Physiology of Pregnancy Flashcards
What pituitary-adrenal changes occur in pregnancy?
- Pituitary gland enlarges
- Increased levels of prolactin, ADH and ACTH
- FSH and LH suppressed
What cardiovascular changes occur in pregnancy?
- Increased cardiac output and HR
- Vasodilation
- Hypervolaemia
- Increased platelets
- Increased RBC mass
- Decreased BP
Why is there a risk of anaemia in pregnancy?
Plasma volume increases which results in haemodilution and hypervolaemia
What symptoms can the cardiovascular changes cause?
Increased blood volume and cardiac output and decreased BP = breathlessness, palpitations and fainting
What is the effect of increased platelets?
Increased haemostasis = 6x increased risk of DVT
What hepatic changes occur in pregnancy?
- Increased liver function
- Increased fibrinogen
- Decreased serum albumin and bilirubin
What respiratory changes occur in pregnancy?
- Increased oxygen consumption
- Increased CO2 output
- Decreased residual volume
- Uterus pushes diaphragm up during labour
What renal changes occur in pregnancy?
- Increased GFR
- Increased renin, aldosterone, ADH and oestrogen
- Retention of salt and water
What is lordosis?
Weight gain leading to altered posture
What changes can be seen in the breasts during pregnancy?
- Enlargement
- Development of glandular tissue
- Vascularised (marbled appearance due to more capillaries)
What is hypervolaemia?
Large volume of fluid in the blood
What does NVP stand for?
Nausea and Vomiting in Pregnancy
What advice should be given to women experiencing NVP
- Usually eases after 1st trimester
- Consume frequent, small meals rich in easily digested carbohydrates and low fat
- Meat and strong smells make nausea worse
What are the benefits of hypervolaemia?
- Haemodilution
- Reduced risk of PET
- Increased blood flow to the skin
- Increased clotting factors reduce the risk of PPH
Why is constipation a problem in pregnancy?
Increased progesterone levels lead to slow movement of food so more water is absorbed
What foods should be advised to avoid constipation?
Fruit and veg
How much of the pregnant woman’s diet should be carbohydrate?
1/3
Why is it safe for women to eat eggs with the Lion stamp on them?
They come from flocks that have been vaccinated against salmonella
Why is it important to wash fruit, vegetables and salad?
To reduce the risk of toxoplasmosis (which comes from toxoplasma in soil)
Why is folic acid recommended in pregnancy?
To reduce the risk of NTDs (as it is used to help form the neural tube)
What other supplement is associated with folic acid that helps prevent NTDs?
Vitamin B12
What can a deficiency of folate or vitamin B12 cause?
Folate/Vitamin B12 deficiency anaemia
Why is vitamin D recommended in pregnancy?
Helps with bone growth and strength
What is the recommended dose for vitamin D?
10mcg
What is the recommended dose for folic acid?
400mcg
or 5mg if BMI>30, Hx NTD, Diabetes etc
What should Hb levels be in pregnancy?
Booking = >110 28/40 = >105 PN = >100
Name some iron-rich foods
- Red meat
- Fish
- Poultry
- Dried fruit
- Leafy greens
- Wholegrain bread
Which foods should be avoided in pregnancy?
- Shellfish
- Blue cheese
- Unpasteurised foods
What should ferritin levels be throughout pregnancy?
> 50
What is the pattern of AN visits?
EPC, Booking, 16, 25 (primips only), 28, 31, 34, 36, 40, 41
When are sweeps routinely performed?
40/40 for primips
41/40 for primips and multips
When should women be recommended to get the whooping cough vaccine?
After 20/40
Why do we recommend getting the whooping cough vaccine?
Protects the baby up until it gets its only vaccines at approximately 6 weeks old
When should women be given a Mat B1 form?
After 25/40
When should a GAP chart be generated?
16/40
When should midwives start plotting on the GAP chart?
After 25/40
When are the trimesters of pregnancy?
1st = <12/40 2nd = 12-28/40 3rd = >28/40
