Pregnancy (Pathophysiology) Flashcards by Zachary Schulz

Pregnant women are _____ (more/less) susceptible to some diseases.

More Susceptible

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How do you determine the expected date of delivery?

Take the date of the last menstrual period, add seven days to that date, count back 3 months (add one year)

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What is this woman’s due date….

The 1st day of her last period was Dec. 12, 2017?

9/19/18

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What is the name of the organ that is the first part of a pregnancy, is specialized in nutrient and oxygen deliver, and is the barrier between the mother and the fetus?

The Placenta

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The endometrium’s blood supply comes from ______ (basal/spiral) arteries

Basal Arteries

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During the luteal phase…..

New _____ (basal/spiral) arteries are made

Spiral Arteries

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With each period, ______ (basal/spiral) arteries are lost and the basalis makes new ones for the next cycle.

Spiral Arteries

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When a pregnancy implants only the _____ (basal/spiral) arteries remain

Spiral Arteries

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The placental barrier allows for the passage of certain material through ____ (active/passive) transport

Passive Transport

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Most large proteins can not pass through the placental barrier, however there is one exception……

What is that exception?

IgG crosses the placenta which allows for maternal immunity

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By the third trimester…..

What percent of cardiac output does the placenta/fetus receive?

20-25%

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T/F: The placenta uses as much O2 as the fetus

True

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What does the placental hormone progesterone do?

Maintains uterine lining and inhibits uterine contraction

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What does the placental hormone lactogen do?

Stimulates mammary glands and supplies energy to the fetus

Also mimics GH and promotes maternal insulin resistance elevating glucose levels

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What does the placental hormone relaxin do?

Softens cervix and weaken the pubic symphysis

This results in pelvic pain

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What does the placental hormone Corticotropin Releasing Hormone (CRH do?

Increases HR, BP, Glucose, and stimulates parturition

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Which of the following placental hormones is most responsible for pigmentation changes associated with pregnancy?

A) Progesterone
B) CRH
C) Estrogen
D) Relaxin

B) CRH

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What are TWO examples of pigmentation changes associated with pregnancy?

Linea Nigra

Melasma

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SVR in pregnancy decreases by 20% due to what?

The low resistance of the placenta

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What major vein is at risk of compression during pregnancy?

Vena Cava

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How much does blood volume increase by during pregnancy?

50-100^%

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Changes in cardiac function are underway by __ weeks of gestation

8 weeks

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Cardiac axis during pregnancy is displaced ______ (caudially/cephalad) and to the _____ (right/left)

Cephalad

Left

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T/F: Murmurs are found in about 96% of pregnant women

If true, why?

True

Due to this increase in blood volume ‘whooshing’ around corners

Can cardiomyopathy happen in pregnancy?

Yes, dont assume its just a physiological change

BP actually _____ (increases/decreases) in the second trimester of pregnancy and returns to the original level by the end of pregnancy

Decreases

When do hypertensive disorders of pregnancy typically onset?

Towards the end of the pregnancy

Cardiac output during pregnancy _______ (increases/decreases) by 43% during pregnancy

Increases

PVR during pregnancy _______ (increases/decreases) by 34% during pregnancy

Decreases

SVR increases ___% during contraction

10-25%

By what gestational week is the uterus at the pelvic brim? Umbilicus?

Pelvic Brim: 12 Weeks Umbilicus: 20 Weeks

Renin production is increased during pregnancy due to progesterone and production by the placenta..... What are THREE manifestations of this?

Increased Na+ absorption Increase K+ secretion Water Retention (6-8 Liters)

Due to the increased renal blood flow during pregnancy..... There is a 50% ______ (increase/decrease) in eGFR Colloid oncotic pressures are ______ (higher/lower) do to dilution of albumin

Increase Lower

T/F: Progesterone causes smooth muscle relaxation

True

Is ureteral obstruction more common on the left or right?

Right

The increased thoracic volume in pregnancy results in a(n) _______ (increased/decreased) minute ventilation and tidal volume

Increased

Due to pH changes during pregnancy, there is a compensated _______ (respiratory/metabolic) _______ (acidosis/alkalosis) What is the mechanism behind this?

Respiratory Alkalosis More CO2 is leaving fetal circulation at the placenta and more O2 is entering fetal circulation

GI motility is _____ (increased/decreased) during pregnancy

Decreased

T/F: Cholelithiasis is less common in pregnancy

False More common

T/F: Pregnancy places women in a hypercoaguable state

True

What hormone produced during pregnancy is most closely associated with hyperemesis gravidarum?

beta-HCG

When is beta-HCG at its highest levels?

9-12 weeks gestation

What are two 'risk factors' for hyperemesis gravidarum?

Twin Gestations | Multiple Pregnancies

How does beta-HCG and the thyroid potentially cause nausea during pregnancy?

Beta-HCG mimics TSH which can increase T3/T4 levels contributing to nausea ****These levels should be re-check in the second trimester

How is hyperemesis gravidarum managed?

IV Fluids | Antiemetics (Zofran, Phenergan)

During pregnancy cortisol levels are _______ (elevated/decreased)

Elevated

T/F: Maternal glucose crosses the placenta via diffusion

True

T/F: Maternal insulin crosses the placenta via diffusion

False It does not as the baby makes it's own

The fetus will store glucose as glycogen.... Where is this stored?

Liver Trunk Shoulders

What are fetal complications of diabetes?

``` Macrosomia Neonatal Hypoglycemia Hyperbilirubinemia Shoulder Dystocia Birth Trauma ```

T/F: All pregnant women should be screened for gestational diabetes

True, by 24-28 weeks

When should pregnant women be screened EARLY for gestational diabetes?

Prior GDM Impaired Glucose Tolerance BMI > 30

Where is weight distributed in macrosomia? Why is this a problem?

Weight is primarily distributed in the shoulders and abdomen which makes delivery through the birth canal difficult

How is the GDM screen done? How is it confirmed or tested?

Screen: a 1 hour glucose check after a 50 gm sugar load (cut-off of normal is around 140, any thing less is fairly normal) Confirmed: A three hour GTT (100 gm load), or a FBS and 2 hour glucose test, if FBS is elevated then it is confirmed -OR- you need two abnormal glucose values 1, 2, or 3 hours out

What pathogens are pregnant women more susceptible to?

CMV HSV Varicella Malaria

When should a women receive her Tdap vaccination?

27-36 weeks gestation of EVERY pregnancy

What is a "TORCH" titer? When is this given?

``` T - Toxoplasmosis O - Other (Hepatitis B, Syphilis, Varicella) R - Rubella, Rubeola C - Cytomegalovirus H - Herpes Simplex ``` Given in the 1st Trimester

Why is a "TORCH" titer given in pregnancy?

These are all common causes of birth defects or still births in fetuses.