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APP Part 2 > Pregnancy > Flashcards

Pregnancy Flashcards

1
Q

What causes dyspnea in pregnancy?

A

5% Dec in total lung capacity (TLC), due to baby pushing up diaphragm.

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2
Q

In pregnancy there is a ___ in minute ventilation in order to maintain normal ____.

A

INCREASE in min ventilation, to maintain normal respiration rate.

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3
Q

Hyperventilation in pregnancy is causes by ____, not ___

A

increase in TV, NOT respiratory rate (RR)

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4
Q

Which pulmonary value decreases in pregnancy?

A

TLC dec by 5% bc diaphragm is pushed up by baby.

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5
Q

Which pulmonary value decreases in pregnancy?

A

Oxygen consumption and TV (min vent inc)

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6
Q

min ventilation and TV increases in preg because ____

A

respiratory centers are more sensitive to CO2.

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7
Q

CO2 levels in pregnancy are ___, but pH is normal due to compensation by _____

A
  • Lower

- Kidney compensated.

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8
Q

Endocrine changes in pregnancy (hint: Estrogen, insulin, progesterone).

A
  • Hyperestrogenic (estrogen from placenta) = hypercoaggulable state (clots)
  • diabetogenic (increased blood sugar due to inc insulin resistance)
  • Progesterone causes uteruis smooth muscle to relax (prevents expulsion of fetus)
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9
Q

____ causes hypercoagulable state in pregnancy, increasing risk of _____

A

Hyperestrogenic state = estrogen from placenta

Inc risk of blood clots (think pulmonary embolism)

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10
Q

____ should double every 48 hrs in early pregnancy

A

hCG levels

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11
Q

What do pregnancy tests detect?

A

hCG levels in blood/urine, being secreted by placenta. Serum test is more sensative

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12
Q

Function of hCG in early pregnancy

A

maintains corpus luteum, which produces progesterone essential for maintaining preg.

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13
Q

Source of progesterone in first trimester vs. 2nd/3rd trimester

A

1st – corpus luteum

2nd/3rd – placenta makes its own progesterone (and estriol), corpus luteum degenerates.

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14
Q

when can ultrasound can be used to detect pregnancy?

A

4-5 wks

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15
Q

Conception to birth is ____ but we calculate gestational pd from ____

A

266 days = 38 wk = 9 months

the last period

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16
Q

Normal gestational pd

A

280 days = 40 wk = 9.5 months. (from last period to birth, NOT conception to birth)

17
Q

gravidity

A

number of pregnancies

18
Q

parity

A

P = Term - preterm - abortions - living children

19
Q

Physiologic anemia of pregnancy

A
  • aka dilutional anemia.

- Caused by inc in plasma volume that’s more than inc in RBC volume (result = hematocrit or %BC in blood V dec)

20
Q

In the first 2 trimesters, what happens to BP and why?

A
  • both systolic and diastolic BP dec. (5-10, 10-15), 2 reasons:
  • due to dec in systemic resistance and dec in blood viscosity (more dilute!)
21
Q

What causes decreased systemic vascular resistance in preg?

A
  • decreased responsiveness to vasoconstrictive hormones

- decreased blood viscosity

22
Q

How is the uterus “primed” for labor?

A
  • Fetal hormone secretion* stimulates massive estrogen release from placenta.
  • Estrogen induces expression of oxytocin and prostoglandin receptors on uterine myometrium.
23
Q

what initiates labor?

A

Fetus. fetal oxytocin initiates:

1) cervical dilation
2) uterine prostoglandin secretion.

24
Q

During parturition, cervical dilation is initiated by ___ and dilation stimulates _____.

A
  • dilation initiated by fetal oxytocin

- stimulates release of maternal oxy from posterior pituitary (Ferguson reflex)

25
Q

Ferguson reflex

A

release of maternal oxytocin from posterior pit in response to cervical dilation (during onset of labor)

26
Q

hcg is secreted by the ____ , should double every ___ in a normal pregnancy.

A

trophoblast (the early placenta), 2 days

27
Q

What do we monitor to see if early pregnancy is progressing properly?

A

hCG levels, should double every 2 days/48 hrs.

28
Q

can detect fetal heart for the first time on doppler ultrasound at ______ because ___

A
  • 5.5-6 wk, when fetal heart develops.

- detectable bc fetal heart rate is higher than maternal.

29
Q

Blood pressure should NOT be ___ in pregnancy

A

above normal. Below normal is fine!

30
Q

1st stage of labor

A
  • LONGEST stage 6-12 hrs)
  • cervix dilates 10 cm.
  • first pregnancy takes longer.
  • epidurals slow dilation.
  • epidurals slow dilation.
31
Q

2nd stage

A

full dilation to delivery of fetus (1 hr)

** head first is optimal position, helps push through cervix**

32
Q

3rd stage

A
  • biggest bleeding risk*

- when placenta detaches and is delivered (30 min after baby delivery)

33
Q

Optimal position of fetus

A

** head first is optimal position, helps push through cervix**

34
Q

When is a woman most at risk for hemorrhage during delivery?

A

MOST at risk for hemorrhage AFTER delivery, during 3rd stage of labor, when placenta detaches from myometrium and is delivered.

35
Q

Reasons for C- section: (4)

A

Generally risk to fetus/mom

  • Labor arrest
  • Malpresentation – baby not in optimal position (breach position = feet down)
  • Non-reassuring fetal tracing – fetal heart doesn’t sound right.
  • Maternal request
36
Q

abnormal levels of which two hormones can cause spontaneous abortion in early pregnancy?

A

progesterone, thyroid hormone.

37
Q

4 causes of spontaneous abortion

A
  • fetal chromosomal abnormality/anembryonic (no embryo)
  • early exposure to teratogens (drug that kills dividing cells)
  • endocrine abnormalities (hormones – progesterone, thyroid hormones)
  • space in uterus (uterine abnormality, leiomyoma)
38
Q

4 risk factors for spontaneous abortion

A
  • advanced maternal age (more likely to have ovum abnormalities)
  • previous miscarriage
  • smoking
  • intrauterine trauma (medical procedure).

APP Part 2 (9 decks)

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