancy :) and tell them to eat 6 small meals instead of 3 large meals.

63
Q

Are hemorrhoids common in pregnancy?

A

YES due to constipation and increased venous pressure below the level of the uterus.

64
Q

What happens to Alk Phos in pregnancy?

A

DOUBLES

65
Q

What happens to AST, ALT, GGT, and bilirubin levels in pregnancy?

A

slightly lower

66
Q

What happens to cholinesterase activity during pregnancy?

A

decreased (meaning you’ll have more Ach around)

67
Q

What happens to the gallbladder during pregnancy?

A
  • progesterone impairs gallbladder contraction, leading to increased stasis and thus stone formation leading to increased cholecystitis risk.
68
Q

Can you do lap chole’s during pregnancy?

A

YES but only after the 1st trimester

69
Q

What happens to the pituitary gland during pregnancy?

A
  • it enlarges and may impinge on the optic chiasm causing visual changes.
    This will INCREASE:
  • GH (weeks 10-28)
  • Prolactin (also found in the placenta).
70
Q

What happens to the thyroid gland during pregnancy?

A
  • INCREASE in thyroxine transport protein and thyroxine binding globulin (TBG) in response to high estrogen levels.
  • DECREASE in availability of IODINE, so vitamins now supplement this.
71
Q

What happens to FREE T4 levels?

A

they do not change

72
Q

What do B-hCG and TSH share?

A

alpha-subunit, so this will bind TSH, and lower it during pregnancy

73
Q

What happens to parathyroid hormone?

A
  • HYPERPARATHYROIDISM due to decreased calcium remember, so this will try to increase calcium levels.
74
Q

Is calcitonin higher or lower?

A

higher

75
Q

Is 1,25 dihydroxyvitamin D3 higher or lower during pregnancy?

A

higher

76
Q

What happens to serum cortisol during pregnancy?

A
  • INCREASES due to its decreased clearance
77
Q

What do maternal adrenal glands do during pregnancy?

A
  • increase ALDOSTERONE secretion to counteract natriuretic effect of progesterone and ANP (which acts to reduce blood volume).
78
Q

What will you see in the musculoskeletal system with pregnancy?

A
  • increased lordosis
  • increased mobility of sacroiliac, sacrococcygeal, and pubic joints.
  • aching and numbness of the lower extremities and upper extremities from marked lordosis.
  • hold onto arm rests when they stand or sit.

RGU 2 (24 decks)

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